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Orthopedics 5th year, 1st & 2nd lectures (Dr. Bakhtyar)
Orthopedics 5th year, 1st & 2nd lectures (Dr. Bakhtyar)
Orthopedics 5th year, 1st & 2nd lectures (Dr. Bakhtyar)
Orthopedics 5th year, 1st & 2nd lectures (Dr. Bakhtyar)
Orthopedics 5th year, 1st & 2nd lectures (Dr. Bakhtyar)
Orthopedics 5th year, 1st & 2nd lectures (Dr. Bakhtyar)
Orthopedics 5th year, 1st & 2nd lectures (Dr. Bakhtyar)
Orthopedics 5th year, 1st & 2nd lectures (Dr. Bakhtyar)
Orthopedics 5th year, 1st & 2nd lectures (Dr. Bakhtyar)
Orthopedics 5th year, 1st & 2nd lectures (Dr. Bakhtyar)
Orthopedics 5th year, 1st & 2nd lectures (Dr. Bakhtyar)
Orthopedics 5th year, 1st & 2nd lectures (Dr. Bakhtyar)
Orthopedics 5th year, 1st & 2nd lectures (Dr. Bakhtyar)
Orthopedics 5th year, 1st & 2nd lectures (Dr. Bakhtyar)
Orthopedics 5th year, 1st & 2nd lectures (Dr. Bakhtyar)
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Orthopedics 5th year, 1st & 2nd lectures (Dr. Bakhtyar)

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The lecture has been given on Oct. 6th - Dec. 18th, 2010 by Dr. Bakhtyar.

The lecture has been given on Oct. 6th - Dec. 18th, 2010 by Dr. Bakhtyar.

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  • 1. D.D.H (Developmental Dysplasia of the Hip)
  • 2.  
  • 3.
    • Anatomy of the hip
  • 4.
    • DDH includes :
    • 1- Dislocation
    • 2- Subluxation
    • 3- Acetabular dysplasia
  • 5.
    • Incidence
    • Instability 5-20 per 1000 livebirths
    • After 3 weeks 1-2 per 1000 infants
    • ( i.e spontaneous correction)
    • Girls ⁄ Boys 7 ⁄ 1
    • Left > Right
    • 20% bilateral
  • 6.
    • Aetiology
    • 1- Genetic factors( families, even in entire population)
    • 2- Hormonal changes in late pregnancy-> lig. laxity
    • 3- Intrauterine malposition( breech + extended legs)
    • 4- Postnatal factors( swaddling+ Beshka)
  • 7.
    • Pathology
    • Acetabulum (1) Shallow(looks like a saucer instead of a cup)
    • (2) The roof slopes too steeply
    • (3) Anteverted
    • Femoral head (1) Dislocated(post. and sup.)
    • (2) Delayed ossific center
    • Femoral neck : Unduly anteverted
    • Capsule : (1) Stretched
    • (2) ± hourglass by iliopsoas
    • Limbus : Superiorly the acetabular labrum and its capsular edge may be
    • pushed into the socket by the dislocated femoral head . This
    • fibrocartilagenous structure may obstruct closed reduction.
    • Lig. Teres : (1) Elongated
    • (2) Hypertrophied
  • 8.
    • Clinical features
    • Neonate : (1) Ortolani’s test +ve
    • (2) Barlow’s test +ve
  • 9.
    • Late features
    • Unilateral DDH
    • (1)Asymmetrical skin creases
    • (2) Difficulty in applying napkins( ↓ abduction)
    • (3) Shorter leg
    • (4) Delayed walking
    • (5) Limping
    • (B) Bilateral DDH
    • (1) ↓abduction
    • (2) Delayed walking
    • (3) Waddling gait
    • (4) Wide perineal gap
  • 10.
    • X- Ray
    • Acetabulum : Shallow and sloping
    • (Acetabular roof angle normally< 30)
    • (B)Femoral head : Underdeveloped and out
    • Perkin’s lines = Vertical line at the outer edge of acetabulum
    • Hilgenreiner’ line = Horizontal line through the triradiate cartilages.
    • Normally the head is medial to vertical
    • and below the horizontal
  • 11. ( C) Shenton’line is broken (Inferior border of superior ramus and inferior border of the neck) (D) Von Rozen line = Hips abducted 45 Femoral shaft should point into the acetabulum
  • 12.
    • Treatment
    • 0-6 months
    • 6 m – 6 years
    • > 6years
    • 0-6 months
    • +ve Ortolani
    • +ve Barlow
    • +ve US
    • Double napkins OR Abduction pillow for 6 weeks
    • Stable hip = follow-up for 6 months
    • Persistent instability = Splint for 3-6 months (Pavlic harness)
  • 13.
    • Principles
      • Reduction before applying it
      • 100 flexion + slight abduction
      • Extreme positions are avoided( Frog position is only for frogs)
      • Some movement is allowed
  • 14.
    • 6monthes- 6 years
    • Reduce + hold reduced
    • Closed reduction
    • Gradual abduction 3 weeks
    • Hip spica 6weeks followed by few months Splint which prevents adduction
    • ( 60 flexion
    • 40 abduction
    • 20 internal rotation )
    • Open reduction if closed reduction failed
    • + hip spica 3 months
  • 15.
    • 6years
    • Unilateral up to 10 years surgery
    • Bilateral = No treatment
    • 1- Symmetrical deformity
    • 2- Less noticeable
    • 3- Failure in one side leads to asymmetrical deformity
    • 4- In future THR

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