Developmental Dysplasia of Hip

 

DEVELOPMENTAL DYSPLASIA OF HIP 

By Umer khiyam

 

DEFINITION  This is a spectrum of disorders ranging from dysplasia to subluxation through frank dislocation of  the hip. OR In others words: developmental dysplasia (dislocation) of the hip (DDH) is an abnormal formation of the hip joint in which the ball on top of the thigh bone (femur) is not held firmly in the socket. In some instances, the ligaments of the hip may be loose and stretched.

 

DDH runs in families and should be ideally diagnosed right after birth. Childern have uneven gluteal folds, physical examination of hip shows that they can be easily dislocated with a jerk and a “click” and returned to normal with a snapping. If signs are equivocal, sonogram is diagnostic (do not order x-rays; the hip is not calcified in new born). Treatment is abduction splinting with Pavlik harnees for about 6 months.

 

  A 1-YEAR-OLD  FRONTAL RADIOGRAPH OF THE PELVIS IN A CHILD WITH A  A DISLOCATED RIGHT HIP. THE DEGREE OF  OSSIFICATION OF THE FEMORAL HEAD ON THE DISLOCATED  SIDE IS DECREASED COMPARED WITH THAT OF THE  NORMALLY LOCATED LEFT HIP. THE ABNORMALL  ABNORMALLY LOCATED 

 A FALSE NEOACETABULUM. HIP ARTICULATES  ARTICULATES WITH A  

CAUSE: DDH tends to run in families it can be present in either hip and in any individual. it usually effects the left hip and is predominant in : Girls  First born children 

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Babies born in breech position

 

SYMPTOMS : Some babies born with a dislocated hip will show no outward signs. Contact a pediatrician if your baby has : Legs of different lengths.  Uneven skin folds on the thigh. 

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Less mobility or flexibility on one side. Limping, toe walking, or a waddling, duck-like gait.

 

TREATMENT: Treatment methods depends on the child's age. It may be: 

Non-surgical

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surgical

 

NON SURGICAL TREATMENT  

Positioning device (e.g. Craig splint), it puts the hips Positioning in abduction.

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Restraining device (e.g. Pavlik harnees)

 

SURGICAL TREATMENT: 

Open surgical techniques.

Progress : Needs to be monitored by ultrasound and x-rays. In most instances,a satisfactory response is obtained. If the hip has not stabilized or the condition is diagnosed late, hip abduction using traction and further period of splinting ( in a plaster hip spica) may be tried.

 

If unsuccessful, an MRI or CT Scan of the hip and or / an arthrogram will provide more detail information of the joint. Weight bearing on a dislocated should be avoided as it causes damage to the femoral head and acetabulum. Open reduction and derotation femoral osteotomy will be required if conservative measures fail.

 

COMPLICATIONS OF TREATMENT: 

Necrosis of femoral head is a potential complication complication of splinting so it must be done expertly.

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Delay in walking if the child was placed in body

cast.  Pavlik harness and other positioning devices may cause skin irritation, and a difference in leg length may remain. 

Growth disturbances of the upper thigh may rarely occur.

 

CLUB FOOT (T ALIPES EQUINOVARUS)

 

CLUB FOOT (T ALIPES EQUINO-VARUS) Talipes:   

Talus = ankle Pes

Equinus: 

= foot

(Latin = horse) Foot that is in a position of  planter flexion at the ankle, looks like that of the horse.

 

 A COMPLEX  T ALIPES EQUINO VARUS IS A  ABNORMALITY  ABNORMAL ITY.

 

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Club foot (talipes equino varus) is seen at birth.

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Both feet are turned inward, and there is plantar  flexion of the ankle, inversion of the foot, adduction of the forefoot, and internal rotation of the tibia.

 

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The entire foot is inverted and supinated and the forefoot is adducted.

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The heel is rotated inward and plantar flexion.

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The affected foot is shorter and the calf muscles thinner than normal.

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The position is fixed and cannot be corrected completely.

 

EPIDEMIOLOGY  

It is often bilateral

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The birth prevalence is 0.9 per 1000 live births.

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Male to female ratio 2:1

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Multifactorial inheritance.

 

 ASSOCIATIONS TIONS   ASSOCIA 

Secondary to oligohydramnios during pregnancy.

 As a feature of malformation syndrome syndrome or of a neuromuscular disorder such as spina bifida.

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 Also associated associated with DDH.

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TREATMENT  

Serial plaster casts started in the neonatal period provide sequential correction starting with,

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The adducted foot, then the

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Hind foot varus, and last the

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Equinus

 

PROGNOSIS   About half the patients patients are fully fully corrected this way

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The other half requir surgery age 6 to 8 months but before age 1 to 2 years.

 

THANK YOU 

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