1: Neonatology - CDH Flashcards
What is congenital dislocation of the hip also known as
Developmental dysplasia hip
What is developmental dysplasia of the hip
Hip instability, subluxation and dislocation and acetabular dysplasia
What is the most common congenital abnormality of skeletal development
CDH
Which gender does DDH predominantly affect
Females (5:1)
What are 5 risk factors for DDH
- Female
- Breech
- Little space - multiple pregnancy, oligohydramnios, macrocosmic
- Talipes
- FH
What hip is CDH more common in
Left
If a neonate less than 6-months has CDH, how will they appear
Asymptomatic
+ve Barlow and Ortolani’s sign
If a infant 6-18m has CDH, what are the presenting features
- Difficultly abducting hip (often detected when changing diapers)
- Asymmetrical gluteal folds
- No ortolans or Barlow sign
When may an individual with CDH not have asymmetrical gluteal folds
If bilateral (20%)
If over 18 months with CDH what are the symptoms
- Lumbar lordosis
- Hip pain
- Leg-length discrepancy
- Waddling Gait
Where will hip pain be referred to
Anterior thigh or knee
Why is there a leg length discrepancy
Compensate
What is a way to remember Barlow’s sign
When Barlow is DOWN he likes to ADD
What is Barlow’s sign
A palpable clunk caused by hip dislocation is felt when hip is flexed, adducted and pushed downwards
What is Ortolani’s sign
A palpable clunk caused by hip re-location is felt when flexed, abducted and pushed upwards
What are features of bilateral CDH
Asymmetrical gluteal folds and leg-length discrepancy are absent
Explain why CDH happens in breech
- 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
Explain screening for CDH
All infants are screened are NIPE and 6-weeks using Barlow or Ortolani tests
What individuals need screening with US at birth, regardless of NIPE
Breech at 36W
First degree relative with childhood hip-problems
Multiple pregnancy
If under 4-months what is used to diagnose CDH
USS
If over 4-months, what is used to diagnose CDH
X-ray
What is a feature on x-ray of CDH
Interrupted Shelton’s lines
What is Shelton’s line
Hypothetical line drawn along inferior border of superior pubic ramus
What is used to manage CDH in neonates under 6-months
Pavlik harness
What does a pavlik harness do
Holds legs in 100’ flexion and 50’ abduction
Remember 50 is half of 100
What is first-line 6-18 months with CDH
Closed reduction
If unable to achieve closed reduction what is used
Open reduction and spica hip cast
If under 12-months what approach is used for open reduction
Medial approach
If 12-18 months what approach is used for open reduction
Anterior approach
What is used 18-24m for CDH
- Trial closed reduction
- Open reduction (using anterior approach) and pelvic osteotomy and hip spica cast
If 2-6 years, how is CDH managed
- Open reduction
- Femoral shortening
- Pelvic osteotomy
What is a complication of CDH
Avascular necrosis of femoral head
What is a late complication of CDH
Leg-length discrepancy
