[81] Developmental Dysplasia of the Hip Flashcards
What is developmental dysplasia of the hip (DDH)?
A problem with the way the hip joint develops
When is DDH present from?
Usually present from birth, although it may develop later
When is the outcome for DDH excellent?
When diagnosed and treated early in a young baby
What happens if treatment for DDH is delayed?
It is more complex, and has less chance of being successful
Describe the head of the femur in a normal hip
It is a smooth, rounded ball
Describe the acetabulum in a normal hip
It is a smooth, cup-like shape
Where is the abnormality in DDH?
Shape of the head of the femur, the shape of the acetabulum, or supporting structures around them
What is the result of abnormalities in the femur, acetabulum, or supporting structures in DDH?
The acetabulum and the femur are not in close contact
What is the spectrum of severity of DDH, in terms of the relationship between the acetabulum and the femur?
It can be a mild deformity, where there is some contact between them (subluxation), or a severe abnormality where there is no contact (dislocation)
What are the risk factors for DDH?
- Female gender
- Family history
- Oligohydraminos
- First-born child
- Breech delivery
- Neuromuscular disorders
Give 2 neuromuscular disorders that increase the risk of DDH?
- Cerebral palsy
- Meningomyelocele
When is screening for DDH done?
It is part of the physical examination of the newborn and 6-8 week old babies
Does normal examination in the neonatal period does not preclude a subsequent diagnosis of DDH?
No
What are the clinical features of DDH in children under 3 months old?
- Asymmetry
- Positive Ortolani and Barlow test
Where may asymmetry be noted in DDH in under 3 month olds?
- Gluteal or thigh skin folds
- Limb length discrepancy
In what age group should you perform the Ortolani and Barlow tests?
Under 3 months
How is the Ortolani test performed?
You apply gentle forward pressure to each femoral head in turn
What do the results of the Ortolani test show?
Palpable movement suggests the hip is dislocated or subluxed, but reducible