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)