Developmental dysplasia of the hip (DDH) refers to a spectrum of abnormalities where the femoral head is not properly seated in the acetabulum. In newborns, DDH ranges from mild dysplasia to severe dislocation. The goals of treatment are to reduce the hip and maintain the reduction to allow for normal development of the femoral head and acetabulum. Treatment may involve use of a Pavlik harness or splint for young infants or closed or open reduction for older children. Early diagnosis and treatment are important to achieve an optimal outcome, while late or untreated DDH can lead to secondary problems like limp length inequality.
This document discusses developmental dysplasia of the hip (DDH). It defines DDH and explains how it occurs due to ligamentous laxity and breech positioning. Risk factors include female sex, family history, and oligohydramnios. DDH can present as a dysplastic, subluxated, or dislocated hip. Diagnosis is made through clinical examination and imaging like ultrasound and x-rays. Treatment depends on age and may include Pavlik harness, closed or open reduction, and hip spica casting. Complications include failure of reduction or avascular necrosis.
Developmental dysplasia of the hip (DDH) refers to a spectrum of abnormalities where the femoral head is not properly seated in the acetabulum. DDH can range from mild dysplasia to complete dislocation. Predisposing factors include breech positioning, female sex, and family history. Diagnosis involves clinical examination of the Ortolani and Barlow signs in infants as well as ultrasound and x-rays. Treatment goals are reduction and maintenance of reduction to allow joint development. For infants under 6 months, the Pavlik harness is most commonly used and aims to maintain flexion and abduction of the hip. Success rates are high if used full-time for 6 months, monitoring progress regularly with examination and ultrasound.
This document discusses developmental dysplasia of the hip (DDH). It begins with an introduction to DDH, covering the etiology, normal hip development, pathoanatomy, clinical presentation, investigations, treatment, and complications. Key points include that DDH has multifactorial causes, involves abnormalities in the femoral head's relationship to the acetabulum, and is diagnosed through physical exams and imaging tests like ultrasound and x-rays. Left untreated, DDH can lead to secondary pathological changes in hip structure and function.
Developmental dysplasia of the hip (DDH) is a spectrum of hip disorders that can include dislocation, subluxation, or dysplasia. It was previously known as congenital hip dislocation. Risk factors include breech presentation, family history, ligament laxity, female sex, and nursing position. Clinical diagnosis involves the Ortolani and Barlow tests. Ultrasound screening can identify dysplastic or dislocated hips and monitor treatment. Treatment for infants under 6 months aims to reduce the femoral head using a Pavlik harness to stimulate acetabular development. Without treatment, instability often leads to degenerative joint disease in adulthood.
This document discusses developmental dysplasia of the hip (DDH), which refers to dysplasia of the hip joint that develops during fetal life or infancy. It can range from shallow acetabulum to complete hip dislocation. DDH is more common in females and risk factors include breech presentation and family history. Treatment depends on age, with Pavlik harness used in infants under 6 months and hip spica casting for older infants and children under 2 years. The goal of treatment is to reduce the femoral head in the acetabulum and allow normal hip joint development.
Role of medical imaging in developemental dysplasia of Hip Dr muhammad Bin Zu...Dr. Muhammad Bin Zulfiqar
In this presentation we will discuss the role of medical imaging---plain Radiography, Ultrasound,Arthrography, CT and MRI in the evaluation of Developemental dysplasia of hip. Our main focuss will be on Sonographic evaluation.
The document discusses developmental dysplasia of the hip (DDH), previously known as congenital hip dislocation. It covers normal hip development, causes of DDH, diagnosis, treatment including the Pavlik harness, and prognosis. DDH can be detected in newborns through clinical exams and worsens over time without treatment. Early reduction and stabilization of the hip is important for recovery and prevention of long-term issues.
This document discusses developmental dysplasia of the hip (DDH), also known as congenital hip dysplasia. DDH ranges from shallow acetabulum to complete hip dislocation. Risk factors include breech presentation and family history. Diagnosis involves clinical tests like Barlow and Ortolani in newborns and ultrasound or x-ray in older infants. Treatment depends on age and includes Pavlik harness in newborns, closed or open reduction and casting in infants, and osteotomies if needed in older children. Complications can include avascular necrosis. Proper screening and treatment can prevent long term issues from untreated DDH.
This document discusses developmental dysplasia of the hip (DDH). It defines DDH and explains how it occurs due to ligamentous laxity and breech positioning. Risk factors include female sex, family history, and oligohydramnios. DDH can present as a dysplastic, subluxated, or dislocated hip. Diagnosis is made through clinical examination and imaging like ultrasound and x-rays. Treatment depends on age and may include Pavlik harness, closed or open reduction, and hip spica casting. Complications include failure of reduction or avascular necrosis.
Developmental dysplasia of the hip (DDH) refers to a spectrum of abnormalities where the femoral head is not properly seated in the acetabulum. DDH can range from mild dysplasia to complete dislocation. Predisposing factors include breech positioning, female sex, and family history. Diagnosis involves clinical examination of the Ortolani and Barlow signs in infants as well as ultrasound and x-rays. Treatment goals are reduction and maintenance of reduction to allow joint development. For infants under 6 months, the Pavlik harness is most commonly used and aims to maintain flexion and abduction of the hip. Success rates are high if used full-time for 6 months, monitoring progress regularly with examination and ultrasound.
This document discusses developmental dysplasia of the hip (DDH). It begins with an introduction to DDH, covering the etiology, normal hip development, pathoanatomy, clinical presentation, investigations, treatment, and complications. Key points include that DDH has multifactorial causes, involves abnormalities in the femoral head's relationship to the acetabulum, and is diagnosed through physical exams and imaging tests like ultrasound and x-rays. Left untreated, DDH can lead to secondary pathological changes in hip structure and function.
Developmental dysplasia of the hip (DDH) is a spectrum of hip disorders that can include dislocation, subluxation, or dysplasia. It was previously known as congenital hip dislocation. Risk factors include breech presentation, family history, ligament laxity, female sex, and nursing position. Clinical diagnosis involves the Ortolani and Barlow tests. Ultrasound screening can identify dysplastic or dislocated hips and monitor treatment. Treatment for infants under 6 months aims to reduce the femoral head using a Pavlik harness to stimulate acetabular development. Without treatment, instability often leads to degenerative joint disease in adulthood.
