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Developmental Dysplasia of the Hip Type 1

DDH1


Presentation

  • Of special value is the thorax and various conditions that exhibit that sign. presentation of variability of the condition with age.[books.google.com]
  • References: [4] Diagnostics Screening Physical examination must be performed at every well-baby visit for up to 6 months Screening with imaging is recommended up to 6 months of age only if one or more of the following risk factors are present Breech presentation[amboss.com]
  • […] displacement of the joint with some contact remaining between the articular surfaces dislocation complete displacement of the joint with no contact between the original articular surfaces teratologic hip dislocated in utero and irreducible on neonatal exam presents[orthobullets.com]
  • As noted above, breech presentation may be the most important single risk factor, with DDH reported in 2 to 27% of males and females presenting in the breech position.[uwhealthkids.org]
  • Hip dysplasia typically presents unilaterally but can also occur bilaterally.[mdedge.com]
Falling
  • If the hip is sufficiently stable and if the ball sits in the socket and doesn't fall out, the child is placed in a cast that extends from just below the nipples to the ankle on the side of the DDH, and to the knee on the other side.[ucsfbenioffchildrens.org]
Fever
  • When to call your baby's doctor Contact your baby's doctor or other health care provider if your baby develops one or more of the following symptoms: Fever Increased pain Increased swelling above or below the cast Drainage or foul odor from the cast Cool[texaschildrens.org]
Fishing
  • Fish DN, Herzenberg JE, Hensinger RN. Current practice in use of prereduction traction for congenital dislocation of the hip. J Pediatr Orthop. 1991 Mar-Apr. 11(2):149-53. [Medline]. Kaneko H, Kitoh H, Mishima K, Matsushita M, Ishiguro N.[emedicine.medscape.com]
Italian
  • Most notably, Ortolani, an Italian pediatrician in the early 1900s, evaluated, diagnosed, and began treating hip dysplasia.[emedicine.medscape.com]
Fatigue
  • The pain is worse with activity and she notices that she has fatigue and pain that extends to the thighs and knees following a soccer match. She is nontender at the pubis symphysis and has no pain with resisted abdominal crunches.[orthobullets.com]
Lordosis
  • ., abnormal gait, scoliosis, lordosis) Accelerated osteoarthritis of the hip Teratologic hip dislocation Hip dislocation occurs early in-utero (especially around the 12 th week of gestation) abnormal hip development in-utero A pseudoacetabulum is present[amboss.com]
  • In older children: Complaints of limping, waddling (bilateral DDH), lumbar lordosis, limitation of hip abduction, toewalking, wide perineum, etc… 11.[slideshare.net]
  • […] true congenital dislocation Degree of subluxation loosely correlates with incidence and timing of the development of OA Adults with bilateral complete dislocation: a false acetabulum is more likely to have poor outcomes back pain secondary to increased lordosis[orthopaedicsone.com]
  • […] placed over the greater trochanter and the index finger over the ASIS should point to the umbilicus if the hip is dislocated, the line will point halfway between the umbilicus and pubis Physical exam ( 1 year - walking child) pelvic obliquity lumbar lordosis[orthobullets.com]
  • Patients may present with excessive lumbar lordosis and a waddling gait. How do you perform a hip examination in a newborn/infant? A calm and content infant is required to perform a good hip examination. Make sure the child is not hungry.[clinicaladvisor.com]
Back Pain
  • Complications Complications of DDH Residual acetabular dysplasia, subluxation, and/or redislocation despite treatment Early osteoarthritis in the hip joint Leg length discrepancy back pain, functional scoliosis, and/or knee pain Genu valgum Complications[amboss.com]
  • pain secondary to increased lordosis is common Adults with complete unilateral dislocation flexion and adduction contractures about the hip cause genu valgum and osteoarthritis of the knee Patient History and Physical Findings History: Ask about risk[orthopaedicsone.com]
Knee Pain
  • Complications Complications of DDH Residual acetabular dysplasia, subluxation, and/or redislocation despite treatment Early osteoarthritis in the hip joint Leg length discrepancy back pain, functional scoliosis, and/or knee pain Genu valgum Complications[amboss.com]
Limited Hip Abduction
  • Unilateral posterior hip dislocation or femoral shortening represents a positive Galeazzi sign. 16 Joint laxity and limited hip abduction have also been associated with DDH. 1,10 Barlow and Ortolani exams are more specific to DDH and should be completed[mdedge.com]
Irritability
  • […] harness if it's soiled – it still should not be removed, but it can be cleaned with detergent and an old toothbrush or nail brush positioning your baby while they sleep – they should be placed on their back and not on their side how to help avoid skin irritation[nhs.uk]
  • The Pavlik harness and other positioning devices may cause skin irritation around the straps, and a difference in leg length may remain.[orthoinfo.aaos.org]
  • Two low-strength studies do suggest potential increased effectiveness of rigid versus soft bracing; 15,16 however, potential harms include incidence of skin irritation with the rigid brace, and avascular necrosis (AVN) of the femoral head with all forms[thischangedmypractice.com]
  • Do not grip firmly, this will only irritate the child and lead to muscle guarding and an unreliable examination. Stress each hip individually. Stabilize the pelvis by holding one hip and then alternate between the Barlow and Ortolani maneuvers.[clinicaladvisor.com]
Delayed Milestone
  • DDH might prevent or delay milestones, such as sitting and crawling. If left untreated, DDH can lead to walking abnormalities, a limb-length difference, early arthritis or hip pain.[gillettechildrens.org]
Neglect
  • Family structure and deprivation have increased the number of neglected cases more commonly in woman.[frontiersin.org]

