Developmental Dysplasia of the Hip

(DDH, Congenital Hip Dysplasia, CHD)

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Definition

-  Abnormal development of hip joint

 

Features

-  Most common MSK abnormality in neonates

-  Incidence 7:1000 live births

-  May be unilateral or bilateral

-  Presents at birth

-  Maternal relaxin plays a role

-  Risk Factors

-  Breech presentation x10

-  Female x4 (+/- 6:1)

-  Oligohydramnios x4

-  Baby >4kg x2

-  First child x2

-  Family Hx

 

Assocaited S/S

-  Limp

-  Asymetric skin creases

-  Limb shortening &/or abduction

-  Positive Barlows or Ortolanis

 

Types

-  Stable

-  Subluxable

-  Dislocatable

-  Dislocated, reducible

-  Dislocated, irreducible

-  Teratological: restricted abduction & flexion, nil clunk

 

Ix

-  New born examination

-  Hip Exam (Ortolani & Barlow tests)

-  Hip Ultrasound

-  Between 6 weeks to 6 months

-  High false positive rate prior to 6 weeks

-  Position of femoral head to acetabulum

-  Acetabular dysplasia

-  Hip X-ray if >4 months & Dx ?

 

Mx

-  Dilocatable or dislocated hips: Abduction splint

-  If Mx from birth = normal hip joint

-  8-12 weeks

-  Flexed & abducted hip

-  Pavlik harness (24/7) or Denis Browne splint

-  +/- GAMP (hip spica)

-  Subluxable hip: observe

-  Hip ultrasound at 6 weeks OR

-  Hip X-ray at 4 months

-  Teratological hips: orthopaedic opinion for surgery

-  If not Dx until walking --> difficult to Mx

 

 

 

 

 

 

References

 

Practical Paediatrics, 6th Ed, 2006 – Roberton & South

RCH website: www.rch.org.au/kidsinfo/factsheets.cfm?doc_id=10054

Pavlik Harness picture from RCH website

Denis Brown picture from eOrthopod: www.eorthopod.com/content/rotational-deformities-in-children