This document discusses developmental dysplasia of the hip (DDH), which refers to dysplasia of the hip joint that develops during fetal life or infancy. It can range from shallow acetabulum to complete hip dislocation. DDH is more common in females and risk factors include breech presentation and family history. Treatment depends on age, with Pavlik harness used in infants under 6 months and hip spica casting for older infants and children under 2 years. The goal of treatment is to reduce the femoral head in the acetabulum and allow normal hip joint development.
Role of medical imaging in developemental dysplasia of Hip Dr muhammad Bin Zu...Dr. Muhammad Bin Zulfiqar
In this presentation we will discuss the role of medical imaging---plain Radiography, Ultrasound,Arthrography, CT and MRI in the evaluation of Developemental dysplasia of hip. Our main focuss will be on Sonographic evaluation.
The document discusses developmental dysplasia of the hip (DDH), previously known as congenital hip dislocation. It covers normal hip development, causes of DDH, diagnosis, treatment including the Pavlik harness, and prognosis. DDH can be detected in newborns through clinical exams and worsens over time without treatment. Early reduction and stabilization of the hip is important for recovery and prevention of long-term issues.
This document discusses developmental dysplasia of the hip (DDH), also known as congenital hip dysplasia. DDH ranges from shallow acetabulum to complete hip dislocation. Risk factors include breech presentation and family history. Diagnosis involves clinical tests like Barlow and Ortolani in newborns and ultrasound or x-ray in older infants. Treatment depends on age and includes Pavlik harness in newborns, closed or open reduction and casting in infants, and osteotomies if needed in older children. Complications can include avascular necrosis. Proper screening and treatment can prevent long term issues from untreated DDH.
Developmental dysplasia of the hip (DDH) is a spectrum of disorders involving instability or displacement of the femoral head from the acetabulum. DDH includes subluxation, where some contact remains between joint surfaces, and dislocation, where there is complete displacement. DDH is caused by ligamentous laxity, prenatal positioning, and postnatal positioning in extension. Treatment depends on age, with Pavlik harness for neonates, traction or closed reduction for ages 1-6 months, and closed or open reduction from 6-24 months. The goal is early reduction to allow acetabular remodeling and prevent complications like degenerative hip disease.
Developmental dysplasia of the hip (DDH) is a condition where the hip joint is not properly formed or does not properly develop during fetal life or infancy. It ranges from shallow hip sockets to partial or complete dislocation of the hip joint. The goals of treatment are to reduce the femoral head into the acetabulum and maintain a concentric reduction to allow for normal hip development. Treatment depends on the age of presentation and severity, and may include use of a Pavlik harness, hip spica cast, closed or open surgical reduction, and osteotomies. Early diagnosis and treatment generally lead to better outcomes.
Developmental dysplasia of the hip (DDH) is a spectrum of hip disorders presenting at different ages. It results from excessive hip joint laxity causing failure to maintain the femoral head in the acetabulum. In infants, DDH can cause hip instability or dislocation detectable on examination or imaging. Over time, untreated dysplasia can lead to a poorly formed acetabulum and permanent hip dislocation. Physical exam findings vary by age but may include a positive Ortolani or Barlow sign in infants, limited hip abduction, leg length discrepancy, and Trendelenburg gait in older children.
Developmental dysplasia of the hip (DDH) is a condition where the femoral head has an abnormal relationship with the acetabulum. The document discusses the normal development of the hip joint, pathoanatomy and clinical presentation of DDH, as well as methods of diagnosis including imaging and treatment options depending on the age of presentation. Treatment in infants less than 6 months involves the Pavlik harness to obtain and maintain reduction of the hip to allow for normal development.
This document provides information on various types of splints used to treat developmental dysplasia of the hip (DDH), including:
- The Pavlik harness, which places hips in flexion and allows abduction, with indications for its use in neonates and infants up to 1 year old.
- The Ilfeld/Craig splint, which positions hips in abduction and external rotation.
- The Frejka pillow and triple diapers, which are no longer recommended due to risk of avascular necrosis.
- The von Rosen splint, which positions hips in 90 degrees flexion and 60-70 abduction with a reported 95% success rate and low risk of complications.
Quick review for Orthopedic Doctors, i present this presentation during my residency for orthopedic doctors in Nationa Guard Hospital - Al Ahsa- Saudi Arabis
Developmental dysplasia of the hip (DDH) is a spectrum of hip disorders involving abnormal development of the femoral head and acetabulum. It ranges from instability where the femoral head can subluxate to full dislocation. Risk factors include ligamentous laxity and breech positioning. Ultrasound and x-rays are used to diagnose and monitor treatment, which may involve closed or open reduction depending on age, along with bracing or casting. The goal is early concentric reduction to prevent future hip degeneration.
Paediatric MSK problems
Signs and symptoms
MSK signs and symptoms:
Limp.
Joint pain and swelling.
Remember that hip pain may be referred to the knee.
Morning stiffness.
Gelling: stiffness following period of inactivity.
Weakness and instability.
Pseudoparalysis: limb fixed in pain.
Associated systemic symptoms:
Fever
↓Feeding or growth.
Rash.
Poor sleep.
History of trauma:
Incongruous signs might suggest non-accidental injury.
Functional limitations.
Differential diagnosis
General:
First exclude trauma – which may be missed/unwitnessed (especially in young e.g. toddler's fracture) – and infection – septic arthritis, osteomyelitis, or discitis.
Consider general causes of MSK pain such as growing pains (often nocturnal), hypermobility, and complex regional pain syndrome.
Acute: irritable hip, neuroblastoma, leukaemia.
Chronic: developmental dysplasia of the hip, talipes, cerebral palsy, juvenile idiopathic arthritis (JIA).
