MSK - Developmental dysplasia of the hip Flashcards
What is Developmental Dysplasia of the Hip (DDH)?
DDH is a structural abnormality in the hips caused by abnormal development of fetal bones during pregnancy, leading to instability in the hips and a tendency for subluxation or dislocation.
When is DDH usually detected?
DDH is usually detected in neonates.
What are the risk factors for DDH?
Female gender (5x more common).
First-degree family history of DDH.
Breech presentation during pregnancy.
Multiple pregnancy (twins, etc.).
Oligohydramnios (low amniotic fluid).
first born child
What are the clinical features of DDH on examination?
Asymmetrical leg length.
Reduced range of movement in the hip.
Limp.
Older children with missed DDH may present with:
Trendelenburg gait.
Leg length discrepancy.
: How is DDH diagnosed clinically?
Barlow Test: Attempts to dislocate an articulated femoral head.
Ortolani Test: Attempts to relocate a dislocated femoral head.
Remember: B before O (dislocate first, then relocate).
What imaging is used for DDH diagnosis?
Ultrasound is the primary imaging for DDH diagnosis in newborns.
For infants older than 4.5 months, an X-ray is the first-line imaging.
Breech babies ≥36 weeks gestation should have an ultrasound at 6 weeks.
Why is ultrasound preferred over X-ray in newborns for DDH diagnosis?
Newborn bones are mostly cartilage, which doesn’t show up on an X-ray.
X-ray exposure to radiation should be avoided in infants if possible.
When should a baby born in breech presentation have an ultrasound for DDH screening?
All breech babies ≥36 weeks gestation should be screened with an ultrasound at 6 weeks of age.
What are the indications for performing an ultrasound at 6 weeks for DDH screening?
Breech presentation at 36 weeks gestation.
Breech delivery.
A first-degree family history of DDH.
What is the first-line management for DDH in newborns under 6 months old?
The Pavlik harness is the first-line treatment.
It keeps the hips flexed and abducted.
Most cases resolve spontaneously by 3-6 weeks.
What are the potential complications of the Pavlik harness?
Avascular necrosis (loss of blood supply to the femoral head).
Femoral nerve palsy (nerve damage affecting leg movement).
: What is the second-line treatment for DDH in children over 6 months old?
Surgery is the second-line treatment for DDH in children older than 6 months.
