Week 3 - Developmental Dysplasia of the Hip Flashcards
what is DDH?
dislocation or subluxation of the femoral head during the perineal period which affects subsequent development of the hip joint
who/where does DDH commonly present?
girls left hip (but can be bilateral)
what are the risk factors for DDH?
family history of DDH breech presentation first born babies down syndrome presence of other congenital disorders
what can happen if DDH is left untreated?
the acetabulum is very shallow or a false acetabulum occurs proximal to the original one with a shortened lower limb
severe arthritis at young age
gait/mobility can be severely affected
what are the signs of DDH?
shortening
asymmetric groin/thigh skin creases
click/clunk on ortolani or barlow manoeuvres
what is the ortolani manoeuvre?
reducing a dislocated hip with abduction and anterior displacement
what is the barlow manoeuvre?
dislocatable hip with flexion and posterior displacement
what is the next step is ortolani or barlow manoeuvre is positive?
US which should detect a dislocated hip, unstable hip or shallow acetabulum
are X rays used DHH?
not at early stage as the femoral head epiphysis is unossified until 4-6 months
X rays are first line after this age
how is mild DDH treated?
close observation with serial examination and ultrasound to ensure the hip remains reduced
how is more severe DDH treated?
dislocated hips are reduced and held with a special harness known as a Pavlik harness which keeps the hips in comfortable flexion and abduction, thus maintaining reduction
how are children with persistent dislocation over 18 months old managed?
open reduction is more likely to be required to clear soft tissues and may also need an osteotomy to shorten and rotate the femur and/or pelvic osteotomy to deepen and re-orientate the acetabulum
