This document discusses hip instability in newborns, which can result in subluxation or dislocation of the femoral head. It outlines risk factors like female gender and breech birth position. For diagnosis, tests like Barlow's and Ortolani's are used in newborns, while ultrasound is preferred over X-ray for babies under 6 months. Treatment for those under 6 months involves closed reduction and immobilization with a Pavlik harness. For older children, open reduction and hip spica casting is often used, and may require femoral or pelvic osteotomies. Complications can include loss of reduction, avascular necrosis, residual dysplasia, and osteoarthritis.
5. INSTABILITY OF HIP IN NEW BORN
• Primary acetabular dysplasia.
• Subluxation of femoral head.
• Dislocated femoral head.
• This is a developmental process.
21. TREATMENT(< 6 months)
• CLOSED REDUCTION AND IMMOBILISATION
WITH PAVLIK HARNESS SPLINT.
• Follow up weekly with USG.
• Check for reduction in each visit
• Maintain splint for 6-8 weeks and then
remove
• f/up monthly upto 6 months
• Then followup yearly upto skeletal maturity.
22.
23. What should I do if I am not able to
reduce hip????
What should I do if I am not able to
maintain reduction???
• Do an mri/arthrography.
evaluate for the causes of irreducible
dislocation…..
Open reduction and hip spica.
24. Treatment—6months to 18 months
child
• Open reduction and hip spica immobilisation
--Always try for closed reduction first even after 6
months child
--Check reduction with usg/xray/ct
--f/up after 6 weeks…remove.. check every thing
ok…then reapply spica for 6 weeks
--f/up after 12 weeks---remov a- check..ok
--Apply splint for 6 more weks
---Then f/up every year upto skeletal maturity
25.
26. 18 months to 3 years child
• Open reduction +/- osteotomies
• Osteotomies
Femoral osteotomy;
Varus derotation osteotomy
Varus extension osteotomy
shortening