Developmental Dysplasia of the Hip Flashcards
pathology
dislocation/ subluxation of the femoral head during the perinatal periodaffects the subsequent development of the hip joint
what happens if it is left untreated?
acetabulum is very shallow more severe cases: false acetabulum proximal to original one with a shortened limbsevere arthritis due to reduced contact area at any area at any age gait/ mobility may be severely affected
who gets it?
happens in the left hip more than the rightmainly in girls bilateral in 20% of cases
risk factors
Positive family Hx of DDHBreech presentationFirst born babiesDown’s syndromeOther congenital disorders – talipes, arthrogryposis
how does it present?
all hips should be examined clinically shortly after birth shortening asymmetric groin/thigh skin creases click or clunk on the Ortolani or Barlow manoevres Ortolani test - reducing a dislocated hip by abduction and anterior displacement Barlow test - dislocatable hip with flexion and posterior displacement
how is it investigated?
Positive Ortolani & Barlow test require ultrasound – detectso Dislocated hipo Unstable hipo Shallow acetabulumXRays can’t be used for the early DDH – femoral head unossified until 4-6 months XRays are the investigation of choice after 4-6 months EARLY DIAGNOSIS
how is it managed if mild case?
slightly shallow acetabulum and mildly dislocatable but reduced hip o Close observation = Serial examination & ultrasound
how is it managed if dislocated/ persistently unstable hips?
Pavlik harness = Keeps the hip in comfortable flexion and abduction thus maintaining reduction (over-flexing & abducting can result in AVN)o Full-time for 6 weekso Part-time for further 6 weeks once hip is confirmed to be stable o Can be used to around 4-6 months of ageo Success rate 85-95%
how is a persistent dislocation over 18 months managed?
open reduction o Acetabulum very shallow by this stageo Clear soft tissueso May also need osteotomy – shorten & rotate femur o Pelvic osteotomy – deepen and re-orientate the acetabulum
prognosis of persistent/ undiagnosed DDH
tends to have poorer prognosis
