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Developmental dysplasia of thehip
(DDH)
M O H A M M E D R J O U B
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Developmentaldysplasia of the hip
Definition
It is a congenital or acquired deformation ormisalignment of the hip joint; at birth, the hips are
usually not dislocated but rather dislocatable. Classification
1. Typical.
2. Teratologic.
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Developmental Dysplasia of the Hip
Types:
1. Complete hip dislocation.
2. Partial hip subluxation.
3. Hip dysplasia (incomplete development). Incidence:
- 7 per 1000 in Jordan
-Female predominance9 times more likely.-Depends on race and geographical variations.
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Etiology
Generalized relaxation of the hip joint.
-Family history.
-Generalized ligamentous Laxity; due to maternal
estrogen and other hormones which prevents thematuration of collagen.
-Primigravida.
-Breech presentation.
-Oligohydramnios.
-Adduction and Extension postnatally.
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Clinical Manifestations
Girls are affected 5 times more than boys.
The left hip is affected in 45%, right one 20% and35% of the cases are bilateral.
2 facts about DDH: 1-not all hip dislocation are present at birth. But
they all occur before the age of 3 months
2-newborns have hypotonic muscles in the 1st6wks till 3 m so not all cases of DDH can be diagnosedat that time.
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To diagnose DDH we have many method:
1) Barlow test.
It is a provocative test that attempts to dislocate an
unstable hip.- Flexion ,adduction, posteriorly.
- Click
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2) Ortolani test
It is a maneuver to reduce a recently dislocated hip.
- Flexion, abduction, anteriorly.
- 3) X-rays.- 4)US
- 5)Galeazzis sign
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Clinical Manifestations
In newborn:
We can diagnose DDH in this period by +veOrtolani test.
Asymmetry of the skin fold may help, but its notspecific.
Shortening of the limb at this age doesnt exist.
We cant use X-rays because the acetabulum and
proximal femur are cartilaginous and wont beshown on X-ray.
US is the best method to Dx.
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In the intermediate age (after 3 months):
The most diagnostic sign is Ortolanis limitation ofabduction.
Abduction less than 60 degrees is almost diagnostic. Shortening of the limb is more obvious
now.(Galeazzis test)
X-rays after the age of 3 can be helpful esp. after theappearance of the ossific nucleus of the femoral head
US is 100% diagnostic.
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In older children:
Complaints of limping, waddling (bilateral DDH),lumbar lordosis, limitation of hip abduction, toe-
walking, wide perineum, etc
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X-ray
von rosen view:
hips abducted 45 &medially rotated.
Anteroposterior.
We draw a line through the central axis of thefemoral shaft.
in normal hip ( ossific nucleus )will be inside theacetabulum.
in dislocated hip it will be above acetabulum.
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X-ray
Horizontal line of Hilgenreiner:
drawn between upper ends of tri-radiate cartilage ofthe acetabulum.
Vertical line of perkins:
drawn from the lateral edge of the acetabulumvertical to horizontal line.
4 quadrants:
Normal hip: the ossification center of the femoral hiplower medial quadrant.
Dislocated hip: upper lateral quadrant.
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X-ray
Acetabular index:
angle between horizontal line of hilgenreiner andthe line between the two edges of the acetabulum.
normal hip 2030dilocated or dysplastic hip 30
Shentonsline:
semicircle between femoral neck and upper arm of
obturator foramen, in dislocated hip this line isbroken.
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Treatment
The earlier the better.
Best time for treatment is in newborn period.
It depends on the device and age of the patient.
Goal is to:1.Flex and abduct hips.
2.Reduce femoral head and maintaining it.
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Treatment
From (1-6 months) use Pavlik Harness.
From 6 months -1 year use hip spika.
From the age of 1 year to 3 years:
traction , adductor tenotomy , surgical closedreduction, salter innominate osteotomy.
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Thank You
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