This document summarizes a medical case of a 1 year 3 month old Thai boy who presented with a limp and leg length discrepancy. Physical examination revealed limited hip abduction on the right side. X-rays showed developmental dysplasia of the right hip. The diagnosis was confirmed with ultrasound which visualized the femoral head. The patient underwent closed reduction under anesthesia and fluoroscopy followed by application of a hip spica cast for treatment of developmental dysplasia of the hip.
Developmental dysplasia of the hip (DDH) refers to a spectrum of hip abnormalities ranging from shallowness of the hip socket to dislocation of the femoral head. It was previously known as congenital dislocation of the hip but the term developmental dysplasia is now preferred as it can develop after birth. Left untreated, DDH can cause limping, leg length discrepancies, and hip arthritis. Treatment depends on the child's age and severity of dysplasia, ranging from splinting or bracing for mild cases to osteotomy surgery for more advanced cases. Early diagnosis before walking begins is important to allow for effective nonsurgical treatment.
This document discusses developmental dysplasia of the hip (DDH), including its etiology, presentation, diagnosis and treatment. Key points include:
- DDH is a spectrum of hip disorders presenting at different ages, including subluxation, acetabular dysplasia and dislocation.
- Risk factors include ligamentous laxity, breech positioning, and postnatal positioning with hips in extension.
- Clinical diagnosis involves the Ortolani and Barlow tests for instability in infants. Imaging includes ultrasound and x-rays.
- Left untreated, DDH can progress from instability to dislocation and eventual osteoarthritis. Treatment aims to prevent this progression.
Developmental dysplasia of the hip (DDH) is a spectrum of hip disorders that can occur from conception to skeletal maturity. It most commonly affects females and risk factors include genetic predisposition, breech positioning, and hormonal influences. Clinical features include limb asymmetry and limited hip movement. Diagnosis involves clinical tests and imaging like ultrasound or X-rays. Management depends on age, with splinting often used for young infants and closed or open reduction with spica casting for older children. Complications can include limping, osteoarthritis, or avascular necrosis if left untreated.
This document discusses developmental dysplasia of the hip (DDH). It describes the signs and symptoms, risk factors, diagnosis, and treatment approaches for different age groups. For newborns under 6 months, treatment focuses on stabilization or reduction of the hip using the Pavlik harness. For infants 6-18 months, closed or open reduction is often needed if the hip is dislocated due to soft tissue contractures. Preliminary traction may help reduce risks of osteonecrosis during reduction in this age group.
This document summarizes various investigative techniques and treatments for developmental dysplasia of the hip (DDH). It discusses ultrasound, radiography, and other imaging modalities used to classify DDH severity. Treatment approaches are divided by age group, including using Pavlik harness for newborns, closed/open reduction and casting for infants, and surgery for older children if needed. The goal is to gently reduce the hip and maintain stability in a safe range of motion to prevent osteonecrosis of the femoral head.
Developmental dysplasia of the hip is a spectrum of disorders involving the hip joint. It is most common in girls and has risk factors like female gender and breech presentation. Diagnosis involves tests like Ortolani and Barlow along with imaging. Treatment goals are reduction of the hip, maintenance, and ensuring normal adult hip function. Early diagnosis and treatment lead to the best outcomes, so neonatal screening is important. A multidisciplinary approach with different treatment options based on age helps manage the condition.
Developmental dysplasia of the hip (DDH) is a spectrum of disorders involving abnormal development of the hip joint that may present as dysplasia, subluxation, or dislocation. It results from excessive laxity of the hip capsule allowing the femoral head to slip out of the acetabulum. DDH is diagnosed through clinical examination including Ortolani and Barlow's tests in infants, and imaging such as ultrasound and x-rays. Treatment depends on the degree of hip involvement and age of presentation, ranging from bracing to closed or open reduction. Screening of newborns is important for early detection and management to prevent long-term complications.
This document discusses developmental dysplasia of the hip (DDH). It begins by defining DDH and providing epidemiological data on incidence. It then covers normal hip development, risk factors, clinical presentation, imaging findings, and management approaches. For newborns, treatment focuses on stabilizing unstable hips or reducing dislocated hips using a Pavlik harness, which places the hips in flexion and abduction. The success rate of the Pavlik harness in newborns is reported to be 85-95%.
This document discusses development dysplasia of the hip (DDH), including its presentation, risk factors, diagnosis, natural history, and treatment. DDH includes a spectrum of disorders like subluxation, dislocation, and acetabular dysplasia. Risk factors include breech presentation, female sex, and family history. Clinical examination involves assessing range of motion and stability tests. Radiographs and ultrasound are used for diagnosis. Without treatment, DDH can progress to osteoarthritis, but early detection and treatment can help prevent long-term issues.
Developmental dysplasia of the hip (DDH) is a spectrum of disorders involving instability or displacement of the femoral head from the acetabulum. DDH includes subluxation, where some contact remains between joint surfaces, and dislocation, where there is complete displacement. DDH is caused by ligamentous laxity, prenatal positioning, and postnatal positioning in extension. Treatment depends on age, with Pavlik harness for neonates, traction or closed reduction for ages 1-6 months, and closed or open reduction from 6-24 months. The goal is early reduction to allow acetabular remodeling and prevent complications like degenerative hip disease.
Developmental dysplasia of the hip (DDH) is a condition where the hip joint is not properly formed or does not properly develop during fetal life or infancy. It ranges from shallow hip sockets to partial or complete dislocation of the hip joint. The goals of treatment are to reduce the femoral head into the acetabulum and maintain a concentric reduction to allow for normal hip development. Treatment depends on the age of presentation and severity, and may include use of a Pavlik harness, hip spica cast, closed or open surgical reduction, and osteotomies. Early diagnosis and treatment generally lead to better outcomes.
Developmental dysplasia of the hip (DDH) is a spectrum of hip disorders presenting at different ages. It results from excessive hip joint laxity causing failure to maintain the femoral head in the acetabulum. In infants, DDH can cause hip instability or dislocation detectable on examination or imaging. Over time, untreated dysplasia can lead to a poorly formed acetabulum and permanent hip dislocation. Physical exam findings vary by age but may include a positive Ortolani or Barlow sign in infants, limited hip abduction, leg length discrepancy, and Trendelenburg gait in older children.
