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DDH - Coggle Diagram
DDH
developmental dysplasia of the hip
definition
dysplasia of the hip that develop during fetal life or in infancy
it ranges from dysplasia of the acetabulum (shallow) to subluxation of the joint to complete dislocation.
the old name was congenital dysplasia of the hip (CDH)
the name has changed to indicate that not all cases are present at birth and that some cases can develop later on during infancy and childhood
congenital hip dysplasia
congenital dislocation of hip
DDH is a condition where there are various degrees of displacement of
the femoral head from the acetabulum.
Subluxation
dislocation
1
incidence
uncommon in india & eastern countries
v common in europe & america
One per 1000 live birth.
Left hip affected in - 67 %of cases.
Family history present - in 20 %
Incidence of breech - 30-50 %
Female preponderance.
1:3 cases are bilateral.
2
aetiology
genetic factor
Hormonal factor-High levels of maternal oestrogen,progesterone and relaxin.
Intrauterine malposition
Primary dysplastic development of the acetabulum.
3
pathology
Acetabulum:
primary acetabular dysplasia and the
acetabulum is shallow.
There could be a gap or groove at
posterosuperior aspect.
Head of femur:
The dislocated head of femur at first appears
normal, ossification is delayed, later head is flat on its posterior and medial aspect.
Neck of femur:
shortening and anteversion.
Pelvis:
The pelvis is usually tilted forwards, it is small and atrophied.
Capsule:
hourglass constriction.
4
muscles effected
shortened
pelvifemoral group
adductors
sartorius
gracilis
rectus femoris
hamstrings
TFL
elongated
pelvitrochanteric group
obturators
quadratus femoris
ilipsoas
power diminished
glutei muscles
5
stages of DDH
the 3 Ds
1
dysplastic/predislocation stage
2
dislocatable/subluxation stage
3
dislocation stage
6
clinical features
6
Shortening of leg
Additional creases in the post and medial aspects of the upper thigh
Klisic sign
used to detect bilateral dislocations
line from the long finger placed over the greater trochanter and the index finger over the ASIS should point to the umbilicus
if the hip is dislocated, the line will point halfway between the umbilicus and pubis
Ortolani test of reduction
a maneuver to reduce a recently dislocated hip
flexion, abduction, anteriorly
the examiner holds the infant's knees and gently abducts the hip while lifting up on the greater trochanter with 2 fingers
when the test is positive- the dislocated femoral head will fall back into the acetabulum with a palpable (but not audible) "clunk" as the hip is abducted (ortalani's sign)
when the hip is adducted the examiner will feel the head redislocate posteriorly
barlow test of exit
is a provocative maneuver used to reveal hip instability.
One hand stabilizes the pelvis whilst the other grasps the knee and flexes the hip to 90 °.
The examiner’s fingers should lie over the greater trochanter with the thumb resting on the inner side of the thigh.
A posterior force is applied through the femur as the thigh is gently adducted by 10-20 °
Mild pressure is then placed on the knee while directing the force posteriorly.
The Barlow Test is considered positive if the hip can be popped out of the socket with this maneuver. The dislocation will be palpable
Telescoping test
is used to check for hip dislocations
patient lies down flat on their back
patient’s legs raised up so that the knee is bent at a 90 degree angle
hen, with one hand on the patient’s knee, and the other grasping the patient’s upper calf, the physical therapist raises the patient’s knee upward, then back down.
The physical therapist is looking for laxity of the hip joint.
Unilateral dislocation of hip
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unilateral dislocation of hip
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Radiological features
7
new born
suspect DDH if
joint space is excessively broad & neck of femur lies far away from the acetabulum.
If the head of the femur is small and the acetabulum is shallow.
ultrasonogram
X-ray:
Von Rosen’s line
Hilgenreiner line
Perkin line
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is a horizontal line through
triradiate cartilage
with hips abducted 45° and 25° internally rotated,
line drawn up the shaft of the femur
should intersect acetabulum
and not ilium above it
Treatment
8
To reduce the hip and maintain it in the reduced position till it remains stable.
Infants below 3 months: Von Rosen splints and Pavlik harness, Ilfeld-Craig splint.
table
osteotomy
Salter’s Osteotomy
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Neglected Developmental Dysplasia of
the Hip
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