DEVELOPMENTAL DYSPLASIA OF HIP

By Umer khiyam

DEFINITION
This is a spectrum of disorders ranging from dysplasia to subluxation through frank dislocation of the hip. OR In others words: developmental dysplasia (dislocation) of the hip (DDH) is an abnormal formation of the hip joint in which the ball on top of the thigh bone (femur) is not held firmly in the socket. In some instances, the ligaments of the hip may be loose and stretched.

DDH runs in families and should be ideally diagnosed right after birth. Childern have uneven gluteal folds, physical examination of hip shows that they can be easily dislocated with a jerk and a click and returned to normal with a snapping. If signs are equivocal, sonogram is diagnostic (do not order x-rays; the hip is not calcified in new born). Treatment is abduction splinting with Pavlik harnees for about 6 months.

FRONTAL RADIOGRAPH OF THE PELVIS IN A 1-YEAR-OLD CHILD WITH A DISLOCATED RIGHT HIP. THE DEGREE OF
OSSIFICATION OF THE FEMORAL HEAD ON THE DISLOCATED SIDE IS DECREASED COMPARED WITH THAT OF THE NORMALLY LOCATED LEFT HIP. THE ABNORMALLY LOCATED

HIP ARTICULATES WITH A FALSE NEOACETABULUM.

CAUSE: DDH tends to run in families it can be present in either hip and in any individual. it usually effects the left hip and is predominant in : Girls First born children Babies born in breech position

SYMPTOMS :
Some babies born with a dislocated hip will show no outward signs. Contact a pediatrician if your baby has : Legs of different lengths. Uneven skin folds on the thigh. Less mobility or flexibility on one side. Limping, toe walking, or a waddling, duck-like gait.

TREATMENT:
Treatment methods depends on the child's age. It may be: Non-surgical surgical

NON SURGICAL TREATMENT

Positioning device (e.g. Craig splint), it puts the hips in abduction. Restraining device (e.g. Pavlik harnees)

SURGICAL TREATMENT:
Open surgical techniques. Progress : Needs to be monitored by ultrasound and x-rays. In most instances,a satisfactory response is obtained. If the hip has not stabilized or the condition is diagnosed late, hip abduction using traction and further period of splinting ( in a plaster hip spica) may be tried.

If unsuccessful, an MRI or CT Scan of the hip and or / an arthrogram will provide more detail information of the joint. Weight bearing on a dislocated should be avoided as it causes damage to the femoral head and acetabulum. Open reduction and derotation femoral osteotomy will be required if conservative measures fail.

COMPLICATIONS OF TREATMENT:
Necrosis of femoral head is a potential complication of splinting so it must be done expertly. Delay in walking if the child was placed in body cast. Pavlik harness and other positioning devices may cause skin irritation, and a difference in leg length may remain. Growth disturbances of the upper thigh may rarely occur.

CLUB FOOT (TALIPES EQUINOVARUS)

CLUB FOOT (TALIPES EQUINO-VARUS)

Talipes:
Equinus:

Talus = ankle Pes = foot (Latin = horse) Foot that is in a position of planter flexion at the ankle, looks like that of the horse.

TALIPES EQUINO VARUS IS A COMPLEX ABNORMALITY.

Club foot (talipes equino varus) is seen at birth. Both feet are turned inward, and there is plantar flexion of the ankle, inversion of the foot, adduction of the forefoot, and internal rotation of the tibia.

The entire foot is inverted and supinated and the forefoot is adducted. The heel is rotated inward and plantar flexion. The affected foot is shorter and the calf muscles thinner than normal. The position is fixed and cannot be corrected completely.

EPIDEMIOLOGY It is often bilateral The birth prevalence is 0.9 per 1000 live births. Male to female ratio 2:1 Multifactorial inheritance.

ASSOCIATIONS Secondary to oligohydramnios during pregnancy. As a feature of malformation syndrome or of a neuromuscular disorder such as spina bifida. Also associated with DDH.

TREATMENT Serial plaster casts started in the neonatal period provide sequential correction starting with, The adducted foot, then the Hind foot varus, and last the Equinus

PROGNOSIS About half the patients are fully corrected this way The other half requir surgery age 6 to 8 months but before age 1 to 2 years.

THANK YOU

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