DDH Developmental Dislocation of Hip
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Transcript of DDH Developmental Dislocation of Hip
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Fahad H. Al Hulaibi
Orthopedic Resident
NGH
DEVELOPMENTAL
DYSPLASIA OF THE HIP
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Abnormal relationship between acetabulum & femoral head
resulting :
Dysplasia, possible subluxation &dislocation of the hip.
DEFINITION
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most common orthopedic disorder in newborns
most common in left hips in females
bilateral in 20%
EPIDEMIOLOGY
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1st born
Female ×5
Breach presentation 3%
Large baby
+ve family history 10%
Oligohydraminous.
RISK FACTORS
Cambpell’s
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Initial instability
(maternal and fetal laxity, genetic laxity, and intrauterine and
postnatal malpositioning )
leads to dysplasia
leads to gradual dislocation
PATHOPHYSIOLOGY
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Typically:
Antero-lateral of acetabulum
In CP patient:
Posterio-superior of acetabulum
WHERE IS THE DEFICIENCY
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Torticollis in 8%
ASSOCIATED CONDITIONS
Cambpell’s
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Metatarsus adductus (10%)
ASSOCIATED CONDITIONS
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Spine anomaly
ASSOCIATED CONDITIONS
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- Vital signs
- Wight
- Height
- HC
- Head to toe examination.
- Look for associated conditions. ( neck, spine, foot)
GENERAL EXAMINATION
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Pt < 3 month
- Barlow test.
- Ortolani test.
- Galeazzi test.
Pt > 3 month
- Limitation in Abduction.
- LLD.
Pt > 1 year
- Pelvic obliquity.
- Lumbar lardosis.
- Trendelberg gait.
- Toe walking.
LOCAL EXAMINATION
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after the femoral head begins to ossify 4-5 Month
IMAGING
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<25 >25
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useful before femoral head ossification (<4 -6 mos)
ULTRASOUND
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> 60
< 55
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alpha angle
angle created by lines along the bony acetabulum and the ilium
normal is greater than 60°
beta angle
angle created by lines along the labrum and the ilium
normal is less than 55
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ARTHROGRAM
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Inverted labrum
Inverted limbus
Transverse acetabular ligament
Pulvinar
Thick ligamentous teres
Iliopsoas tendon contracture.
OBSTACLES THAT BLOCK REDUCTION
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after reduction and hip spica
CT SCAN
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Treatment
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< 6 months & reducible hip
Success rate up to 95% ( C a m b p e l l )
PAVLIK HARNESS
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Complication of pavlic harness: < 1%
1. AVN.
In extreme abduction
2. femoral nerve palsy
In hyper flexion
( C a m b p e l l )
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When to say It’s failed Pavlic harness ?
3 to 4 weeks with no improvement
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Pavlic harness failed
Patient 6-18 months
CLOSED REDUCTION, HIP ARTHROGRAM,
ADDUCTOR TENOTOMY + HIP SPICA
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DDH > 2 yr with residual hip dysplasia
failure of closed reduction
Increased Acetabular index.
OPEN REDUCTION, PELVIC OSTEOTOMY
+_ FEMORAL SHORTENING
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Femoral anteversion
Coxa valga
FEMORAL SHORTENING
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PELVIC OSTEOTOMIES
Ost Age Coverage correction Hinge Contraindications
Salter 1-9 years Supero-
lateral
10-15 Symphysis • Posterior wall
deficiency
• Neurogenic hips
Pember-
Dega
18 mth All 10-40 Triradiate Coxa Magna
Double-
triple
8-15
years
Supero-
lateral
10-50 Symphysis
Open triradiate
Ganz Closed
triradiate
All 10-60
Most
Separate Open triradiate
Shelf Closed
triradiate
All - - Open triradiate
Chiari Closed
triradiate
All - - Open triradiate
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COMPLICATIONS
Redislocation
Residual dysplasia
Lateralization
Stiffness
Impengement
Early OA
AVN
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THANK YOU