Developmental dysplasia of the hip (DDH) is a condition where the femoral head has an abnormal relationship with the acetabulum. The document discusses the normal development of the hip joint, pathoanatomy and clinical presentation of DDH, as well as methods of diagnosis including imaging and treatment options depending on the age of presentation. Treatment in infants less than 6 months involves the Pavlik harness to obtain and maintain reduction of the hip to allow for normal development.
This document provides information on various types of splints used to treat developmental dysplasia of the hip (DDH), including:
- The Pavlik harness, which places hips in flexion and allows abduction, with indications for its use in neonates and infants up to 1 year old.
- The Ilfeld/Craig splint, which positions hips in abduction and external rotation.
- The Frejka pillow and triple diapers, which are no longer recommended due to risk of avascular necrosis.
- The von Rosen splint, which positions hips in 90 degrees flexion and 60-70 abduction with a reported 95% success rate and low risk of complications.
Quick review for Orthopedic Doctors, i present this presentation during my residency for orthopedic doctors in Nationa Guard Hospital - Al Ahsa- Saudi Arabis
Developmental dysplasia of the hip (DDH) is a spectrum of hip disorders involving abnormal development of the femoral head and acetabulum. It ranges from instability where the femoral head can subluxate to full dislocation. Risk factors include ligamentous laxity and breech positioning. Ultrasound and x-rays are used to diagnose and monitor treatment, which may involve closed or open reduction depending on age, along with bracing or casting. The goal is early concentric reduction to prevent future hip degeneration.
Paediatric MSK problems
Signs and symptoms
MSK signs and symptoms:
Limp.
Joint pain and swelling.
Remember that hip pain may be referred to the knee.
Morning stiffness.
Gelling: stiffness following period of inactivity.
Weakness and instability.
Pseudoparalysis: limb fixed in pain.
Associated systemic symptoms:
Fever
↓Feeding or growth.
Rash.
Poor sleep.
History of trauma:
Incongruous signs might suggest non-accidental injury.
Functional limitations.
Differential diagnosis
General:
First exclude trauma – which may be missed/unwitnessed (especially in young e.g. toddler's fracture) – and infection – septic arthritis, osteomyelitis, or discitis.
Consider general causes of MSK pain such as growing pains (often nocturnal), hypermobility, and complex regional pain syndrome.
Acute: irritable hip, neuroblastoma, leukaemia.
Chronic: developmental dysplasia of the hip, talipes, cerebral palsy, juvenile idiopathic arthritis (JIA).
This document summarizes a medical case of a 1 year 3 month old Thai boy who presented with a limp and leg length discrepancy. Physical examination revealed limited hip abduction on the right side. X-rays showed developmental dysplasia of the right hip. The diagnosis was confirmed with ultrasound which visualized the femoral head. The patient underwent closed reduction under anesthesia and fluoroscopy followed by application of a hip spica cast for treatment of developmental dysplasia of the hip.
Developmental dysplasia of the hip (DDH) refers to a spectrum of hip abnormalities ranging from shallowness of the hip socket to dislocation of the femoral head. It was previously known as congenital dislocation of the hip but the term developmental dysplasia is now preferred as it can develop after birth. Left untreated, DDH can cause limping, leg length discrepancies, and hip arthritis. Treatment depends on the child's age and severity of dysplasia, ranging from splinting or bracing for mild cases to osteotomy surgery for more advanced cases. Early diagnosis before walking begins is important to allow for effective nonsurgical treatment.
This document discusses developmental dysplasia of the hip (DDH), including its etiology, presentation, diagnosis and treatment. Key points include:
- DDH is a spectrum of hip disorders presenting at different ages, including subluxation, acetabular dysplasia and dislocation.
- Risk factors include ligamentous laxity, breech positioning, and postnatal positioning with hips in extension.
- Clinical diagnosis involves the Ortolani and Barlow tests for instability in infants. Imaging includes ultrasound and x-rays.
- Left untreated, DDH can progress from instability to dislocation and eventual osteoarthritis. Treatment aims to prevent this progression.
Developmental dysplasia of the hip (DDH) is a spectrum of hip disorders that can occur from conception to skeletal maturity. It most commonly affects females and risk factors include genetic predisposition, breech positioning, and hormonal influences. Clinical features include limb asymmetry and limited hip movement. Diagnosis involves clinical tests and imaging like ultrasound or X-rays. Management depends on age, with splinting often used for young infants and closed or open reduction with spica casting for older children. Complications can include limping, osteoarthritis, or avascular necrosis if left untreated.
This document discusses developmental dysplasia of the hip (DDH). It describes the signs and symptoms, risk factors, diagnosis, and treatment approaches for different age groups. For newborns under 6 months, treatment focuses on stabilization or reduction of the hip using the Pavlik harness. For infants 6-18 months, closed or open reduction is often needed if the hip is dislocated due to soft tissue contractures. Preliminary traction may help reduce risks of osteonecrosis during reduction in this age group.
This document summarizes various investigative techniques and treatments for developmental dysplasia of the hip (DDH). It discusses ultrasound, radiography, and other imaging modalities used to classify DDH severity. Treatment approaches are divided by age group, including using Pavlik harness for newborns, closed/open reduction and casting for infants, and surgery for older children if needed. The goal is to gently reduce the hip and maintain stability in a safe range of motion to prevent osteonecrosis of the femoral head.
Developmental dysplasia of the hip is a spectrum of disorders involving the hip joint. It is most common in girls and has risk factors like female gender and breech presentation. Diagnosis involves tests like Ortolani and Barlow along with imaging. Treatment goals are reduction of the hip, maintenance, and ensuring normal adult hip function. Early diagnosis and treatment lead to the best outcomes, so neonatal screening is important. A multidisciplinary approach with different treatment options based on age helps manage the condition.
Developmental dysplasia of the hip (DDH) is a spectrum of disorders involving abnormal development of the hip joint that may present as dysplasia, subluxation, or dislocation. It results from excessive laxity of the hip capsule allowing the femoral head to slip out of the acetabulum. DDH is diagnosed through clinical examination including Ortolani and Barlow's tests in infants, and imaging such as ultrasound and x-rays. Treatment depends on the degree of hip involvement and age of presentation, ranging from bracing to closed or open reduction. Screening of newborns is important for early detection and management to prevent long-term complications.
