Developmental dysplasia of the hip

introduction 1- previously called CDH . 2- its incidence is 5-20/1000 live birth at time of delivery . 3- after 3 weeks of the delivery its incidence will be 1-2/1000 live birth . 4- girls affected more than boys 7:1 . 5- left hip affected more than the right . 6- in 1 of 5 cases the condition is bilateral .

AETIOLOGY 1- GENETIC FACTORS 2-HORMONAL FACTOR 3-INTRAUTERINE MALPOSITION 4-POST-NATAL FACTOR

PATHOLOGY 1- acetabular dysplasia 2- femoral head dysplasia 3- femoral neck antiversion 4- inverted labrum 5- long ligamentum teres 6- tight iliopsoas tendon

Clinical features Any newborn baby should be examined for sign of hip instability , and we should concentrate on babies which carry high risk example. 1- +ve family history . 2- baby with congenital anomalies . 3- baby with breech presentation .

symptoms 1- the mother may observe a short limb in unilateral DDH . 2- the mother may observe externally rotated limb . 3- asymmetry of the skin crease (folds) . 4- difficulty in changing the napkins . 5- delay walking mainly at 18 months or older .

Symptoms(cont.) 6- wide perineum in bilateral DDH . 7- limping gate in neglected cases or when the patient presented after walking age .

examination 1- limb length asymmetry . 2- skin folds asymmetry . 3- Barlow’s test . 4- Ortolani’s test .

Asymmetry of skin folds

imaging 1- Ultrasound is used in the 1st 6 months . 2- Plain x-ray is used as follow . A- Von-rosen’s line in the 1st 6 months . B- Perkin’s line above the age of 6 months C- shunton’s line above the age of 6 months.

Perkin’s line

Shunton’s line

Von rosen’s line

Management 1-80-90% of unstable hip at birth will be stable spontaneously after 2-3 weeks . 2- baby with high risk of DDH should be examined by Ortolani’s and Barlow’s test ,ultrasound is much useful for diagnosis and follow up . 3- babies in the 1st month of life with +ve Ortolani’s or Barlow’s or ultrasound, should be nursed by double napkins or abduction pillow for 6 weeks then reexamined

Abduction pillow

management If: A-the hip is stable :we should leave the patient free and follow him up for 6 months B- the hip is still unstable: Abduction splint is used until the hip becomes stable

Types of abduction splints 1- Von-Rosen (H) shape malleable splint . 2- Pavlic Harness splint . The splints should keep the limbs flexed 90* and abducted 45* .

Management (cont.) C- if the hip is unredusable from the start or still dislocated after conservative treatment ; then the treatment will be by manipulation under general anesthesia with or without adductor tenotomy with hip P.O.P spica in flexion and abduction for 6 weeks . D- if close reduction failed, then we should do open reduction

Von-Rosen splint

Pavlic harnes splint