Developmental Dysplasia Of Hip Flashcards
Definition
It compromises spectrum of disorders from hip dysplasia to irreducible dislocation
Etiology/ risk factors @ F4 COC
- female child
- first born
- faulty intrauterine position ( breech position)
- familial history
- faulty carrying
- caucasian
- oligohydramnios
- comorbidities such as CTEV, torticollis
Pathological changes in dislocated joint
- acetabulum shallow with steep sloping roof
- femoral head dislocated upwards and laterally
- epiphysis small and ossifies late
- femoral neck excessively anteverted
- capsule is stretched and shows hourglass constriction
- ligamentum teres hypertrophied
- adductor muscles shortened
Stages
- reduced stable but dysplastic
- reduced but dislocatable
- dislocated but reducible
- dislocated and irreducible
Diagnosis in neonate
- routine screening
- limitation of hip abduction
TESTS
- barlow’s test: provocative test where hip gently ADDUCTED and hip is pushed outward. If clunk heard then dislocatable
- ortolani’s test: test of entry or relocation test
where hips are in 90 degree flexion and fully adducted, when tried to ABDUCT hearing of clunk sound signifies reduction - klisic sign: line passing through GT and ASIS passes below the umbilicus ( normally through umbilicus
- limited abduction of hip
Diagnosis in infants
- asymmetry of thighs and gluteal folds
- abduction decreased by 50%
- widened perineum
TESTS
- ortolani
- barlow
- galaezzi or allis test
Diagnosis in older children and adolescents
- asymmetry
- clicking hips
- difficulty in applying napkin
- features of osteoarthritis hip in adult
TESTS
- trendelenburg test
- telescopy test positive
- vascular sign of narath positive
Unilateral DDH in older child
- asymmetrical crease
- shortened limb
- trendelenburg gait
Bilateral DDH
- wide perianal gap
- decreased abduction and external rotation at flexion
- waddling gait
- lordosis
- shortening of lower limb
- compensatory genu valgum
Imaging in newborn
- alpha decreases and beta increases
- morin index<50%
Morin’s index
Percentage of femoral head covered by acetabulum
X-ray findings in DDH
- delayed appearance of ossific centre of femoral head
- ossification centre of epiphysis lies in outer and upper quadrant
- break in shenton line
- sloping acetabulum
- Von Rosen line prolongation towards ASIS and crosses midline in lower lumbar region
- centre edge angle of wiberg reduces(N: 20-30 degree)
- acetabular roof angle increases
Treatment for 0-6months
- dislocatable observe for 3 weeks; if undtable abduction splint in reduced position until xrays show good acetabular roof
- dislocated: pavlik harness which is a dynamic flexion abduction orthoses promoting and maintaining reduction
Features of pavlik harness
— dynamic flexion abduction orthoses
- promotes and maintains reduction
- used in child below 6 months of age
- anterior strap controls flexion of hip
- posterior strap limits adduction and promotes abduction
- allows active movement in all directions except adduction and extension
- nappies can be changed easily
Persistent dislocation in 6-18 months t/t
1) closed reduction
- preoperative traction followed by
- adductor tenotomy
- closed reduction under GA and arthrography
- splintage in 60• flexion 40• abduction and 20• internal rotation with plaster spica for 6 weeks,6 weeks more if necessary ✅
2) open reduction by using bikini incision at 1 year of above measure fails