Treatment

  • […] detection of treatment failure.[ijoonline.com]
  • Conservative treatment with the Pavlik harness remains the most widely used treatment for DDH in infants.[clinicaladvisor.com]
  • The short treatment duration seems ascribable to the early treatment initiation, and delayed treatment would be expected to require a longer treatment duration.[em-consulte.com]
  • Treatment of Hip Dysplasia with a Pavlik Harness. Image courtesy My Hipster Bub. Surgical Treatment If the above treatments are unsuccessful or if DDH is diagnosed late, open surgery or an open reduction is required.[revivephysio.com.au]
  • At this time, treatment is more complicated, with less predictable results. Nonsurgical Treatment Treatment methods depend on a child's age. Newborns.[orthoinfo.aaos.org]

Prognosis

  • […] age 3 months, the deformity is expected to persist without treatment; - type III: dislocation - acetabulum is shallow; - cartilaginous roof is displaced with eversion of labrum; - type IV: high dislocation - acetabular cup is flat and has the worse prognosis[wheelessonline.com]
  • In individuals for whom the diagnosis is made later, the prognosis is not as positive. These children may require more extensive surgery. After surgery, however, the prognosis for normal development of the hip and leg is excellent.[healthofchildren.com]
  • The satisfactory prognosis associated with early treatment of severe congenital dislocation of the hip joint underlines the advisability of scheduling routine hip screening programs to ensure early diagnosis and effective treatment of the disorder.[ncbi.nlm.nih.gov]
  • Prognosis If diagnosed before 6 months of age, 80-95% have normal development of the hips Later diagnosis and treatment associated with development of avascular necrosis, osteoarthritis, and functional disability in adulthood. References Ballock, R.[pedclerk.bsd.uchicago.edu]