This document discusses developmental dysplasia of the hip (DDH). It begins by defining DDH and providing epidemiological data on incidence. It then covers normal hip development, risk factors, clinical presentation, imaging findings, and management approaches. For newborns, treatment focuses on stabilizing unstable hips or reducing dislocated hips using a Pavlik harness, which places the hips in flexion and abduction. The success rate of the Pavlik harness in newborns is reported to be 85-95%.
This document discusses development dysplasia of the hip (DDH), including its presentation, risk factors, diagnosis, natural history, and treatment. DDH includes a spectrum of disorders like subluxation, dislocation, and acetabular dysplasia. Risk factors include breech presentation, female sex, and family history. Clinical examination involves assessing range of motion and stability tests. Radiographs and ultrasound are used for diagnosis. Without treatment, DDH can progress to osteoarthritis, but early detection and treatment can help prevent long-term issues.
Developmental dysplasia of the hip is a condition where the femoral head does not properly fit into the acetabulum. It can present as hip dislocation or dysplasia. Risk factors include family history and breech presentation. Examination involves tests like Ortolani and Barlow. Treatment depends on age and severity, and may include casting, bracing, or surgery. Other congenital anomalies of the lower limbs discussed include congenital dislocation of the knee, clubfoot, and proximal femoral focal deficiency.
club-foot in children pediatric nursing.pptxaasthasubedi3
- Clubfoot is a congenital deformity where the foot is twisted out of shape. It occurs in 1-2 per 1000 live births.
- The most common type is talipes equinovarus, where the foot is pointed downward and inward.
- Treatment involves serial casting in the first few months of life to gradually correct the deformity, followed by bracing to maintain the correction. Surgery may be needed in more severe cases that do not respond to casting.
- The goal of treatment is to achieve a painless and stable foot.
Developmental dysplasia of the hip (DDH) is a partial or complete displacement of the femoral head from the acetabular cavity present since birth. Risk factors include being female, a first born, or having a family history. Clinical features in infants include positive Ortolani's and Barlow's tests, while features in older children and adults include a waddling gait, limb length discrepancy, and decreased hip range of motion. Radiographs are used to assess parameters like the acetabular index and femoral head position to diagnose and monitor DDH at various stages.
This document discusses developmental dysplasia of the hip (DDH), also known as congenital hip dysplasia. DDH ranges from shallow acetabulum to complete hip dislocation. It is more common in females and breech babies. Clinical signs include leg length discrepancy, limited hip abduction, and Trendelenberg gait. Ultrasound is the best initial imaging method, using the alpha and beta angles to assess acetabular depth and femoral head position. X-rays become more useful after age 4-7 months as ossification centers appear. Early diagnosis and treatment are important to prevent long-term complications of DDH like osteoarthritis.
Developmental dysplasia of the hip (DDH) is a condition where the ball and socket joint of the hip do not develop properly. It can affect one or both hips and is more common in females. Treatment depends on the age of the patient, ranging from hip harnesses or splints for young infants to closed or open surgical reduction for older patients. Common spinal deformities discussed include scoliosis, kyphosis, lordosis, torticollis, and flat back. Scoliosis causes an abnormal lateral curvature of the spine. Treatment involves observation, bracing, or surgery depending on the severity of the curvature. Kyphosis and lordosis refer to abnormal curvatures of the thoracic and lumbar
1. Developmental dysplasia of the hip (DDH) refers to dysplasia or dislocation of the hip joint that develops during fetal life or infancy. It can range from shallow acetabulum to partial or complete dislocation.
2. Risk factors include female sex, breech presentation, family history, and swaddling practices that restrict hip movement. Screening involves clinical examination and ultrasound of newborns and infants.
3. Treatment depends on age and severity but aims to reduce the femoral head and maintain the reduction to allow for normal hip development. Options include Pavlik harness, hip spica casting, and surgery.
1. Developmental dysplasia of the hip (DDH) refers to dysplasia or dislocation of the hip joint that develops during fetal life or infancy. It can range from shallow acetabulum to partial or complete dislocation.
2. Risk factors include female sex, breech presentation, family history, and swaddling practices that restrict hip movement. Screening involves clinical tests and ultrasound imaging to detect abnormalities.
3. Treatment depends on age and severity but generally aims to reduce the femoral head and maintain the reduction through devices like Pavlik harness or hip spica casting. Surgical intervention may be needed for older patients or failed non-surgical treatment.
1. Developmental dysplasia of the hip (DDH) refers to dysplasia or dislocation of the hip joint that develops during fetal life or infancy. It can range from shallow acetabulum to partial or complete dislocation.
2. Risk factors include female sex, breech presentation, family history, and swaddling practices that restrict hip movement. Screening involves clinical examination and ultrasound of newborns and infants.
3. Treatment depends on age and severity but aims to reduce the femoral head and maintain the reduction to allow for normal hip development. Options include Pavlik harness, hip spica casting, and surgery.
This document discusses developmental dysplasia of the hip (DDH), including its causes, types, diagnosis, and treatment approaches. DDH encompasses a spectrum of hip abnormalities from instability to dislocation. It can be syndromic, associated with other conditions, or non-syndromic. Diagnosis involves physical exams and ultrasound to assess hip stability and anatomy. Treatment depends on age and severity, ranging from harnessing like Pavlik to manage instability, to closed or open reduction surgery for older children with dislocation. The goal is stable, concentric reduction and correction of any acetabular dysplasia.
Legg-Calve-Perthes disease is a self-limiting condition affecting the femoral head in children. It presents with limp and hip or knee pain in boys aged 4-8 years. Diagnosis is made based on x-ray findings of femoral head collapse and MRI evidence of avascular necrosis. Treatment depends on age and severity but involves containment of the femoral head through casting, bracing or surgery to prevent deformity and allow remodeling. The goal is to achieve a spherical femoral head and prevent osteoarthritis.
