جراحة العظام / علاج العظام في الاردن / افضل دكتور عظام في الاردن / افضل اخصائي عظام في الاردن / استشاري عظام/افضل استشاري عظام في الاردن /جراحة عظام / /عمليات تطويل العظام في الاردن / اطباء العظام في الاردن / دكتور طب عظام في الاردن / الاطباء في الاردن / خلع ورك / عمليات اليزاروف في الاردن /علاج الكسور /خلع الولادة / تركيب المفصل / اوجاع العظام /افضل طبيب عظام اطفال في الاردن / استشاري اطفال عظام في الاردن / /علاج خلع الورك / علاج التواء الكاحل / التواء الكاحل / علاج الام العظام / علاج هشاشة العظام / ارقام اطباء عظام في الاردن / مشاكل العظام والمفاصل /مستشار جراحة العظام والمفاصل والكسور/مستشار جراحة عظام الأطفال.

1. Freih Odeh Abu Hassan
F.R.C.S (Eng.), F.R.C.S(Tr.&Orth.)
Professor of Orthopedics and Pediatrics Orthopedics Surgery
University of Jordan

2. Developmental dysplasia
But not developmental dislocation
And not
developmental disturbances
1-
Jordan University

3. Dislocation
Subluxation
Unstable hips
Hip dysplasia
Acetabular dysplasia
Jordan University

4. Dislocation at birth
1- Neuromuscular disorders
(AMC , Spina bifida…….)
2- Sacral agenesis
3- Syndromatic, Larsen….
Jordan University

5. Jordan University

6. 2-
Jordan University

7. Suspicion from hx.
•Female
•Family hx 10 times
•First born
•First presenting part (F.Breech) 5-10 times
•Feet deformity
•Fetal anomalies
•Facial asymmetry
•Faulty gait !!!!!!!!
•Family habits

8. Family habit
Jordan University

9. Suspicion from Exam.
• Limited abduction
• Unilat. groin crease
• Short leg
Jordan University

11. 10-20% has DDH

12. Clinical Dx
-Ortolani
-Barlow
3-
Jordan University

13. Jordan University

14. •1st 3 months.
•Negative in A.D.
•Only +ve for dislocation.
•You should examine each hip alone.
Jordan University

16. Jordan University

17. -Harmful ,Done once
-Used with USS !!!!!
Jordan University

18. Crying Tense Hungry baby
4-
Child problems

19. Jordan University

20. = Hurried doctor = Little experienced = Poor understanding of the tests
Treating Doctor problems
Jordan University

21. Jordan University

22. *Business motivation !!!!! *Not before 9 weeks. *Iliac line must be vertical. *Cost !!!!!!
5-
Jordan University

23. *Needs the (Orth.) expert !!!! *Dynamic more conclusive *If you depend on it you may treat more normal hips !!!
Jordan University

24. Jordan University

25. 6-

26. X-ray at 2-3 M
• Diagnostic.
• Easy follow up.
• Cheap.
Jordan University

27. Jordan University

28. *Protective shield *Where is the O.N? *High AV angle !!!!!! *ABDIR 30, 15. *Pelvic tilt

29. Normal acetabulum
No DDH

30. Who is responsible?

31. Jordan University

33. Normal acetabulum
+ Dislocation
Not DDH
Pathological dislocation

34. Jordan University

35. +ve Pregnancy
+ve DDH

37. High anteversion *Straight neck-shaft angle *O.N Symmetrical *Disturbance of Shenton’s lines
7-
False pregnancy

39. Intoe gait
Jordan University

40. High Crescent
Jordan University

41. Jordan University

42. Full abduction doesn’t
mean no DDH.
Normal acetabulum means no DDH
Jordan University

43. 1-Von-Rosen
8-

44. 2- Pavlik Harness
Jordan University

45. 3-Double Napkins
Treats only normal hips

46. 4-Ilfeld/ Craig

47. Problems
= Can’t reduce hips
= AVN
= Long R/
= Abd. Position only
= Frequent removal
Jordan University

48. Frejeka pillow
Jordan University

49. Flexion

50. * Bad 1st look from the parents.
* Poor manufacturer.
* Doctors hate it !(Doctors problem)

51. *Simple, Safe, Easy. *Needs only orientation. *Acceptable by the parents. *Very effective. *Short duration of R/ *No need to be removed .
Jordan University

52. 1-We don’t know the Diamonds !!!
2-We don’t know how to use
the Diamonds properly?
3-We have other cheap Jewelry!!!
4-We have sensitivity to Diamonds.
Jordan University

53. * Teratologic dislocation ( CDH)
* >6m, Obese child
*Failure of reduction after 4 weeks.
* Irreducible dislocation.
Jordan University

54. 9

55. Lorenz
Jordan University

56. Human Position

58. I am sorry! I am out.
Cut the doubt by 2 cuts CT
In or Out
Jordan University

59. How long you will keep the spica ?
1- After closed reduction
6 W + 6 W
2- After open reduction
6 W
Jordan University

60. Spica Problems
1- Osteoporosis  fracture
2- Can hide unreduced hip
3- Hip stiffness
4- Pressure sore
5- Hygiene problems
6- Heavy
7- May break
Jordan University

61. The mother of the crisis
Jordan University

62. Jordan University
Dirty spica

63. Minimal injury
Jordan University

64. Don’t examine the hips After removing Spica!!
Only AP Pelvis and hips X-ray
Jordan University

65. Surgeon did inform the parents , Probably I did break his bones ! I will do X-ray next week !!!!
Surgeon’s fracture

66. Rehabilitation fracture
Avoid passive movements
R
L

67. Radiographer fracture

68. Don’t Force the reduction !!!
= False reduction = AVN = Fracture = Redislocation
10
Jordan University

69. 11
All dislocated or subluxed hips
coming for closed reduction
Jordan University

70. Jordan University

71. 12
Jordan University

72. Your child had poor incision

73. Wrong Bikini
Femoral
head

74. Femoral
head

75. 13
Time will tell !!!!!!
Follow up till maturity
Jordan University

78. = DDH is very common.
= Needs a warness in Dx.
= Wrong R/.disability.
= Would you allow this to be
done for your child?
= Pavlik harness.