DDH

Question 1

Teratologic hip

Answer 1

o These hips dislocated in utero and are irreducible on neonatal examination
o Have to be associated with neuromuscular conditions or genetic disorders e.g. Arthrogryposis ,
Myelomeningocele (Spina Bifida)

Question 2

Late (Adolescent) Dysplasia

Answer 2

The hip is stable and reduced but dysplastic (Not completely congruent or spherical)

Question 3

Dysplasia

Answer 3

a shallow or underdeveloped acetabulum

Question 4

Subluxation

Answer 4

e supero-lateral migration of the femoral head in relation to the acetabulum

Question 5

Mechanical risk factors of DDH

Answer 5

o First Born 
o Prolonged labour 
o Left hip due to foetal position 
o Torticollis 
o Breech babies (25% hip instability) 
o Swaddling to extend hips and knees 
o Oligohydramnios

Question 6

Presentation in walking patients

Answer 6

Pelvic Obliquity
Trendelenburg sign in walking patients
Increased lumbar lordosis esp with bilateral dislocations

Question 7

why are X-rays are unreliable < 4 months of age?

Answer 7

epiphysis of the femoral head is only visible on x-ray after it has ossified

Question 8

treatment

birth to 6 months

Answer 8

Pavlik Harness - Abduction Splinting/Bracing for 16 weeks

remove it if not reduced by 3-4 week

Question 9

pavlik harness pitfalls

Answer 9

Improper Placement will cause incorrect forces on the hip and prevent relocation
Femoral nerve palsy
Avascular necrosis

Question 10

Open Reduction and Spica Casting

Indications

Answer 10

DDH in patient that only present at >18 months of age

Failure of closed reduction

Question 11

treatment when the diagnosis of DDH is only made at 6 - 18 months of age

Answer 11

Closed Reduction and Spica Casting for 3 months

Question 12

5 complications

Answer 12

Joint contractures
AVN of the femoral head
Redislocation
Early OA
Back/Knee pain