Congenital disorders are commonly screened by pediatricians and certain disorders like club foot needs early intervention to get satisfactory results .I have tried to present common disorders in neonates for early diagnosis.
Developmental dysplasia of the hip (DDH) is a condition where the hip joint does not properly form in infants and children. It can range from mild acetabular dysplasia to full dislocation of the femoral head. Girls are more commonly affected than boys. Treatment involves devices like Pavlik harnesses or hip spica casts to position the hip correctly as the child grows. Nursing management focuses on promoting mobility, preventing injury and infection, and providing education to parents on caring for orthotic devices. Complications can include redislocation, stiffness, or avascular necrosis if left untreated.
Developmental dysplasia of the hip (DDH) refers to abnormal development of the hip joint during infancy. It ranges from mild hip instability to complete dislocation. Risk factors include breech positioning, family history, and neuromuscular disorders. Diagnosis is made through clinical examination and imaging studies like ultrasound and x-rays. Treatment depends on the severity and may include closed or open reduction and casting or bracing. Complications can include degenerative joint disease, leg length discrepancy, and back pain if left untreated.
Developmental dysplasia of the hip (DDH) is a condition where the hip joint is not properly formed or does not properly develop during fetal life or infancy. It ranges from shallow hip sockets to partial or complete dislocation of the hip joint. The goals of treatment are to reduce the femoral head into the acetabulum and maintain a concentric reduction to allow for normal hip development. Treatment depends on the age of presentation and severity, and may include use of a Pavlik harness, hip spica cast, closed or open surgical reduction, and osteotomies. Early diagnosis and treatment generally lead to better outcomes.
A 7-month-old girl was referred to an orthopedic surgeon after her pediatrician noticed asymmetric skin folds in her upper thighs during a vaccination appointment. Upon examination, the orthopedic surgeon found palpable hip instability, unequal leg lengths, and limited abduction on the left side. An ultrasound confirmed a diagnosis of developmental dysplasia of the hip. Treatment options included abduction splints, hip spica casting, or reduction procedures.
This document discusses developmental dysplasia of the hip (DDH), formerly known as congenital dislocation of the hip. DDH is a spectrum of pathology in the development of the immature hip joint, ranging from mild dysplasia to frank dislocation. Risk factors include increased joint laxity, female sex, breech presentation, tight intrauterine space, and family history. Diagnosis involves physical examination maneuvers in infants and imaging like ultrasound and x-rays in older children. Treatment depends on age, with harnesses and casting for young infants and open reduction and casting for older children. Complications can include avascular necrosis, redislocation, and residual deformities.
Grisel Syndrome is a rare condition where there is non-traumatic atlantoaxial rotatory subluxation, typically affecting children under 21 years old with a history of head and neck infection. The case report describes a 7-year old boy who presented with torticollis, cough, and odynophagia after a recent upper respiratory tract infection. Imaging showed left atlantoaxial facet anterior dislocation. He was treated conservatively with analgesics, muscle relaxants, antibiotics, and cervical collars, with clinical and radiological reduction achieved after 48 hours. Grisel Syndrome is believed to occur due to an inflammatory response spreading from head and neck infection via pharyngovertebral veins, causing irrit
This meta-analysis reviewed randomized controlled trials examining whether bisphosphonate drugs affect indirect bone healing. The analysis included 8 studies and 2508 patients. It found no statistically significant differences in short-term or long-term bone healing between bisphosphonate-treated groups and controls. A subgroup analysis found higher lumbar fusion rates at 6 months for bisphosphonate groups. While some animal studies suggest bisphosphonates may increase callus formation and delay remodeling, the dosage for treating osteoporosis in humans appears insufficient to affect healing. The timing of bisphosphonate infusion also did not impact fracture healing. However, the meta-analysis had limitations due to variability between studies and small sample sizes.
1) The initial management of open fractures, including the timing of debridement, choice of antibiotic regimen, and wound coverage, remains controversial with debate around several key issues and a lack of strong evidence to guide certain practices.
2) While early debridement and antibiotics are generally recommended, the literature does not provide clear guidance on the optimal timing of debridement or whether adding gram-negative coverage improves outcomes for Type III fractures.
3) Antibiotic regimens of short-course cephalosporins begun promptly are supported, but prolonged courses lack evidence. Routine wound cultures also do not predict infection.
Grisel Syndrome is a rare condition where there is non-traumatic atlantoaxial rotatory subluxation, typically affecting children under 21 years old with a history of head and neck infection. The case report describes a 7-year old boy who presented with torticollis, cough, and odynophagia after a recent upper respiratory tract infection. Imaging showed left atlantoaxial facet anterior dislocation. He was treated conservatively with analgesics, muscle relaxants, antibiotics, and cervical collars, with clinical and radiological reduction achieved after 48 hours. Grisel Syndrome is believed to occur due to an inflammatory response spreading from head and neck infection via pharyngovertebral veins, causing irrit
This meta-analysis reviewed randomized controlled trials examining whether bisphosphonate drugs affect indirect bone healing. The analysis included 8 studies and 2508 patients. It found no statistically significant differences in short-term or long-term bone healing between bisphosphonate-treated groups and controls. A subgroup analysis found higher lumbar fusion rates at 6 months for bisphosphonate groups. While some animal studies suggest bisphosphonates may increase callus formation, the dosage for treating osteoporosis in humans appears insufficient to affect healing. The timing of bisphosphonate infusion also did not impact fracture healing. However, limitations include variability between studies and potential for bias.
1) The initial management of open fractures, including timing of debridement, choice of antibiotics, and timing of wound coverage, involves several controversies with little consensus in the literature.
2) While early antibiotic administration and debridement are agreed upon, there is no evidence that debridement must occur within 6 hours as was once believed; many surgeons now find urgent rather than emergency debridement acceptable.
3) Timing of wound coverage is also debated, but most evidence suggests covering Type III wounds within 7 days is appropriate once tissues have stabilized and debridement is complete.
