3. ETIOLOGY AND EPIDEMIOLOGY
• INCIDENCE OF DDH IS 1 IN 1000 LIVE BIRTHS.
• FEMALE TO MALE RATIO IS 4 : 1
• POSITIVE FAMILY HISTORY
• FIRSTBORN CHILD
• MORE COMMON IN LEFT HIP
• BREECH DELIEVERY
• LIGAMENTOUS LAXITY DUE TO MATERNAL HORMONE
RELAXIN
4. CLINICAL PRESENTATION AND DIAGNOSIS
IN NEWBORNS ( < 6 MONTHS OLD):
• CLINICAL EXAMINATION IN NEWBORN IS DONE WITH
POSITIVE HISTORY OF RISK FACTORS.
• DYNAMIC ULTRASOUND IS USEFUL IN DIAGNOSIS OF DDH
IN NEONATES THAN XRAY AS FEMORAL HEAD
OOSIFICATION OCCURS AT AGE 4-6 MONTHS.
5. IN NEONATES ON PHYSICAL EXAMINATION
ORTOLANI TEST IS +ve (elevation and abduction of
femur relocates a dislocated hip)
BARLOW TEST IS +Ve (adduction and depression of
femur dislocates hip)
21. RADIOGRAPHY IS USED IN INFANTS AND
WALKING AGE GROUPS FOR DIAGNOSIS
OF DDH AS OSSIFICATION OF FEMORAL
HEAD HAS COMPLETED.
22.
23.
24.
25.
26. TREATMENT:
• THE EARLIER THE BETTER.
• SPECIFIC TREATMENT DEPENDS ON CHILD AGE.
• BEST TIME FOR TREATMENT IS NEWBORN PERIOD.
• THE GOALS IN THE MANAGEMENT OF DDH ARE TO
OBTAIN A CONCENTRIC REDUCTION OF THE FEMORAL
HEAD WITHIN THE ACETABULUM TO PROVIDE THE
OPTIMAL ENVIRONMENT FOR THE NORMAL DEVELOPMNT
OF BOTH THE FEMRAL HEAD AND ACETABULUM.
• THE LATER THE DIAGNOSIS OF DDH IS MADE,MORE
DIFFICULT IS TO ACHIEVE THESE GOALS AND THE IS
LESS POTENTIAL FOR ACTETABULAR AND PROXIMAL
FEMORAL REMODELING.
27. TREATMENT 1-6 MONTHS :
• FIRST CHOICE IS PAVLIK HARNESS
BRACE.
• IT PREVENTS HIP EXTENSION AND
ADDUCTION BUT ALLOWS FLEXION
AND ABDUCTION WHICH LEAD TO
REDUCTION AND STABILIZATION.
28.
29.
30. • PAVLIK HARNESS IS WORN 23 HOURS A
DAY FOR 6 WEEKS AFTER REDUCTION,
AND FOR NIGHT ONLY FOR NEXT 6-8
WEEEKS.
• PATIENT IS FOLLOWED UP FOR EVERY
TWO WEEK INTERVAL AND STRAPS ARE
ADJUSTED TO ACCOMMODATE GROWTH.
• USG IS USED FOR FOLLOW UP TO VERIFY
POSITION OF HIP.
31. • COMPLICATIONS OF PEVLIK HARNESS INCLUDE AVN,
FEMORAL NERVE NEUROPATHY.FAILURE OF
REDUCTION.
• IF ANY COMPLICATION OCCURS DISCONTINUE
BRACE.
• CLOSE REDUCTION AND SPICA CASTING SHOULD BE
CONSIDERED
32. TREATMENT 6-18 MONTHS:
• CLOSE REDUCTION AND SPICA CAST IMMOBILIZATION
IS RECOMMENDED IN THIS AGE GROUP.
• SKIN TRACTION IS APPLIED 1 -2 WEEKS BEFORE
REDUCTION.
• PERCUTANEOUS OR OPEN ADDUCTOR TENOTOMY
CAN BE DONE FOR ADDUCTOR CONTRACTURE.
• SPICA CAST IS APPLIED WITH HIP JOINT IN 95 DEGREE
OF FLEXION AND 40-45 DEGREE OF ABDUCTION.
• SPICA CAST IS CONTINUED FOR 3-4 MONTHS.
33. • RADIOGRAPH IS USED TO ENSURE FEMORAL
HEAD IS REDUCED ANATMOMICALY IN TO
ACETABULUM.
• IF CLOSE REDUCTION FAILS OPEN REDUCTION
IS CONSIDERED.
34. TREATMENT 18 MONTHS ---3YEARS
• OPEN REDUCTION IS RECOMMENDED IN
THIS GROUP,
• ANTERIOR APPROACH (SOMERVILLE)
• MEDIAL (LUDLOFF)
• SPICA CAST IS APPLIED AFTER REDUCTION
FOR 3-4 MONTHS.
39. TREATMENT IN 3 YEARS AND ABOVE
IN THIS AGE GROUP STRUCTURAL ALTERATIONS IN
FEMORAL HEAD AND ACETABULUM HAVE OCCURRED.SO
IN ADDITION TO OPEN REDUCTION THEY NEED
• FEMORAL OSTEOTOMY(VARUS DERORATIONAL
OSTEOTOMY OF FEMUR)
• FEMORAL SHORTENING
• PEVLIC OSTEOTOMIES (SALTER ,PAMBERTON).
