A 7 months old girl ( was brought to the vaccination clinic by her mother )
The pediatrician refers the infant to the orthopedic surgeon after he noticed asymmetric
skin folds in the upper thigh.
The infant was born with the breech presentation
taking history, physical examination ( musculoskeletal and neurological )
Palpable hip instabiulity
Unequal leg lengths
The abduction was limited on left side
Galezzi sign was positive
Developmental dysplasia of the hip
Proximal femoral focal deficiency
Residual effects of septic arthritis
PLAN: History, physical examination, Ultrasonography, plain X-ray
ELABORATION: Abduction splints, Hip Spica cast , reduction procedures
study developmental dysplasia of the hip
7th week - acetabulum and hip formed from same mesenchymal cells
11th week - complete separation between the two
Prox fem ossific nucleus - 4-7 months
Tight fit of head in acetabulum
Transection of capsule
Still difficult to dislocate
• Developmental dysplasia of the hip (DDH) is a spectrum of disorders of
development of the hip that present in different forms at different ages.
• The common etiology is excessive laxity of the hip capsule with a failure to
maintain the femoral
1/1,000 born with dislocated hip
10/10,000 born with subluxation or dysplasia
• In all cases of DDH, the socket (acetabulum) is shallow, meaning that the
ball of the thighbone (femur) cannot firmly fit into the socket. Sometimes,
the ligaments that help to hold the joint in place are stretched.The degree
of hip looseness, or instability, varies among children with DDH.
• Dislocated. In the most severe cases of DDH, the head of the femur is
completely out of the socket.
• Dislocatable. In these cases, the head of the femur lies within the
acetabulum, but can easily be pushed out of the socket during a physical
• Subluxatable. In mild cases of DDH, the head of the femur is simply loose in
the socket. During a physical examination, the bone can be moved within
the socket, but it will not dislocate.
• The cause is not clear. However, there are factors that are known to contribute to the chance of a baby
being born with DDH. Only 1 in 75 babies with a risk factor have a dislocated hip. Risk factors include:
• Family history.
• Gender.About 8 in 10 cases of DDH are female.
• Pregnancy conditions. If there is only a small amount of fluid in the womb (uterus) this is called
• Firstborn baby. About 6 in 10 cases of DDH occur in firstborn children.
• Other abnormalities. If the baby has cerebral palsy, spinal cord problems or other nerve and muscle
disorders, this increases the risk of developing DDH.
• Breech position. If an unborn baby is in the breech position (feet down position in the uterus).
• Some babies born with a dislocated hip will show no outward signs. baby
• Legs of different lengths
• Uneven skin folds on the thigh
• Less mobility or flexibility on one side
• Limping, toe walking, or a waddling, duck-like gait
Ortolani’s and Barlow’s maneuvers with a thorough history and
Warm, quiet environment with removal of diaper
Head to toe exam to detect any associated conditons (Torticollis,
Ligamentous Laxity etc.)
Baseline Neuro and Spine Exam
* After 3 months of age tests become negative
Femoral head ossification center
4 -7 months
Open vs closed reduction
>60 = normal
*line w/ ilium
bisects head 50/50
Von rosen splint
• 6 months to 2 years. If a closed reduction procedure is not successful in
putting the thighbone is proper position, open surgery is necessary. In this
procedure, an incision is made at the baby's hip that allows the surgeon to
clearly see the bones and soft tissues.
• In some cases, the thighbone will be shortened in order to properly fit the
bone into the socket. X-rays are taken during the operation to confirm that
the bones are in position. Afterwards, the child is placed in a spica cast to
maintain the proper hip position.
• Older than 2 years. In some children, the looseness worsens as the child
grows and becomes more active. Open surgery is typically necessary to
realign the hip. A spica cast is usually applied to maintain the hip in the