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Developmental hip dysplasia - Coggle Diagram
Developmental hip dysplasia
Neonate
First child, female, oligohydramnios, size, etc
Presenting complaint; hip pain
Past medical history; pregnancy/delivery complications, type, issues, etc
Family history; positive family history
Allergies
Medications
Demeanour
Swaddling method
Examination
Observation; facial features, posture skin, finger tracking, thigh and gluteal folds.
Measure; head, length and weight
Head/eyes/nose/mouth; scalp, fontanelles, shape, light reflex, nystagmus, cleft palate, bifid uvula
Heart and lungs; listen; air entry into the lungs, murmurs, dual sounds
Abdomen; organomegaly, abnormal soft tissue masses, umbilical abnormalities.
Hip orthopaedic examination; positive barlow, ortolani, galeazzi, click and clunk sounds.
Neurological; tone, moro reflex, babinski, grasping, rooting, etc.
Vital signs
Heart rate
Respiratory rate
Blood pressure
Temperature
Referral
GP/Paediatrician/Radiologist
Condition
Defined as an array of dysfunction and/or deformities in relation to the growth of the femoral head and/or acetabulum in relation to one another as a joint complex. In relation to this anatomy, may be dislocated/dislocatable or subluxated/subluxatable.
Development
Epidemiology:
Per 1000 live births ranges from 0.06 in Africans in Africa and 76.1 in Native Americans. 64% of cases as left sided and 63.4% are unilateral.
HLA A, B, and D increase prevalence.
Hormone deficiencies such as estrogen metabolism increase metabolism.
Increased prevalence in winter.
Premature term
When ultrasonography screening is applied range has been found to increase from 1-5:1000 to 25-50:1000. 80% female.
Increased incidence in countries that practice swaddling with lower extremities fully extended.
First born child
Oligohydramnios.
Brech presentation
Genetic susceptibility
Family history
Progression
The longer it is left untreated the worse the prognosis and increased likelihood of complications with treatment and associated degenerative conditions later in life.
Imaging and close monitoring is essential throughout the patients life.
Subgroups
Separated into 2 categories:
Dislocation in healthy infant = typical - either pre/postnatal.
Dislocation that is associated with neuromuscular disorders known as teratologic, generally occurring prenatally .
Testing
Physical exam is the most important means of detection.
Galeazzi sign.
Ortolani test (most important test).
Barlow test
Ultrasonography
Radiography
Computed Tomorgraphy
Magnetic Resonance Imaging
Gestational
Oligohydramnios
Pre-term
Breech presentation
Mother
Age, occupation, health
How many gestations and pregnancies
Past medical history
Family history; hip dysplasia
Social history; life at home
Pregnancy complications/issues
Medication?
Pre-natal exam
Oligohydramnios
Breech position
ultrasound
Treatment
Pavlik harness
Spica cast with open or closed reduction
Femoral osteotomy
Acetabula osteotomy