Developmental dysplasia of the hip literature

DDH

1. DEVELOPMENTAL DYSPLASIA OF THE HIP 1

2. Definition Developmental dysplasia of the hip (DDH) is a spectrum of disorders of development of the hip that present in different forms at different ages 2

3. Definition 3

4. Epidemiology R anged from a low of 1 per 1000 to a high of 3.4 per 100. M ore common in females (6:1) M ore commonly in Native Americans  due to cultural traditions such as swaddling with hips together in extension More often in left side 4

5. Etiology 5 Ligamentous Laxity Prenatal Positioning (breech position)

6. Etiology 6 Postnatal Positioning  wrap their newborn babies in a hipextended position Racial Predilection  whites and Native Americans

7. Normal Hip Development 7

8. Patophysiology of DDH 8

9. Clinical Manifestation L imited abduction in the infant A symmetric gait , painless limp in the toddler H ip pain in adolescence O steoarthritis in the adult S hortened lower extremity O ne-sided toe-walking If the condition is bilateral  swayback appearance , walk with a waddle 9

10. Physical Examination 10

11. Physical Examination in Neonates Barlow Test 11 Ortolani Test

12. Physical Examination in Infant Limited abduction 12 Galeazzi Sign

13. Physical Examination in Infant Asymmetry 13 Klisic Sign A, With a normal hip, an imaginary line drawn between the two fingers points to the umbilicus. B, When the hip is dislocated, the trochanter is elevated, and the line projects halfway between the umbilicus and the pubis.

14. Physical Examination in Walking Child Tredelenburg Gait 14 Excessive lordosis

15. Imaging Radiograph of Pelvis 15 USG MRI Arthrography

16. Radiographic Finding Measurement of alpha and beta angles to establish Graf class 16

17. Radiographic Finding Measurement of Acetabular indeks, Hilgenreinerline line, The Wilberg center–edge angle , Shenton line, Perkin line 17

18. Classification 18

19. Treatment for neonates and 1-6 months Pavlik Harness 19

20. Treatment for 1-6 months The Ilfeld or Craig splint 20 The Von Rosen splint

21. Treatment for Child (6 Months to 2 Years Old) Traction 21

22. Treatment for Child (6 Months to 2 Years Old) Closed reduction 22

23. Treatment for Child (6 Months to 2 Years Old) Open reduction 23 I ndication : a failure to obtain a stable hip with a closed reduction Medial Approach Anterior Open Reduction Open Reduction With Femoral Shortening Open Reduction With Innominate Osteotomy

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27. Treatment for Older Child (>2 years old) Open reduction 27 2-6 years old: open reduction, pelvic osteotomy >8 years old: open reduction, femoral shortening, varus osteotomy, and, in some cases, Chiari pelvic osteotomy

28. Treatment Complication following Pelvic Harness 28 Avascular necrosis of the femoral head Femoral nerve palsy Residual hip dysplasia S kin irritation and knee subluxation

29. THANKYOU 29