Contains epidemiology, Etiology, Clinical features, Examination, investigations

1. - By Vidhi (108)

2. Spontaneous dislocation of hip
before, during or shortly after
birth.
One of the most common
disorders in Western countries.
Uncommon in India due to the
culture of mother carrying the
baby on the side of her waist
with hips of the child abducted.
This helps in reduction of
unstable hip

3. Hereditary predisposition to joint laxity
Hormone induced joint laxity: 3-5 times more common in
females
Breech malposition: 10times more common
More common in first born. M:F=1:5
Types
Dislocated at birth- hereditary faulty
development of acetabulum; difficult to treat
Dislocated after birth- joint laxity,
precipitating factor causing dislocation

4. Femoral head is dislocated upwards and laterally
Acetabulum is shallow
Ligamentum theirs is hypertrophied
Capusle is stretched
Muscles undergo adaptive shortening
Femur neck antevertedinverted limbus

5. More common in first born
M:F= 1:5
20% bilateral
Caught during routine screening at birth
Assymetry of groin creases,
Limitation of movement
Click when hip is moved
Peculiar gait

6.  Barlow’s test:
1st part – Examiner faces child’s perineum , grab upper part of each thighs with his
fingers behind greater trochanter and thumb in front, knees fully flexed and hips at rt
angle, hips gently adducted. Thumb tries to push out the hip.
Abnormal posterior movement- suggests DDH
2nd part – hips at 90 degrees, fully adducted and thighs are gently abducted. Examiners
hand exerts pressure in forward direction
Clunck sound – DDH
 Ortlani’s test – second part of barlow’s
 Limitation of abduction of hip
 Assymetric tight folds

7. Higher buttock fold on affected side
Galeazzi’s sign: lowering of knee on affected side when hip
flexed at 70 degree in lying down position
 Trendelenburg’s test – opposite ASIS dips down when
child stand on affected side
Limb is short and slightly externally rotated
Telescopy test – up and down piston like movements of hip
possible on affected side
Trendelenburg’s gait- Unilateral DDH
Waddling gait- bilateral DDH
D/D : Coxa vara, posterior hip dislocation and paralytic
hip dislocation

8. Waddling Gait
Trendelenburg’s gait

9.  X ray – delayed appearance of ossification centre of head of femur
 sloping Acetabulum
 Lateral and upward displacement of ossification centre of femur head
 Break in shenton’s line
 USG - shows dislocated head on the
 posterior aspect