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Questions and Answers
What age range is typically associated with the appearance of the femoral head in imaging?
What is a characteristic of Graf's alpha angle when it is greater than 60°?
Which factor is NOT a consideration for treatment options in developmental dysplasia of the hip?
What is the primary purpose of the Pavlik harness?
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Which imaging method was introduced in 1978 for early evaluation of hip dysplasia?
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What is the recommended duration for the use of a Pavlik harness?
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What complication is associated with a Pavlik harness due to forced hip abduction?
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At what age is closed reduction indicated after a failed Pavlik trial?
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What position should the spica cast be in after closed reduction?
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What is a potential intervention if concentric reduction is not achieved?
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What is the preferred term for developmental dysplasia of the hip?
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Which of the following is not an intraarticular soft tissue change associated with developmental dysplasia of the hip?
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How does prolonged subluxation or dislocation affect soft tissue changes?
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Which condition is not considered a risk factor for developmental dysplasia of the hip?
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What maneuver is typically ineffective after three months of age in diagnosing hip dysplasia?
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Which of the following factors is a teratogenic influence that may impact hip development?
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What is the primary method of screening newborns for developmental dysplasia of the hip?
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Which condition is associated with increased risk of undervaluation of hip dysplasia in children?
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What is a common soft tissue obstacle to reduction in developmental dysplasia of the hip?
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In assessing hip abnormalities, which is not a key physical finding during examination?
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Study Notes
Developmental Dysplasia of the Hip (DDH)
- Commonly referred to as DDH, includes teratogenic hips, subluxation, and dislocation.
- Dislocation often occurs posterosuperior; classified into reducible and irreducible.
- Range of dysplasia severity stretches from mild forms to frank dislocation.
Pathoanatomy
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Bony Changes:
- Shallow acetabulum typically on the acetabular side.
- Femoral anteversion may be present.
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Soft Tissue Changes:
- Result from prolonged subluxation or dislocation.
- Intraarticular changes include inverted labrum, hypertrophied ligamentum teres, and fibrofatty pulvinar in the acetabulum.
- Extraarticular soft tissue changes include tight adductors (e.g., adductor longus) and iliopsoas muscle dysfunction.
Obstacles to Reduction
- Extraarticular obstacles influenced by tight iliopsoas and adductors.
- Intraarticular obstacles consist of labrum, ligamentum teres, transverse acetabular ligament, pulvinar, redundant capsule, and possibly limbus.
Etiology and Epidemiology
- Multifactorial causes including genetic syndromes (Ehler’s Danlos, Arthrogryposis, Larsen’s syndrome), intrauterine factors (teratogens, oligohydramnios positioning), and neurologic disorders (e.g., spina bifida).
- Occurrence rate is approximately 1 in 1,000 births with dislocated hips; 80% are female.
Risk Factors
- Being a first-born child.
- Family history and intermarriage.
- Associated conditions like oligohydramnios and vertebral deformities (torticollis).
Diagnosis
- Conduct newborn screening using Ortolani’s and Barlow’s maneuvers in a calm, warm environment.
- Comprehensive head-to-toe physical exam to identify associated conditions (e.g., torticollis).
- Neurological and spinal examinations are important for baseline assessment.
Key Physical Findings
- Asymmetry in limb length (Galeazzi test) and hip abduction range of motion.
- Presence of skin folds, limp, waddling gait, or hyperlordosis may indicate bilateral involvement.
Imaging
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Ultrasound:
- Introduced in 1978; Graf's technique is operator-independent, effective for confirming dysplasia.
- Assesses reducibility and cartilaginous acetabulum issues.
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Radiographic Evaluation:
- Femoral head ossifies between 4 to 7 months; Shenton's line and acetabular index significant in assessments.
Treatment Options
- Dependent on patient age, family factors, reducibility, and degree of acetabular dysplasia.
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Birth to Six Months:
- Pavlik harness is the primary treatment; allows for free movement while safely positioning the hip.
- Regular follow-ups for adjustments are necessary; treatment duration is patient age at stability plus three months.
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Complications of Pavlik Harness:
- Avascular necrosis due to forced hip abduction and potential femoral nerve palsy from hyperflexion.
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> Six Months:
- Closed reduction with spica cast if no improvement within three weeks of Pavlik harness usage.
- Possible open reduction if closed methods fail, especially in teratogenic hip cases.
Summary of Treatment Ages
- Optimal treatment before six weeks.
- For ages 0-6 months, use Pavlik harness.
- For ages 6-18 months, consider closed or open reduction and spica immobilization.
- For ages 18-48 months, approach involves closed techniques, open procedures, and possible osteotomies.
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Description
This quiz covers key concepts related to Developmental Dysplasia of the Hip (DDH), including its pathoanatomy, teratogenic hips, and various forms of dislocation. It is designed for students and professionals in orthopedics and traumatology to test their understanding of this condition.
