#3+4. CONGENITAL DYSPLASIA OF HIP JOINT; CDHJ in Walking Children

Question 1

What is the ANATOMY of the Hip Joint?

Answer 1

1) Femur Head = Ball

2)Acetabulum = Socket (Forms around FH)

• It has a Fossa, where Ligament Teres ORIGINATES
• Connecting with Fovea Capitis (FH), keeping joint in place
• Also a Acetabular Labrum = Rim of Cartilage, where underneath lies transverse ligament

3) Ischium / Ileum / Pubis = 3 Pelvic Bones

4) Ileofemoral / Pubofermoral / Ischiofemoral Ligaments = Making up Joint Capsule, allowing femur in place when walking / running

Question 2

What happens if the Femur is NOT in the Acetabulum?

Answer 2

• Causes Hypotrophy of Lig Teres / Acetabular Labrum (Rim of C) / Transverse Lig
• Making Acetabulum shallow + poor fit for the Femur Head, leading to Complete Dislocation

Question 3

Where is Congenital Dysplasia of HJ, most commonly seen?

Answer 3

• Girls
• 1st Pregnancies of Women, since Uterus is unable to dilate as much

Question 4

What is the ETIOPATHOGENESIS of CDHJ?

(The Theories)

Answer 4

1) MECHANICAL Theory

• There’s INCREASED Force on Foetal Thigh = DUE to SHORTAGE of Amniotic Fluid in Womb

2) HARMFUL Factors

• Infrared Radiation / Meds
• Endocrine / Metabolic Disorders
• Infection
• Premature Birth during Pregnancy

3) PARALYTIC Theory = Where ADDUCTOR Tone is STRONGER&raquo_space; than the Abductor

4) GENETIC Theory = Affected Parents are 10x MORE LIKELY to pass this down

5) LAX / LOOSE Joints = More common in Women, due to Hormonal reasons

Question 5

What is the PATHOANATOMY of CDHJ?

Answer 5

1) JULUIS WOLF LAW

• Where bone adapts to pressure on it
• Wrong Pressure = INCREASED *Trabeculation internally** + Cortical Thickness externally

2) SUBLUXATION = FH is at edge of Acetabulum

3) LUXATION = FH is at Completely outside of Acetabulum i.e. Dislocated

• Is in contact with Iliac Bone
• Joint Capsule is an hourglass now = Narrow part is destroyed, forming an isthmus

Question 6

What are the 3 Types of Luxations?

Answer 6

1) Luxatio coxae iliaca

2) Luxatio coxae supracotyloidea

3) Luxatio coxae cotyloidea

Question 7

What are the DIAGNOSTIC TESTS for CDHJ?

Answer 7

1) ORTOLANI’s Maneuver = Manipulating the HJ, to check for clicks / sign’s of instability

2) BARLOW’s Maneuver = Identifying whether hip can be dislocated; Flexion at Hip / Knee joints, followed by abduction

3) PETER-BLADE Symptom = Asymmetrical Folds of the Hip - either unilateral / bilateral

** 4) PALMEN’S TEST**

• Similar to Barlow Test, but done w/ GREATER Adduction + Extension
• When pressing along Longitudinal-Axis of the Hip, it DOES NOT leave the Acetabulum

5) THOMAS Test = Assessing Hip Flexor Tightness / presence of contractures

• By flexing the hip to the stomach, and if opposite leg LIFTS OFF = Indication of Hip Flexion Contracture

5) Delayed Walking = At 14 - 15 Months

6) PUTTI’s X-Ray TRINITY

• Abnormal / slanting arch of Acetabulum
• Delayed formation of the Epiphyseal Nucleus of FH
• Ectopia (congenital displacement of proximal end of Hip Bone

Question 8

What is the CLINICAL EXAMINATION for New-borns to 2 Months Old?

Answer 8

1) Thomas Test = By 2-3 Months
2) BARLOW’s Maneuver = By 10 Days old
3) ORTOLANI’s Maneuver = By 10 Days old
4) PALMEN’s TEST = By 10 Days old

Question 9

What is the CLINICAL EXAMINATION for 3 -12 Months Old?

Answer 9

1) PETER-BLADE Symptoms

2) Marked HYPERLAXITY = CT is NOT FORMED of Pelvic Joint

3) Roser-Nelaton Axillary Lines = By 10 Days old

4) PUTTI’s X-Ray TRINITY