1: Neonatology - CDH Flashcards

1
Q

What is congenital dislocation of the hip also known as

A

Developmental dysplasia hip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is developmental dysplasia of the hip

A

Hip instability, subluxation and dislocation and acetabular dysplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the most common congenital abnormality of skeletal development

A

CDH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which gender does DDH predominantly affect

A

Females (5:1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are 5 risk factors for DDH

A
  1. Female
  2. Breech
  3. Little space - multiple pregnancy, oligohydramnios, macrocosmic
  4. Talipes
  5. FH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What hip is CDH more common in

A

Left

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

If a neonate less than 6-months has CDH, how will they appear

A

Asymptomatic

+ve Barlow and Ortolani’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

If a infant 6-18m has CDH, what are the presenting features

A
  • Difficultly abducting hip (often detected when changing diapers)
  • Asymmetrical gluteal folds
  • No ortolans or Barlow sign
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When may an individual with CDH not have asymmetrical gluteal folds

A

If bilateral (20%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

If over 18 months with CDH what are the symptoms

A
  • Lumbar lordosis
  • Hip pain
  • Leg-length discrepancy
  • Waddling Gait
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Where will hip pain be referred to

A

Anterior thigh or knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why is there a leg length discrepancy

A

Compensate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is a way to remember Barlow’s sign

A

When Barlow is DOWN he likes to ADD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is Barlow’s sign

A

A palpable clunk caused by hip dislocation is felt when hip is flexed, adducted and pushed downwards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is Ortolani’s sign

A

A palpable clunk caused by hip re-location is felt when flexed, abducted and pushed upwards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are features of bilateral CDH

A

Asymmetrical gluteal folds and leg-length discrepancy are absent

17
Q

Explain why CDH happens in breech

A
  • Frank breech (hips flexed, knee’s extended) puts pressure on dorsal acetabular ridge. Preventing its formation
  • Shallow acetabulum leads to instability, subluxation and dislocation
  • this results in contractures
  • contractures cause further acetabular dysplasia enabling it to be infiltrated by fatty substances
  • fatty substance occupies space causing hypoplasia of femoral head
18
Q

Explain screening for CDH

A

All infants are screened are NIPE and 6-weeks using Barlow or Ortolani tests

19
Q

What individuals need screening with US at birth, regardless of NIPE

A

Breech at 36W
First degree relative with childhood hip-problems
Multiple pregnancy

20
Q

If under 4-months what is used to diagnose CDH

A

USS

21
Q

If over 4-months, what is used to diagnose CDH

A

X-ray

22
Q

What is a feature on x-ray of CDH

A

Interrupted Shelton’s lines

23
Q

What is Shelton’s line

A

Hypothetical line drawn along inferior border of superior pubic ramus

24
Q

What is used to manage CDH in neonates under 6-months

A

Pavlik harness

25
Q

What does a pavlik harness do

A

Holds legs in 100’ flexion and 50’ abduction

Remember 50 is half of 100

26
Q

What is first-line 6-18 months with CDH

A

Closed reduction

27
Q

If unable to achieve closed reduction what is used

A

Open reduction and spica hip cast

28
Q

If under 12-months what approach is used for open reduction

A

Medial approach

29
Q

If 12-18 months what approach is used for open reduction

A

Anterior approach

30
Q

What is used 18-24m for CDH

A
  • Trial closed reduction

- Open reduction (using anterior approach) and pelvic osteotomy and hip spica cast

31
Q

If 2-6 years, how is CDH managed

A
  • Open reduction
  • Femoral shortening
  • Pelvic osteotomy
32
Q

What is a complication of CDH

A

Avascular necrosis of femoral head

33
Q

What is a late complication of CDH

A

Leg-length discrepancy