1. Developmental Dysplasia of the Hip (DDH)
Presented By: Alaitia Enjady & Esther Kim

2. What is it? Previously known as Congenital Dislocation of the Hip
Abnormal formation of hip joint where acetabulum is shallow, causing ball of the femur to be loose in the socket
Ligaments that hold joint in place stretched
renamed to show better how there are different degrees of abnormality (not just dislocated hips)

3. Develop during child’s first year Severity
Onset
Present at birth
Develop during child’s first year
Severity
Can affect either hip, but most common in left hip
Degree of hip instability varies:
Dislocated- head of femur completely out of socket
Dislocatable- head of femur w/in acetabulum but easily pushed out of socket
Subluxatable- loose in socket, can be moved w/in socket but does not dislocate

4. In the U.S. about 1 to 2 babies per 1000 are born with DDH
Prevalence
In the U.S. about 1 to 2 babies per 1000 are born with DDH

5. Etiology Cause unknown, but condition related to several factors:
Family Hx
Gender (Female> Male)
Race (Native Americans)
Oligohydramnios- low volume of amniotic fluid
Born in breech position
First born
Improper swaddling that forces hip adduction
Frequency of hip dysplasia is 10 times higher in children whose parents had DDH

6. Clinical Presentation
Left hip > Right hip
Positive Special Tests
Ortolani maneuver
Barlow test
Galeazzi
Symptoms
Different leg lengths
Asymmetrical skin folds on thigh
Decreased mobility/flexibility on one side
Limping, toe walking, waddling gait
The left hip is more commonly associated with DDH than the right hip, possibly because of the common intrauterine position of the left hip against the mother's sacrum, which forces it into an adducted position.
Bilateral dislocation of the hip, especially at a later age, can be quite difficult to diagnose. This condition often manifests as a waddling gait with hyperlordosis.
Galeazzi- when hip and knees flexed, knees on involved hip lower

7. Case Study
Meet our patient Skyler Getchman. A baby diagnosed with hip instability in the form of developmental dysplasia of the hip (DDH).

8. Use of Orthotics
Pavlik harness Denis Browne Bar

9. Treatment
Spica Cast
Hip abduction Brace
Von Rosen Splint
Pavlik Harness: Soft positioning device worn for 1-2 months to keep the bone in the socket
Denis-Browne Bar: Thigh and hip bone contact to keep hip in a flexed and abducted position
Hip Abduction Brace: More rigid cast to keep hip in position
Closed Reduction: Doctor places hip in position and child is put in spica cast to keep hip in right position
Open Reduction- open procedure where femur is shortened and child is casted to keep proper hip positioning for healing
Von Rosen Splint- Hip must be flexed to 90 degrees & abducted to degrees
r_for_ddh/

10. Treatment cont... Closed Reduction Open Reduction
Usually done with traction
Followed by a spica cast
Open Reduction
More invasive

11. Take Home Message Needs to be addressed as early as possible
At greater risk with family hx of DDH
Early interventions include braces and casting
More invasive treatments later on
Proper treatments can prevent future OA & hip replacement

12. References
Developmental Dislocation (Dysplasia) of the Hip (DDH). American Academy of Orthopedic Surgeons Website. Updated October Accessed July 16,
Developmental Dysplasia of the Hip: Background, Anatomy, Pathophysiology. Emedicinemedscapecom Available at: overview#showall. Accessed July 19, 2016.
Developmental Dysplasia of the Hip. International Hip Dysplasia Institute Available at: Accessed July 19, 2016.
Melbourne T. Kids Health Info : Denis Browne Bar for DDH. Rchorgau Available at: Accessed July 19, 2016.
Hip Pain in a Teenaged Girl | Consultant for Pediatricians. Pediatricsconsultant360com Available at: Accessed July 19, 2016.

13. Questions?