Developmental Dysplasia of the Hip Flashcards
Define developmental dysplasia of the hip.
Abnormal growth of the hip resulting in dislocation or instability.
Explain the aetiology/risk factors for developmental dysplasia of the hip.
Multifactorial: Racial association, intrauterine positioning, gender and ligamentous laxity.
Associations: FHx (first-degree relative; 20%), first born (smaller uterus), oligohydramnios, breech delivery, caesarean section, neuromuscular disorders, metatarsus adductus, torticollis.
Summarise the epidemiology of developmental dysplasia of the hip.
1–3 % of newborns. Female 6 times greater risk. More common in the left hip. Around 20% of cases are bilateral.
What are the symptoms of developmental dysplasia of the hip?
Risk factors in the history.
What are the signs of developmental dysplasia of the hip?
General inspection: Lack of labral folds, reduced movement of the legs, decreased abduction on the affected side, standing or walking with external rotation, and asymmetry; leg positions, leg length, gluteal thigh or labral skin folds.
Barlow test: Attempts to dislocate an articulated femoral head.
Ortolani test: Attempts to relocate a dislocated femoral head.
What are some investigations for developmental dysplasia of the hip?
USS Hip or X-ray Hip (2 views adduction and abduction).
What is the management for developmental dysplasia of the hip?
Supportive: Pavlik harness splints until age 5-6 months. USS monitoring.
Surgical correction: Late diagnosis (post 6 months) requires preoperative traction then closed reduction. Surgical release of muscles may be required.
What are complications associated with developmental dysplasia of the hip?
Irritation from reduction devices, avascular necrosis of the femoral head and osteoarthritis of the hip.
What is the prognosis of developmental dysplasia of the hip?
Pavlik harness has good results when used below 6 months. The prognosis is worse when the patient is older.
