1. Developmental dysplasia of the hip

2. 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 .

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

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

5. 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 .

6. 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 .

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

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

10. 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 months.

11. Perkin’s line

12. Shunton’s line

13. Von rosen’s line

14. Management
% 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

15. 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

16. 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* .

17. 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

18. Abduction pillow

19. Von-Rosen splint

20. Pavlic harnes splint

21. Asymmetry of skin folds