2. • CDH is old term
• Congenital means: condition existed at birth
• DDH is more representative of the wide range of
abnormalities seen in this condition
• embryonic, fetal, and infantile periods
• It includes congenital and those that are
developmental, incorporating subluxation,
dislocation, and dysplasia of the hip
3. • In the newborn, the term dysplasia refers to
any hip with a positive Ortolani sign
• Dysplasia has anatomical and radiological
definition.
Anteroposterior view at 15 years of age. Note
the bilateral anatomic dysplasia. The right hip
is radiographically dysplastic, and the left hip is
radiographically subluxated
4. • A cleft develops in the precartilaginous cells at
about the 7th week of gestation. This cleft
defines the acetabulum and the femoral head.
By the 11th week of intrauterine life, the hip
joint is fully formed
• Theoretically, the 11th week is the earliest
time at which a dislocation could develop,
although this rarely happens
5. • In normal hip at birth, the femoral head is
deeply seated in the acetabulum and held
within the confines of the acetabulum by the
surface tension of the synovial fluid
• It is extremely difficult to dislocate a normal
infant's hip, even after incising the hip joint
capsule
6.
7. • acetabular cartilage complex is a three-
dimensional structure that is triradiate
medially and cup-shaped laterally
8. w
• triradiate cartilage is a triphalangic structure. Each phalangis is composed of very cellular
hyaline cartilage
• labrum, or fibrocartilaginous edge of the acetabulum, is at the margin of the
acetabular cartilage. The hip joint capsule inserts just above the labrum
• capsule insertion is continuous with the labrum below, and with the periosteum of
the pelvic bones above
9. • In the infant the entire proximal end of
the femur is composed of cartilage
• Between the 4th and 7th months of
life, the proximal femoral ossification
center appears
• three main growth areas in the
proximal femur are the physeal plate,
the growth plate of the greater
trochanter and the femoral neck
isthmus
10.
11. • growth of the proximal femur is affected by
muscle pull, the forces transmitted across the
hip joint by weightbearing, normal joint
nutrition, circulation, and muscle tone
12. • Experimental studies and clinical findings in
humans with unreduced dislocations suggest
that the main stimulus for the concave shape
of the acetabulum is the presence of a
spherical femoral head
• Growth of the acetabular cartilage occurs by
means of interstitial growth within the
cartilage and appositional growth under the
perichondrium
13. Pathoanatomy
• tight fit between the femoral head and the
acetabulum is lost. The femoral head can be
made to glide in and out of the acetabulum
• DDH in the newborn refers to a spectrum of
anatomic abnormalities, from mild dysplastic
changes to the severe
14. • most common pathologic change in the
newborn with DDH is a hypertrophied ridge of
acetabular cartilage in the superior, posterior,
and inferior aspects of the acetabulum.
• This ridge was referred to by Ortolani as the
neolimbus
• neolimbus is composed of hypertrophied
acetabular cartilage
15. • There is empiric evidence that the pathologic
changes are reversible in the typical newborn
with DDH, because there is a 95% success rate
of treatment using simple devices such as the
Pavlik harness
16. Right acetabular cavity and femoral head of a newborn baby with bilateral
congenital hip dysplasia. There is an acetabular bulge (B) or neolimbus along the
upper acetabular cartilage, and the acetabular cavity is small. B: Frontal section
of the same hip. The femoral head is very large in relation to the acetabular
cavity. Note how the labrum is everted and adheres to the joint capsule above.
The neolimbus (B) is composed of hypertrophied acetabular cartilage.
17. Causes
• incidence of DDH as high as 25 to 50 in 1000
live births among Lapps and Native Americans
• very low rate among the southern Chinese
population and persons of African descent
• positive family history for DDH may be found
in 12% to 33%
– tenfold increase among the parents and a sevenfold increase
among siblings
18. • Intrauterine mechanical factors, such as
breech position or oligohydramnios, and
neuromuscular mechanisms such as
myelomeningocele
• first-born child (primigravida)
• high rate of association of DDH with other
intrauterine molding abnormalities, such as
torticollis and metatarsus adductus (crowding
theory)
19. • left hip
• more common among girls
• breech presentation
• Twice as many girls as boys are born breech
• Fifty-nine percent of breech presentations are
first-born children
• postnatal environment (swaddling)
20.
21. Diagnosis
• Neonates screening (ortolani)
• High-pitched soft tissue clicks are often elicited in
the hip examination of newborns. These clicks are
usually transmitted from the trochanteric region
or the knee and have no diagnostic significance
• This led to overdiagnosis
• If only “clicks” wait for one month prior to doing
an u/s as normal infant laxity with subluxation
mostly resolves.
22. • Some physicians make treatment decisions on
the basis of whether they feel that the hip is
Ortolani-positive rather than Barlow-positive, the
general opinion being that the Barlow-positive
hip is more stable and hence may stabilize
spontaneously
• Newborn clinical screening programs estimate
that 1 of every 100 newborns examined has
evidence of some hip instability (i.e., positive
Ortolani or Barlow sign), although the incidence
of true dislocation is reported to be between 1
and 1.5 cases per 1000 live births
23. • Complete irreducible dislocations are
extremely rare in newborns and are usually
associated with other generalized conditions,
such as arthrogryposis, myelodysplasia, and
other syndromes. These perinatal teratologic
dislocations are at the extreme end of the
DDH pathologic spectrum and account for
only 2%
24. Late Diagnosis
• most reliable physical finding in late-diagnosed
DDH is limitation of abduction
• opposite hip held in maximal abduction to lock
the pelvis
• Apparent femoral shortening (Galeazzi sign)
• asymmetry of the gluteal, thigh, or labial folds
• limb-length inequality
• In patients with bilateral dislocations, clinical
findings include a waddling gait and
hyperlordosis of the lumbar spine
25. • If DDH goes undetected, normal hip joint growth
and development are impaired. With increasing
age at detection and reduction, and particularly
in children older than 6 months, the obstacles
(intraarticular and extraarticular)
to concentric reduction become increasingly
difficult to overcome by simple treatment
methods such as use of the Pavlik harness, and
closed or open reduction usually must be
performed under general anesthesia
26.
27.
