Developmental dysplasia of the hip (DDH)

Definition
  • A spectrum of disorders ranging from complete dislocation of the femoral head to a reduced hip joint with acetabular dysplasia



Types:
1. Complete hip dislocation.
2. Partial hip subluxation.
3. Hip dysplasia (incomplete development).

Risk factors:
  • family history - may reflect laxity of ligaments
  • Race- common in white 
  • Breech  presentation - Exaggerated positioning in acute flexion and adduction in utero may occur
  • Female sex - the presence of maternal relaxin in the fetal circulatory system
  • large fetal size 
  • First born child
Galeazzi's test
  • With the child is lying on a flat surface, flex the hips and knees so the heels rest flat on the table, just distal to the buttock . 
  • A dislocated hip is signaled by relative shortening of the thigh compared with the normal leg, as shown by the difference in knee height level. 
  • This test is almost always useless in children under 1 year of age and is negative if dislocation is bilateral.


Barlow's test
  • This is a provocative test that picks up an unstable but located hip; it is unsuitable for a dislocated hip. 
  • Thighs are gently grasped in the hand, with the thumb at the lesser trochanter and fingers at the greater trochanter . The hip is adducted slightly and gently pushed posteriorly with the palm. 
  • Detection of "pistoning," or the sensation of the femoral head subluxating over the posterior rim of the acetabulum, is a positive finding.



Ortolani's test:
  • This test detects hips that are already dislocated. 
  • The flexed limb is grasped as in Barlow's test. The hip is abducted while the femur is gently lifted with the fingers at the greater trochanter. 
  • In a positive test, there will be a sensation of the hip reducing back into the acetabulum. 







Clinical Manifestations

In newborn:
  • We can diagnose DDH in this period by positive Ortolani’s test or Barlow’s test.
  • Asymmetry of the skin fold may help, but its not specific. 
  • Shortening of the limb at this age doesn’t exist.
  • We cant use X-rays because the acetabulum and proximal femur are cartilaginous and wont be shown on X-ray.
  • USG is the best method to Dx.

In the early childhood:
  • Parents notice asymmetry of creases of groin, limitation of movement of affected hip or click every time hip is moved

In older children:
  • Complaints of limping, waddling gait (bilateral DDH), Trendelenburg’s gait (unilateral DDH), lumbar lordosis, limitation of hip abduction, etc…

X-ray

Von Rosen view:
hips abducted 45º & medially rotated.
Anteroposterior.
We draw a line through the central axis of the femoral shaft.
        in normal hip ( ossific nucleus )will be inside the acetabulum.
        in dislocated hip it will be above acetabulum.


Delayed development of ossific nucleus / smaller
Horizontal line of Hilgenreiner:
   drawn between upper ends of tri-radiate cartilage of the acetabulum.
Vertical line of Perkins:
  drawn from the lateral edge of the acetabulum vertical to horizontal line.
4 quadrants:
Normal hip: the ossification center of the femoral hip lower medial quadrant.
Dislocated hip: upper lateral quadrant.


Acetabular index:
    angle between horizontal line of Hilgenreiner and the line between the two edges of the acetabulum.
    normal hip 20º-300 
    dilocated or dysplastic hip ≥ 30º
Shenton’s line:
    semicircle between femoral neck and upper arm of obturator foramen, in dislocated hip this line is broken.

Treatment:


The earlier the better. 
Exact treatment depends on patient age at presentation and degree of involvement
Goal is to:
1.Flex and abduct hips.
2.Reduce femoral head and maintaining it.
Reduction can be achieved by closed manipulation , traction followed by closed reduction and opened reduction  
 maintenance can be done using plaster cast(frog leg or Batchelor) or splint (von Rosen’s splint)

  • Acetabular reconstruction procedure
  • Salter’s osteotomy
  • Chiari’s pelvic displacement osteotomy 
  • Pemberton’s pericapsular osteotomy

  • From (0-6 months)  
A dislocated hip at this age may spontaneously reduce over 2-3 weeks if the hip is held in a position of flexion. 
Reduction by closed manipulation and maintained with plaster cast or splint
  • From 6 months -2 year
Gentle closed reduction of the dislocation under a general anesthetic and maintenance of a located position for 2-3 months in a hip spica cast usually stabilize the joint
  • From the age of 2-6 years:

open reduction with osteotomy

  • 6-10 years

No treatment for bilateral
Open reduction with reconstruction for unilateral

  • After 10 years

Only indication for treatemnt is pain. If only one hip affected total hip replacement may be done.

4 comments:

  1. mbbs in Philippines
    Every year, almost 8000 foreign students take admission in Philippines Medical universities and out of which around 50% are Indian students. The standard of education in Philippines universities is well known around the world. Thousands of doctors from these medical universities are sent to various countries like USA and UK every year. There are around 2299 higher educational institutions and 40 medical colleges. The main benefits of pursuing MD degree from

    Top Medical Colleges in Philippines :

    EMILIO AGUINALDO COLLEGE OF MEDICINE
    UNIVERSITY OF PERPETUAL HELP SYSTEM DALTA
    LYCEUM NORTHWESTERN UNIVERSITY
    DAVAO MEDICAL SCHOOL FOUNDATION
    SOUTHWESTERN UNIVERSITY

    Top Searched Topics on MBBS in Philippines


    study mbbs in philippines
    philippines medical colleges list
    best medical colleges in philippines for indian students
    philippines medical colleges
    best medical colleges in philippines
    mci approved medical colleges in philippines

    for more information contact us : +91 90329 55688

    ReplyDelete
  2. UV GULLAS COLLEGE OF MEDICINE is one of Top Medical College in Philippines in Cebu city. International students have the oppertunity to study medicine in phillipines at affordable cost and world class University. The college has successful alumni who have achieved well in the fields of law, business, politics, academe, medicine, sports and other endeavors. At University of the Visayas, we prepare students for a global competition.

    Direct MBBS Admissions Open: 2020-21
    Mobile No: +91 90329 55688
    Apply Now: https://www.careerplus.org.in/philippines-medical-college/uv-gullas-college-of-medicine

    ReplyDelete
  3. Hey there! This is kind of off topic but I need some help from an established blog. Is it hard to set up your own blog? I’m not very techincal but I can figure things out pretty fast. I’m thinking about creating my own but I’m not sure where to begin. Do you have any tips or suggestions? Appreciate it hip replacement surgery pune

    ReplyDelete
  4. A hip replacement, or hip arthroplasty, is surgery that replaces a diseased or injured hip joint by with an artificial joint or implant. People usually receive hip replacements when arthritis causes severe hip pain and inflammation.  Cost of hip replacement surgery

    ReplyDelete

Popular Posts