Paediatric Hip Flashcards
Limitations of radiographs of paediatric hip
The cartilage has not fully ossified and the cartilage does not show on a radiograph so looks like there are holes
What is developmental dysplasia of the hip?
abnormal development resulting in dysplasia, subluxation or dislocation of the hip secondary to capsular laxity
Spectrum of disease in DDH
inc severity:
dysplasia: disordered growth
Subluxation:Increased laxity.. partial dislocation
Dislocation: femoral head fully outside acetabulum
Epidemiology of DDH
Most commonly seen in the left hip of females
bilateral in 20%
rarely seen in africans but common in native americans; positions
Pathophysiology of DDH
the ball and socket joint is not fully developed at birth most happens in first few months but normal development depends on correct alignment between femoral head and acetabulum. In DDH the anatomical relationship is incorrect so there is abnormal development.
Risk Factors for DDH
first born
women 6:1 men
oligohydramino’s
breech presentations
Diagnostic factors of DDH:
\+ve ortolani/Barlow test <6 months dec hip abduction >6months limping child trendelenberg gait pain later in life : secondary arthritic changes
What is the barlow and ortolani test?
Barlow:adducting the hip and put pressure on nee, if the hip dislocates its +ve
Orlotani: reduction of the dislocated hip, confirms the barlow test
Investigation of DDH?
<6 months… ultrasound
>6 months… X ray
Management of DDH
Early presentation: Pavlik Harness for 12 weeks until US normal… flexed and abducted
Late presentation: worse outcomes, 1 year-18 months closed reduction, 18 months + is open reduction