28. intraarticular obstacles to reduction in
late-diagnosed DDH
• ligamentum teres
• transverse acetabular ligament
• constricted anteromedial joint capsule (most
segnificant)
• rarely an inverted and hypertrophied labrum
29. Diagnostic Imaging and Radiography
• clinical examination remains the gold standard
• Ultrasonography
– Morphogenic
– Dynamic
• Its routine use in newborn nurseries has
resulted in overdiagnosis
31. • Some centers advocate the use of
ultrasonography in all Ortolani-positive infants
to assess stability at the completion of
treatment
• An ideal use for ultrasonography is for
monitoring the progress of reduction of a
subluxated or dislocated hip being treated in a
Pavlik harness
• US 7- to 10-day intervals to check the progress
of reduction of the hip and its stability during
Pavlik
32. • Other use of US is monitoring of the hip position
while the patient is in traction before attempting
reduction and evaluating closed reductions in the
operating room
• In the newborn, DDH is not a radiographic
diagnosis; the diagnosis should be made by
clinical evaluation, which may be enhanced by
ultrasonography if the examination results are
questionable
• After the newborn period (4 to 6 weeks of age),
the diagnosis of DDH should be confirmed by
radiography
33. • Because it is difficult to standardize the
radiographic positioning of infants, many
centers use positioning frames
• it is essential to notice changes in the
radiographic measurements over time, and
not to make significant decisions based on a
single radiograph.
• In late ddh (AE, shenton,
tear drop)
• CEA helpful if >5 yrs.
34. normal hip at maturity: note
intact Shenton line, well-
developed and appropriately
shaped teardrop, down-
sloping sourcil, and normal
gothic arch above the sourcil
35. • Because it is not possible to predict the
outcome of unstable hips in newborns, all
newborns with clinical hip instability, as
manifested by a positive Ortolani or Barlow
sign, should be treated
36. Course in adults
• depend of laterality and pewsence of well-
developed false acetabulum
• Worse in false acetabulum
• In unilateral complete dislocations, secondary
problems of limb-length inequality, ipsilateral
knee deformity and pain, scoliosis, and gait
disturbance are common
• Pt with subluxation presented earlier than
completely dislocated
37. Treatment
• treatment goals in DDH are the same,
regardless of the age
• first goal is to obtain reduction and maintain
that reduction to provide an optimal
environment for the development of the
femoral head and acetabulum
38. • acetabulum has the potential for development
for many years after reduction as long as the
reduction is maintained
• femoral head and femoral anteversion can
remodel if the reduction is maintained
• The later the diagnosis of DDH is made, the
less potential
• Triple diapers or abduction diapers have no
place in the treatment of DDH
39. • most commonly used device for the treatment
of DDH in the newborn is the Pavlik harness
• von Rosen splint, Frejka pillow
• before child able to stand in presence of
reducible hip
• Pavlik prevents hip axt. And adduction but
allows further abduction and flexion
• 95% resolve of hip instability if used 6/52 with
full-time basis
40. • After 6/12: 50% failure (difficult to maintain
active crawling Pt)
• failures of treatment result from problems
related to the physician, the device, or the
patient.
41. • Physician factors:
• Inappropriate application
• CIC:
– muscle imbalance, such as those with myelodysplasia or
cerebral palsy
– significant stiffness of the joints, such as children with
arthrogryposis
– excessive ligamentous laxity, as seen in Ehlers-Danlos
syndrome
• Not all pavlik are exactly the same
42. • chest strap, two shoulder straps, and two stirrups
• Each stirrup has an anteromedial flexion strap and a posterolateral
abduction strap
• applied with the child supine
• chest strap is fastened first, allowing enough room for three fingers
• shoulder straps are buckled to maintain the chest strap at the nipple line
• feet are placed in the stirrups one at a time
• hip is placed in flexion (90 to 110 degrees) and fix it by ant. straps
• lateral strap is loosely fastened to limit adduction, not to force
abduction. Excessive abduction to ensure stability is unacceptable
• knees should be 3 to 5 cm apart at full adduction in the harness
43. • US is a useful for documenting relocation of
the Ortolani-positive hip
• Used full time for 6-12/52
• Some recommend 6/52 more after stability is
reached
• Most hips stabelize in days or weeks
• Check every 7-10/7
• adjust straps for infant growth
44. • clinical examination is usually sufficient to check
on the progress at each visit; but if uncertainty is
present, US may be used
• Radiographs are unnecessary
• In a child younger than 6 months who has a
complete dislocation, Pavlik may be used in a
trial of US-monitored reduction
• Put in hyperflexion and abduction and monitor
with US in such case
• F/U 7-10/7
45. • If hip is reduced after 2-3 weeks of Pavlik’s
treatment f/u q 2weeks with serial examination
– Duration of treatment is determined by age of child at
hip stability + 3 months
– Pavlik harness worn full time for ½ the time of treatment
– At ½ mark child is taken out of Pavlik night before visit
– If clinical and radiologic / US assessment during visit
shows stability start weaning harness
46. – First third of remaining treatment period – kid out of
Pavlik for 4 hrs & if stability ok proceed
– Last third of treatment period – kid out of Pavlik for 12
hrs & if stability ok clinically and on x-ray d/c harness
47. • If not reduced by 2-3 weeks change tx – stop Pavlik
• Closed reduction under GA with spica casting if unreducable
or unreliable social situation – AT 3 MONTHS OF AGE
– GA
– If stiff in abduction – adductor tenotomy
– Arthrogram without reduction
– Arthrogram with hip in reduced : 5-7mm medal pooling
– Spica casting in “safe zone”
– CT post-op to confirm reduction
• Open reduction if stable concentric reduction cannot be
achieved by closed methods , usually in teratologic cases.
Wait untill child at least 10 months of age.
48. • Coplications
– Inferior dislocation
– Femoral n. compression (generaly improves after
removal of pavlik)
– Imp. To check quadrecips during visits.
– Brachial pluxes inj.
– Knee subluxation.
– Skin breakdown (mainly in groin)
49. • most disastrous consequence of Pavlik
harness treatment is damage to the
cartilaginous femoral head and the proximal
femoral physeal plate