Please enable JavaScript.
Coggle requires JavaScript to display documents.
Developmental dysplasia of the hip (DDH) (Risk factors (Breech birth,…
Developmental dysplasia
of the hip (DDH)
Definition
Orthopedic hip disorder
of varying severity
Epidemiology
L>R hip
Usually 0-5 y
F>M
50% bilateral
Risk factors
Breech birth
Congenital malformations
Female
FH
First born
High birth weight
Oligohydraminos
Primip/older mother
Post maturity
Pathophysiology
Defect
Interaction of genetic susceptibility
and mechanical factors
Mechanism
Intrauterine positioning plus capsular laxity
results in abnormal hip development and dislocation
Spectrum of severity (complete disclocation, subluxation, instability, acetabular dysplasia)
Clinical
presentation
Birth
(newborn/ 6-8 week check)
Delayed
presentation
Delay in walking
Limp
(toe walk, Trendelenberg)
Hip/knee pain
Diagnosis
Examination
Unstable hip
Orlatani test
Function: relocates a subluxed/partially dislocated hip
Method: flex and abduct hips, put finger on greater
trochanter and try to lift femoral head into acetabulum
+ve - palpable 'clunk' as it relocates
Barlow test
Function: dislocates an unstable hip
Method: flex and adduct hip, apply load to femur
and try and dislocate femoral head with the thumb
+ve test: feel head dislocate (clunk)
Dislocated hip
Galeazzi test
Function: checks foreshortening of femur caused by hip dislocation
Method: lie child supine, hips flexed and feet flat on table,
ankles touching buttocks; +ve test = knees at different heights
NB: doesn't work if bilateral dislocation
Orthopedic examinations
Hip - buttock flattening/asymmetrical creases
on affected side, unequal leg length, limited abduction
Gait - waddling/limp, Trendelenberg +ve (weak adductors)
Investigations
Imaging
Hip USS
Babies <4.5 months (less invasive, better
visualisation of femoral head as not ossified yet)
Can detect and grade dislocation
Pelvic X-radiograph
Babies/children >4.5m
Shenton's line
History
SH
Living arrangements,
nursery/school
FH
DDH, joint disorders
DH
Meds, allergies
PMH
Growth and development
Known medical conditions
POH
Scans, bloods, gestation, delivery,
weight, complications
PC/HPC
Newborn examination,
delayed walking, pain, limp
Management
Conservative
Watch and wait 2-8w (spontaneous resolution)
Referral to paeds ortho
Double nappies, Pavlik harness, von Rosen splint
Surgical
Hip replacements
May be needed eventually
Open reduction
Indication: failed closed or >18m
Method: femoral/pelvic osteotomy
Complication: osteonecrosis
Closed reduction
Indication: baby <18m, hip remains unstable
Method: Pavlik harness (splint in flex/abduct)
Complications: osteonecrosis
Complications
Osteoarthritis
If not addressed early
Femoral head necrosis
Inexpertly applied splints
Screening
Neonatal examination
<72 birth and 6-8 week check