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Developmental Dysplasia of the Hip (DDH) - Coggle Diagram
Developmental Dysplasia of the Hip (DDH)
Intro
aka Congenital hip dislocation (CHD)
spectrum ranging from dysplasia to subluxation to frank dislocation
Early recognition NB as responds to conservative tx (splinting)
Dysplasia = abnormal cellular organisation or function of a specific tissue
Physical exam
Infant needs to be relaxed, kicking/crying results in muscles tightening + prevents satisfactory exam
Barlow manoeuvre
Adduct + flex hip + push fem head down
see if hip is dislocatable post
Ortolani manoeuvre
abduct hip + apply upward leverage
see if dislocated hip returns to acetabulum - listen for a clunk
hips should be fully abductable
Performed prior to discharge home + @ 8 wks
abnormal exam in 6-10 per 1000
true incidence only 1-2 per 1000
most resolve spontaneously
Will miss some cases
Risk factors
female
+ve family hx
breech
NM disorder
first born
macrosomia
Tx
Splint or harness
comp = necrosis of fem head, so expert fitting NB
keep hip flxed + abducted
usually works
monitor progress using US/X-ray
Surgery if conservative measures fail
US
done for abnormal exam, breech, +ve family hx
! false +ves
does identify some babies missed on clinical exam
if +ve refer to ortho
Late presentation
limp
abnormal gait
assym of skin folds around hip
limited abduction
shortening of affected leg