developmental

dysplasia of the
hip (DDH)
Definisi
 The term developmental dysplasia of the
hip (DDH) represents a spectrum of
conditions affecting the proximal femur
and acetabulum, ranging from
acetabular immaturity to hip subluxation
and frank hip dislocation.
Epidemiologi
 Insidensi:1 - 2 per 1000 bayi
 Perempuan> anak laki-laki
 Anak pertama
 Letak sungsang
 Lebih sering yg kiri
 Riwayat keluarga
 Kebiasaan membedong anak (geography)
Etiology multifaktorial
 Genetic:
 syndromic :
 Ehler’s Danlos
 Arthrogryposis
 Larsen’s syndrome

sex-linked
 Hormonal: oestrogen ; relaxin
 Mechanical: breech
liquor deficiency
Mechanical
 Left : Right – 4 : 1
 Breech : DDH ≥ x 10 (N.B. frank)
 Liquor ↓ : moulded baby
- plagiocephaly
- scoliosis
- foot deformity
- skew pelvis
Genetic / mechanical
Joint laxity
Acetabular and femoral version
Joint laxity
 Diagnosis
 Key physical findings :
 Asymmetry
 Limb length- Galeazzi
 Abduction ROM
 Skin folds
 Waddilng gait
Ortolani’s Maneuver
Barlow’s Maneuver
Galleazi sign
Trendelenburg sign
Tatalaksana
Dislokasi Sendi Panggul bawaan di koreksi berdasarkan
umur.
 Terapi pada bayi berusia kurang dari 6 bulan
adalah dengan memasang
 Pavlik Harness, yaitu sebuah alat berbentuk M yang
dikenalkan oleh Arnold Pavlik, ahli bedah ortopedi
berkebangsaan Ceznia, tahun 1950 . Alat ini
membantu mendorong femur masuk ke dalam
acetabulum. Alat ini umumnya dipasang selama 3
sampai 9 bulan dan tidak boleh dibuka. Orang tua
akan mengalami kesulitan dalam memandikan dan
mengganti popok karena alat ini tidak boleh dibuka.
Tingkat keberhasilan alat ini mencapai 90%.
Pelvik harness
Birth - Six months
 Pavlik harness
 Indications
 Fully reducible hip*
 Prevents hip adduction
 Child not attempting to stand
• Duration
• Childs age at hip stability + 3 months
Pavlik Harness
 Complications
 Avascular necrosis
 Forced hip abduction
 Safe zone (abd/adduction and
flexion/extension)
 Femoral nerve palsy
 Hyperflexion

*Be aware of Pavlik Harness Disease

*Follow until skeletal maturity
0-3 bulan
 Observasi , double pampers
3-9 bulan
 Abduction splint
Birth - Six months
 Closed reduction + Spica
 Failure after 3 weeks of Pavlik trial
TX Summary
 Best if treated before 6 weeks of age
 0 - 6 months of age
 Pavlik
 6 - 18 months
 Closed vs open reduction and spica
 18 - 48 months
 Closed
 Open +/- osteotomies
DDH: what influences
arthritis risk?
Age at treatment
 Quality of reduction
 Stability
 AVN
Avascular Necrosis
 Most common
 Not part of the natural history of DDH
 Iatrogenic
 Etiology unknown
 Femoral head compression
 Injury to blood supply
 Excessive abduction
 Sullivan et al 1997
 Sig  blood flow w/ increasing abd angle