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Developmental (Congenital) Dysplasia of the Hip.Natural History and Prevention Levels.
Nicolas PadillaProfessor of Pediatrics
School of Nursing and Obstetrics of Celaya
University of Guanajuato
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Definition
• It is a lost of the relationships between hip joint components.
• Occurs in neonatal period.
• 1 of each 6 newborn have hip instability.
• Incidence of true hip dislocation is 2-5/1000 live births.
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Clasification
Typical
Teratologic
Developmental (Congenital) Dysplasia of the Hip
Dysplasia
Subluxation
Dislocation
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Prepatogenic Period.Agent
• Generalized ligamentous laxity increased by maternal estrogens and/or other hormones.
• Genetic influences.
• Multifactorial
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Prepatogenic Period.Host.
• > Female sex (5-7:1) to hip dislocation
• > Male sex to dysplasia.
• 20% of DDC associated with congenital abnormalities (congenital muscular torticolis, metatarsus adductus).
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Prepatogenic Period.Environment
• Macro environment. Incidence increased during winter in Mexico.
• Maternal environment. First-born
• Micro environment. Breech position (with the hips flexed and the knees extended).
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Primary Prevention.First Level.
Health Promotion.
• Community should know the risk factors.
• Better distribution of medical centres, especially in rural areas.
• To promote perinatal and postnatal care for health care professionals.
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Primary Prevention.First Level.
Specific Protection.
• To avoid hold the baby by the ankles.
• To avoid extraction of the newborn with traction of groins or tights.
• To avoid dressing the newborn with extension and adduction of the hips.
• Always check the hips of babies in each visit to pediatrician
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Patogenic Period.Subclinic Period.
• Dysplasia is a progressive process.
• Teratologic dislocation is accompanied by other serious malformations as neuromuscular disorder (myelodysplasia, arthrogryposis multiplex congenita).
• Subluxable hip has ligamentous laxity and it is possible to move the femoral head without dislocated.
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Patogenic Period.Subclinic Period.
• Dislocation: femoral head is out of the acetabulum in supero lateral position.
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Patogenic Period.Clinic Period.
• Barlow test
• Ortolani test
• Galeazzi
• Limitation of hip abduction
• Peter-Baden sign (Asymetry of tight folds)
• Compared transmission of the sound tests
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Patogenic Period.Complications.
• Avascular necrosis of the femoral head
• Redislocation
• Residual subluxation
• Acetabular dysplasia
• Postoperative complications (wound infections)
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Patogenic Period.Sequelae.
• Coxa vara
• Coxa plana
• Claudication
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Secondary Prevention.Third Level.
Precocious Diagnosis.
• Clinic diagnosis Clinical maneuvers
• Ultrasonographic diagnosis It is of first election in lesser of 4 months of age It is used Graf’s scale with dynamic and static test
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Secondary Prevention.Third Level.
Precocious Diagnosis.
• Radiologic diagnosis It is not useful if the head femoral is not evident. Anteroposterior and AP in abduction. Hilgenreiner line, angle of Winberg, Shenton line.
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Secondary Prevention.Third Level.
Timely Treatment.
• Pavlik harness
• Fredjka splint
• Double and triple diapers are controversial
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Secondary Prevention.Fourth Level.
Limitation of Damage.
• Treatment of complications is surgical and the patients should be treated by expert.
• Patients should be checked monthly, then each six months, until adult life.
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Tertiary Prevention.Fifth Level.
• Excercise of hips and knees
• Reducation of the gait
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References• Padilla N, Figueroa RC. Pruebas de transmision del
sonido en el diagnostico de la luxacion de cadera en el neonato. Rev Mex de Pediatr 1996;63: 265-8.
• Padilla N, Figueroa RC. Displasia congenita de la cadera. Historia natural y sus niveles de prevencion. Rev Mex de Pediatr 1991;58:337-45.
• Padilla N, Figueroa RC. Diagnostico de luxacion congenita de cadera mediante la transmision comparada del sonido. Rev Mex de Pediatr. Rev Mex de Pediatr 1992;59:149-51.