2 – Congenital dislocation of the hip: Difference between revisions

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(Created page with " ==== 7. DDH (developmental dysplasia of the hip), etiology and pathology of ==== * DDH is the most common congenital musculoskeletal deformity ** Affects approx. 2 out of 100 000 newborns in Europe * Left hip is slightly more often affected than the right ** Bilateral DDH is rare * Etiology ** Girls > boys ** Breech position during delivery *** Causes abnormal flexion of the hip ** Firstborn children > later-born children ** Family history ** Oligohydramnios * Patholog...")
 
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== 7. DDH (developmental dysplasia of the hip), etiology and pathology of ==
==== 7. DDH (developmental dysplasia of the hip), etiology and pathology of ====
 
* DDH is the most common congenital musculoskeletal deformity
* DDH is the most common congenital musculoskeletal deformity
** Affects approx. 2 out of 100 000 newborns in Europe
** Affects approx. 2 out of 100 000 newborns in Europe
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**** This makes it difficult to reduce the head of the femur through the narrowed opening
**** This makes it difficult to reduce the head of the femur through the narrowed opening


==== 38. DDH, clinical and X-ray features of ====
== 38. DDH, clinical and X-ray features of ==
 
* Clinical features
* Clinical features
** Limited motion of the limb
** Limited motion of the limb
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*** Femoral head is lateral to the Perkin line
*** Femoral head is lateral to the Perkin line


==== 41. Conservative treatment of DDH ====
== 41. Conservative treatment of DDH ==
 
* If patient is < 6 months
* If patient is < 6 months
* Baby must use a so-called Pavlik harness or an abduction splint, which secures the baby’s hips in a stable “frog-leg” position, allowing them to develop normally
* Baby must use a so-called Pavlik harness or an abduction splint, which secures the baby’s hips in a stable “frog-leg” position, allowing them to develop normally
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* Has high success rate when used correctly
* Has high success rate when used correctly


==== 52. Surgical treatment of DDH (developmental dysplasia of the hip) ====
== 52. Surgical treatment of DDH (developmental dysplasia of the hip) ==
 
* If patient is already > 6 months old OR conservative treatment didn’t work
* If patient is already > 6 months old OR conservative treatment didn’t work
* The specific surgical treatment depends on the exact pathology, but it always involves open reduction of the joint
* The specific surgical treatment depends on the exact pathology, but it always involves open reduction of the joint

Latest revision as of 11:01, 27 August 2024

7. DDH (developmental dysplasia of the hip), etiology and pathology of

  • DDH is the most common congenital musculoskeletal deformity
    • Affects approx. 2 out of 100 000 newborns in Europe
  • Left hip is slightly more often affected than the right
    • Bilateral DDH is rare
  • Etiology
    • Girls > boys
    • Breech position during delivery
      • Causes abnormal flexion of the hip
    • Firstborn children > later-born children
    • Family history
    • Oligohydramnios
  • Pathology
    • The acetabulum is dysplastic and shallow
      • Normally the acetabulum contains 2/3 of the femoral head
      • In DDH the acetabulum contains less than 2/3
      • This increases the pressure on the surface of the hip
    • Subluxation / dislocation of the femoral head
      • Due to the shallow acetabulum
  • Secondary changes
    • Occurs in untreated DDH -> secondary changes develop in the femoral head and acetabulum
    • These secondary changes make hip reduction more and more difficult
    • Bony changes
      • Delayed ossification of femoral head
      • Increased femoral antetorsion
        • = the shaft of the femur has a torsion, causing the femoral neck to rotate anteriorly
        • This increases the angle between the femoral neck and the condylar axis
      • Increased collodiaphyseal angle
      • Coxa valga
        • Due to increased collodiaphysal angle
    • Soft tissue
      • Loose capsule
      • Abnormal position of iliopsoas
        • The iliopsoas normally runs in front of the head of the femur
        • In DDH the tendon of the iliopsoas comes between the cavity of the acetabulum and the head of the femur
        • This makes it difficult to reduce the head of the femur through the narrowed opening

38. DDH, clinical and X-ray features of

  • Clinical features
    • Limited motion of the limb
      • Especially abduction (adduction contracture)
    • Asymmetric skin folds on the thigh and gluteal region
    • Positive Barlow sign
      • A click is heard and felt when pressure is applied to dislocate the hip
      • This test shows that the hip can be dislocated, but is not currently dislocated
    • Positive Ortolani sign
      • A click is heard and felt when pressure is applied to reduce the hip
      • This test shows that the hip is reduceable and therefore currently dislocated
      • Positive Ortolani sign is the only definitive sign of DDH
    • Late
      • Limb length difference
      • Trendelenburg gait
  • Diagnosis
    • Screening at birth, 3 weeks, 3 months, 6 months
      • Only in those with risk factors or if there is clinical suspicion
      • US or X-ray
    • Ultrasound
      • Used for infants < 4 months
      • Can detect clinically silent DDH
    • X-ray
      • Used for infants > 4 months
      • In AP and Lauenstein view
      • Shows acetabular dysplasia and hip location
      • Femoral head is above the Hilgenreiner line
      • Femoral head is lateral to the Perkin line

41. Conservative treatment of DDH

  • If patient is < 6 months
  • Baby must use a so-called Pavlik harness or an abduction splint, which secures the baby’s hips in a stable “frog-leg” position, allowing them to develop normally
    • Pavlik harness fixes the femoral head in the correct position
    • Over the time acetabulum will be deepened
    • Abnormal use of the Pavlik harness can cause osteonecrosis of the femoral head
  • Pavlik harness rapidly becomes ineffective after 4 months of age -> abduction splint or plaster cast
  • Has high success rate when used correctly

52. Surgical treatment of DDH (developmental dysplasia of the hip)

  • If patient is already > 6 months old OR conservative treatment didn’t work
  • The specific surgical treatment depends on the exact pathology, but it always involves open reduction of the joint
  • Other procedures which may be necessary
    • Soft tissue procedures
      • Adductor and/or iliopsoas muscles may need operation because they adapt to the dislocated joint, causing contracture
    • Femur osteotomy (= varus de-rotational osteotomy)
      • Corrects collodiaphyseal angle and antetorsion
    • Pelvic osteotomy (= acetabulum-plasty)
      • Dega osteotomy
        • Done when socket is too wide and too shallow
      • Salter osteotomy
        • Done when the socket doesn’t sit properly on the femoral head
  • Patient must wear spica cast afterwards