developmental dysplasia of the hip (DDH)

genetically determined hip dysplasia includes defective _____ ?

development of acetabulum and femur

DDH includes ? (3)

hips that are malformed, unstable, subluxated, dislocated

(pathology) the primary disturbance in DDH is ?

loss of femoral head congruency within the acetabulum , resulting in abnormal development of the femoral head and acetabular concavity

describe DDH in neonatal (2)

may be sufficient ligamentous laxity that the hip spontaneously dislocates and reduces, new born my dislocate and reduce the hip with kicking movements,

incidence and sex of DDH

1.5 of every 1000 live births, 6 times more common in female infants, bilateral in 30 percent of cases

in neonatal, if the hip spontaneously resolves within a few days, the subsequent development is usually ____?

normal

normal development of the hip requires ? (2)

normal positional relationship between the femoral head and the acetabulum, intimate dynamic relationship between the spherical femoral head in the reciprocal acetabulum

2 years or more management ?

open reduction, increase / decrease femoral shortening / pelvic osteotomy

clinical manifestations of DDH ? (5)

painless clicking of hip, asymmetrical buttocks folds, limb shortening, hip click, uneven skin folds

genetic laxity of ligaments may be present in ______ and leads to ____ ?

parents, joint instability

investigations of DDH ? (2)

radiology (x-ray), mri (rare cases if they suspect neurovascular compromise / avascular necrosis)

6 months - 2 years management

reduceable = closed reduction spica cast . irreducable = open reduction = medial <1yr, anterolateral >1yr

hormonal laxity of the ligaments caused by ______ and has an increased ______ ?

relaxin released to foetal uterus, incidence in females

what is developmental dysplasia of the hip ?

spectrum of anatomical abnormalities of the hip joint in which the femoral head has an abnormal relationship with the acetabulum

management of neonate ?

subluxation / dislocation, orthosis

1-6 months management ?

subluxation = orthosis. dislocation = redactable = orthosis. dislocation = non redactable = abduction splint or closed reduction and hip spica

what is a subluxation vs a dislocation ?

subluxation is an incomplete dislocation with some residual contact between the femoral head and acetabulum, dislocation is a complete loss of contact

laxity of ligaments DDH tends to be ______ ? (2)

unilateral, more correctable

what does a malformation include ?

any abnormality in the development of the femur or acetabulum

DDH assessment ?

barlows manoeuvre - manually dislocate and reduce the abnormal hip with infant in supine position with both knees flexed

dysplasia of the femur and acetabulum tends to be _______ (2)

bilateral, more difficult to correct

environmental factors contributing to hip dysplasia ? (3)

foetal size, tight uterus, breech position

ligamentous laxity can be caused by ? (2)

genetically determined, hormonal laxity

dysplasia of the femur and acetabulum can be caused by ? (2)

genetics, environmental factors

name the 2 most common types of DDH

laxity of ligaments, dysplasia of femur and acetabulum (malformation)