MSK: Developmental Dysplasia Of The Hip (DDH) Flashcards
What percentage of newborns are affected?
Around 1-3%
Is it a spectrum of disorders?
Yes ranging from dysplasia to subluxation through to frank dislocation of hip
Why is early detection important?
It usually responds to conservative treatment
What is late diagnosis associated with?
Hip dysplasia - requires complex treatment, which often includes surgery
When is screening done?
As part of routine neonatal screening
Repeated at routine surveillance at 6 week check
At some centres an ultrasound examination is done on newborns for those who are high risk e.g FH and breech presentation
What risk factors are there?
Female - 6 times greater risk Breech presentation FH First born child Oligohydramnios Birth weight > 5kg Congenital calcaneovalgus foot deformity
What percentage are bilateral?
Around 20%
Is it slightly more common in left or right hip?
Left
What tests are done during screening?
Barlow
Ortolani
Describe the Barlow test
An attempt to see if the hip can be dislocated posteriorly out of the acetabulum
Flex knee at 90 degrees and adduct while applying pressure to knee , directing force posteriorly
Describe the Ortolani test
An attempt to relocate the hip back into the acetabulum on abduction .
Flex hip and knee to 90 degrees, place anterior pressure on greater trochanter and gently abduct the leg
During clinical examination, what else is looked for?
Symmetry of leg length (affected shortened)
Level of knees when hips and knees are bilaterally flexed
Restricted abduction of the hip in flexion
Asymmetry of skin folds
How can in present later?
Limp
Abnormal gait
Do most resolve spontaneously?
Yes - most unstable hips spontaneously stabilise by 3-6 weeks of age
Does clinical neonatal screening miss some cases?
Yes
May be inexperienced examiner
In some not possible to detect dislocation at this stage - where there is only a mildly shallow acetabulum
What is used to confirm diagnosis in clinically suspected?
USS - qualify degree of dysplasia
But if the infant is > 4.5 months then x ray is the first line investigation
How is it managed?
If indicated, infant may be placed in a splint or harness to keep hip flexed and abducted for several months. Progress monitored by repeated USS or x ray. Splinting must be done expertly as necrosis of femoral head is a potential complication.
Why is required if conservative methods fail?
Surgery
