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DYSLOCATION OF
THE HIP
Introduction
Congenital hip dislocation occurs
when the connection between the
thighbone and the pelvic
bone is out of socket or dislocated.
A child may have one or both hips
dislocated.
Congenital hip dislocation is also
called developmental dysplasia of the
hip (DDH).
antero-superior position as a
consequence of the excessive
anteversion, this way becoming
progressively flat and oblique.
This occurs as a consequence of lack of
contact between the acetabulum and
the femoral head, which is generally in a
15 anteversion.
Incidence :
5-20 per 1000 live birth
Girls are much more commonly affected
than boys, the ratio about 7 : 1
The left hip is more often
In 1 in 5 cases the condition is bilateral
ETIOLOGI
Genetic factors
Wynne-Davies (1970) identified two
heritable features which could
predispose to hip instasbility :
generalize joint laxity (a dominant
trait) and shallow acetabuli (a
polygenic trait which is seen mainly in
girls and their mothers)
Hormonal factors
Oestrogen,progesteron, and relaxin
in the last few weeks of the
pregnancy may aggravate ligamentous
in the infant
Intauterine malposition
especially a breech position with
extended legs, this so called
packaging disorder is linked with
the higher incidence in first-born
babies
Ortolanis test
The babys thigh are held with the thumbs
medially and the fingers resting on the
greater trochanters,the hips are flexed
Barlows test
the thumb is placed in the
groin and by grasping the
upper thigh, to lever the
femoral head in and out of the
acetabulum during abduction
and adduction, normally in the
reduce position,if the slip out
of the socket and back in
again
dislocatable
Imaging
X-ray of infants are difficult to
interpret because the acetabulum and
femoral head are largely cartilaginous
Ultrasound scanning has largely replaced
radiography for imaging hips in the
newborn
Management
If there is any abnormality the infant is
placed in a splint with the hip flexed and
abducted
The hip that are unstable at birth,8090% will stabilize spontaneously in 2-3
weeks
Do not to start splintage immediately
unless the hip is already dislocated
Splintage
The object of splintage is to hold the
hips somewhat flexed and abducted
For the newborn,double nakins or a soft
abduction pillow may suffice
Von rosens splint is an H-shaped
malleable splint
The pavlik harness is more difficult to
apply but gives the child more freedom
while still maintaining position
Splintage
The concentrically reduced hip is held in a
plaster spica at 60o of flexion, 40o of
abduction and 20o of internal rotation
Operation
The psoas tendon is divided : obstructing
tissues ( redundant capsule,thickened
ligamentum teres).
If stability can be achieved only by markedly
internally rotating the hip
subtrochantericosteotomy