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DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH) (CLINICAL EXAMINATION (hip…
DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH)
Congenital Dysplasia Of The Hip (CDH)
Congenital Dislocation Of The Hip (CDH)
complex of changes presenting itself as:
shallow and steep socket --> SUBLUXATION
increased antetorsion and neck-shaft angle --> DISLOCATION
Etiology
MULTIFACTORIAL
GENETIC INHERITANCE:
FAMILY HISTORY-15%,
TWINS-34%,
4-8 TIMES MORE COMMON in FEMALES
PHYSIOLOGIC
HORMONE- INDUCED JOINT LAXITY (FEMALES-MATERNAL RELAXINE)
MECHANICAL:
-PRENATAL:
BREECH PRESENTATION, OLIGOHYDROAMNION, FIRST- BORNS, LARGE INFANTS, LEFT HIP MORE FREQENTLY
-POSTNATAL:
BABY CARE - HIPS IN ADDUCTION & EXTENSION
due to ligamentous laxity, muscular underdevelopment, and abnormal shallow slope of acetabular roof
conditions that lead to hip subluxation and dislocation
dislocated femoral head completely out of acetabulum
dislocatable head in socket
head subluxates out of joint when provoked
dysplastic acetabulum, more shallow and more vertical than normal
painless (if painful suspect septic dislocation)
CLINICAL EXAMINATION
hip instability signs
•click sign (ortolani) (for dislocated hip): palpable clunk is felt (not heard) if hip is reduced
•barlow test (for dislocatable hip)
•p.1 dislocation maneuver (ultrasonography)
•p.2 reposition
*piston sign
*hyperrotabilitas
after 3 months of age
*galeazzi sign: knees at unequal heights when hips and knees flexed
*hyperrotabilitas
after walking age
*trendelenburg’s sign
*duchenne sign
*duck-like waddle gait
*lumbar hyperlordosis (when bilateral !)
limited abduction of the flexed hip (<50-60°)
affected leg shortening results in asymmetry in skin folds and gluteal muscles, wide perineum
RADIOLOGICAL EXAMINATION
PUTTI’S TRIAD
1.STEEPNESSOF ACETABULAR ROOF
2.GROWTH RETARDATION OF FEMORAL HEAD OSSIFICATION CENTRE
3.SUPERO-LATERAL MIGRATION OF PROXIMAL FEMORAL METAPHYSIS
x-ray signs (at 4-6 mo): false acetabulum, acetabular index >25°, broken Shenton’s line, femoral neck above Hilgenreiner’s line, ossification centre outside of inner lower quadrant (quadrants formed by intersection of Hilgenreiner’s and Perkin’s line)
TREATMENT
LENGTH OF TREATMENT= AGE AT WHICH THE TREATMENT STARTS × 2
MOTHERS EDUCATION:
CARE OF PHYSIOLOGIC HIP FLEXION- ABDUCTION CONTRACTURE
(WIDE NAPPIES)
ORTHOPAEDIC & ULTRASOUND SCRENING
1.FIRST DAYS OF LIFE
2.6th WEEK
3.4-5 MONTH
BETWEEN 0 TO 6 MONTHS OF AGE:
PAVLIK HARNESS,
ABDUCTION SPLINTS (KOSZLA SPLINT)
BETWEEN 6-18 MONTHS OF AGE:
OVERHEAd TRACTION (INDIRECT WITH STRAPS) 3 WEEKS
CLOSED REDUCTION IN GENERAL
ANAESTHESIA UNDER
FLUOROSCOPIC CONTROL
(IN CASE OF NEED - ARTHROGRAPHY)
AFTER CLOSED REDUCTION:
*2 MONTHS PLASTER CAST „HUMAN POSITION” (formerly FROG POSITION)
2 MONTHS “FUNCTIONAL CAST I
2 MONTHS “FUNCTIONAL CAST I
AFTER 18 MONTHS OF AGE:
-“REPOSITIO SIMPLEX”= OPEN REDUCTION
REMOVING OBSTACLES PREVENTING PLACING FEMORAL HEAD DEEP IN THE ACETABULUM
•ELONGATED & HYPERTROPHIED LIGAMENTUM TERES
•TRANSVERSE LIGAMENT
•HYPERTROPHIED INVERTED
LABRUM (NEOLIMBUS)
•HYPERTROPHIED PULVINAR
•HOURGLASS CAPSULE DEFORMITY CAUSED BY ILIPSOAS TENDON
IMMOBILISATION IN PLASTER CAST
LANGE POSITION (INTERNAL ROTATION & ABDUCTION)
-SALTER’S INNOMINATE OSTEOTOMY
-INTERTROCHANTERIC VARUS DEROTATIONAL OSTEOTOMY (+ SHORTENING)
-PEMBERTON PERICAPSULAR
-ACETABULOPLASTY (OSTEOTOMY)
residual acetabular dysplasia in adolescents and young adults
history: chiari osteotomy.
reconstructive osteotomies (spherical (wagner) pericapsular (ganz))
triple pelvis osteotomy (steel, tőnnis)
abnormal development of hip resulting in dysplasia and subluxation/dislocation of hip.
most common orthopedic disorder in newborns