Etiology

  • Etiology The exact etiology remains unknown but a number of risk factors have been associated with DDH Family history Breech presentation Inadequate intrauterine space for the fetus ; (e.g., oligohydramnios, first born child, twins, large birth weight[amboss.com]
  • , and hormonal factors all contributing; female predominance is 6:1. con·gen·i·tal hip dys·pla·si·a ( kŏn-jen'i-tăl hip dis-plā'zē-ă ) A developmental abnormality in which a neonate's hips easily become dislocated; etiology is complex, with mechanical[medical-dictionary.thefreedictionary.com]
  • Genetic and environmental factors in the etiology of congenital dislocation of the hip. Clin Orthop Relat Res. 1964 Mar-Apr. 33:119-28. [Medline]. Salter RB. Etiology, pathogenesis and possible prevention of congenital dislocation of the hip.[emedicine.medscape.com]
  • Etiology Generalized relaxation of the hip joint. -Family history. -Generalized ligamentous Laxity; due to maternal estrogen and other hormones “which prevents the maturation of collagen”. -Primigravida. -Breech presentation. -Oligohydramnios.[slideshare.net]
  • Etiology Multifactorial family history in 20% incidence of breech 30-50%, thought to be secondary to stretching of the hip capsule. 15% associated with congenital muscular torticollis, 1-10% associated with metatarsus adductus Majority of infants have[pedclerk.bsd.uchicago.edu]

Epidemiology

  • […] populations Low incidence in Chinese and black populations References: [1] [2] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • An epidemiological assessment of neonatal screening for dislocation of the hip. J R Coll Physicians Lond. 1986;20:56–62. 25. Jones DA. Principles of screening and congenital dislocation of the hip. Ann R Coll Surg Engl. 1994;76:245–50. 26.[aafp.org]
  • Developmental dysplasia of the hip: epidemiology and pathogenesis. UpToDate 03 Jul Rosenfeld. 2018b. Developmental dysplasia of the hip: treatment and outcome. UpToDate 03 Jul Shorter D, Hong T, Osborn DA. 2013.[babycentre.co.uk]
  • The epidemiology and demographics of hip dysplasia. ISRN Orthop 2011;2011:238607. 12. Moosa NK, Kumar PT, Mahmoodi SM. Incidence of developmental dysplasia of the hip in Dubai. Saudi Med J 2009;30:952-5. 13. Mirdad T.[thejhs.org]
  • Untreated congenital hip disease: a study of the epidemiology, natural history, and social aspects of the disease in a Navajo population. Am J Public Health Nations Health. 1965 Feb. 55(suppl):1-44. [Medline]. Bjerkreim I, Arseth PH.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • ., oligohydramnios, first born child, twins, large birth weight) Diseases associated with ligamentous laxity Teratologic hip dislocations Arthrogryposis Spina bifida Larsen's syndrome References: [3] Pathophysiology Typical DDH Children with DDH have[amboss.com]
  • […] femoral anteversion Hip may be subluxatable or dislocated (reducible or irreducible) a dysplastic hip does not necessarily need to be subluxated a subluxated hip is dysplastic by definition Subluxation invariably leads to degenerative joint disease Pathophysiology[orthopaedicsone.com]
  • […] the fetal uterus breech more commonly seen in female children, firstborn children, and pregnancies complicated by oligohydramnios higher risk of DDH with frank/single breech position compared to footling breech position family history oligohydramnios Pathophysiology[orthobullets.com]
  • It is important to understand the pathophysiology of DDH.[ijri.org]
  • In the clinical context of caring for infants, would a clinic practice model that takes into account the contributions of patient’s values, understanding pathophysiology of disease, and a physician’s clinical experience such as the one used in the 2000[uwhealthkids.org]

Prevention

  • The primary goals of treatment for Perthes disease are to alleviate pain and to prevent lasting deformity of the femoral head.[scottishritehospital.org]
  • The goal, though, is to prevent these signs from manifesting by correcting DDH in early childhood.[pedclerk.bsd.uchicago.edu]
  • Prevention Prevention includes proper prenatal care to determine the position of the baby in the womb. This may be helpful in preparing for possible breech births associated with hip problems.[healthofchildren.com]
  • Avoiding excessive and prolonged infant hip adduction may help prevent strain on the hip joints. Early diagnosis remains an important part of prevention of congenital hip dysplasia.[medical-dictionary.thefreedictionary.com]
  • Cover the cast during feedings to prevent spills from entering the cast. Prevent small toys or objects from being put inside the cast. Elevate the cast above the level of the heart to decrease swelling.[texaschildrens.org]

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