Guidelines

How is DDH diagnosed?

How is DDH diagnosed?

Diagnosing DDH The examination involves gently moving your baby’s hip joints to check if there are any problems. It should not cause them any discomfort. Your baby should have an ultrasound scan of their hip between 4 and 6 weeks old if a doctor, midwife or nurse thinks their hip feels unstable.

Which is the diagnostic test for DDH in infant?

The Ortolani Test: The examiner’s hands are placed over the child’s knees with his/her thumbs on the medial thigh and the fingers placing a gentle upward stress on the lateral thigh and greater trochanter area. With slow abduction, a dislocated and reducible hip will reduce with a described palpable “clunk.”

What is the pathophysiology of DDH?

DDH involves abnormal growth of the hip. Ligamentous laxity is also believed to be associated with hip dysplasia, though this association is less clear. DDH is not part of the classic description of disorders that are associated with significant ligamentous laxity, such as Ehlers-Danlos syndrome or Marfan syndrome.

What are the two most common methods used to evaluate for DDH?

WHAT METHODS ARE USED FOR SCREENING? The Ortolani (reducing a dislocated hip) and Barlow (dislocating an unstable hip) maneuvers are the physical examination tests most commonly performed for detection of DDH in early infancy (Figure 112).

What is the Barlow and Ortolani test?

The Barlow maneuver is a test used to identify an unstable hip that can be passively dislocated. The infant is placed in a supine position with the hip flexed to 90º and in neutral rotation.

What is Barlow and Ortolani test?

Barlow test (hip started reduced): test will dislocate the hip. Ortolani test (hip started dislocated ): test will reduce the hip. These tests are done for children in the neonatal period. The hips are examined one at a time and usually the hips are flexed during these maneuvers.

What is von Rosen view?

The abduction-internal rotation view (AIR view) also known as the Von Rosen view is a radiographic projection of the hip that demonstrates the relationship between the femoral head and the acetabulum.

What is the incidence of DDH?

The incidence of DDH is variable and depends on many factors. Approximately one in 1,000 children is born with a dislocated hip, and 10 in 1,000 may have hip subluxation. Factors contributing to DDH include breech presentation, female sex, positive family history, firstborn status, and oligohydramnios.

What are the three forms of congenital hip dysplasia?

Types of Hip Dysplasia Subluxed: In resting position, the ball is not located normally in the socket. Instead, it rests partway out of the socket. Dislocatable: The hip rests in the normal position, but it can be dislocated easily. Dislocated: The hip is completely out of the socket when the child is at rest.

What is positive Barlow test?

Barlow’s Test Adduct the hip, then apply a downward pressure over the knee with your thumb. If the hip is unstable, the femoral head will slip out of the acetabulum, producing the palpable sensation of the hip dislocating. If the hip is dislocatable, then Barlow’s test is positive.

What is a positive Barlow test?

When do you need a DDH ultrasound?

If the hip feels normal but risk factors for DDH are present, CHOP orthopedists recommend that screening ultrasounds be performed at 4-6 weeks of age. Ordering ultrasounds for a child younger than 4 weeks can lead to false positive results.

What is the alpha angle of the hip?

The alpha angle is the measured angle between the line connecting the point of no sphericity of the femoral head from the center of the femoral head and the other line extending up to the center of the femoral head from the center of the femoral neck at the narrowest point. Translateral view of hip is used.

What is Shenton line?

[ shĕn′tənz ] n. A curved line formed by the top of the obturator foramen and the inner side of the neck of the femur, seen in a radiograph of the normal hip joint.

How is DDH treated?

Treatment may include a brace, a plaster cast called a hip spica, movement of the hip into position under anaesthetic, or surgery to the ligaments around the joint. Children will often need to wear a brace or cast for several months. If DDH is not treated, your child may develop a painless limp.

What is the treatment for hip dysplasia?

Hip dysplasia is often corrected by surgery. If hip dysplasia goes untreated, arthritis is likely to develop. Symptomatic hip dysplasia is likely to continue to cause symptoms until the deformity is surgically corrected. Many patients benefit from a procedure called periacetabular osteotomy or PAO.

What is the goal of arthrography in DDH?

Goal of arthrography in DDH is to demonstrate the position of the femoral head with respect to other joint structures both at rest and during reduction or stress manoeuvres It also outlines any deformities or obstructions to concentric reduction Inverted limbus, Capsular constriction, Pulvinar Hypertrophy Hypertrophied ligamentum teres 41.

What is the best way to diagnose DDH?

Klisic sign in bilateral DDH The Ortolani and Barlow manoeuvres are the mainstay of clinical diagnosis in the first months of life Even in the best hands physical examination can fail to detect DDH, and after 3 months of age the Ortolani and Barlow tests become negative due to progressive soft tissue contractures. 20.

Are teratologic hips part of the DDH spectrum?

Teratologic hip conditions are considered a different entity from DDH. They arise earlier in fetal development and are associated with other malformations. However, there is conflicting literature in whether teratologic hips are part of the DDH spectrum or not. 3DJHI

What is the classification system for DDH?

• In DDH , alpha angle decreases and beta angle increases, depending upon femoral head subluxation. • Depending upon alpha angle measurment he proposed a classification system 53. GRAF CLASSIFICATION..!! β decreased:better cartilagenous acetabulum decreased:shallow acetabulum 54. MRI • It gives excellent anatomical visualization of infant hip.