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.

1. HIP
INSTABILITY IN
NEWBORN
Dr Kishore. V Ms(ortho)
Senior Resident ,
Depa. Of orthopaedics,
s.v medical college.

2. WHICH IS THE MOST COMMON JOINT TO
DISLOCATE???
• Why???

4. Any difference???

5. INSTABILITY OF HIP IN NEW BORN
• Primary acetabular dysplasia.
• Subluxation of femoral head.
• Dislocated femoral head.
• This is a developmental process.

7. classification
• Primary hip dysplasia (idiopathic)---CDH/ DDH.
• Secondary hip dysplasia
Neurological; cerebral palsy,
myelomeningocele.
CTD’S : Ehlers danlos syndrome.
Myopathic: AMC (arthrogryposis
multiplex congenita)

8. WHY DID THIS HAPPEN??
• RISK FACTORS:
Female gender
First born
Foot first / breech
Family history
Fluid less(oligohydromnios)
.

9. COMBO
• ASSOCIATED CONDITIONS:
• Torticollis,
• metatarsus adductus,
• club foot,
• cong knee dislocations

10. What happens if I miss the case….

11. NATURAL HISTORY
• Acetabular changes:
Delayed ossification.
Shallow acetabulum
Anteverted limbus
Excess fat in acetabulum.
Streched ligamentum teres.
False acetabulum
Progressive ARTHRITIS

12. NATURAL HISTORY
• Femur changes:
-Delayed femoral head ossification.
- Exaggerated femoral anteversion
- AVN

13. HOW DO I KNOW IT??
• NEW BORN:
Tests: Barlow’s test
Ortolani’s test
Positive upto three months

16. DIAGNOSIS
• <6 MONTHS : Widened perineum.
Asymmetrical gluteal folds
Limited abduction.

17. Radiological? ,6MONTHS CHILD
USG is the investigation of choice.
X-Ray– No role- Head ossification appears at
3-6 months.

18. > 6 months
• Painless limp.(MC)
• Shortened limb.
• Limited abduction.
• Exaggerated lumbar lordosis.
• Allie’s test(Galeazzi’s sign +).
• Telescopic test +
• Trendelenberg gait.
• Waddling gait.

19. DIAGNOSIS
• X-Ray : Investigation of choice after 6 months.
• CT: Limited role.
• MRI: Soft tissue changes, unreducible
dislocations

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.

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

26. 18 months to 3 years child
• Open reduction +/- osteotomies
• Osteotomies
Femoral osteotomy;
Varus derotation osteotomy
Varus extension osteotomy
shortening

27. Femur osteotomy

28. • Pelvic osteotomies
• Salter
• Pembertons
• Chiari
• Shelf operations
• Steel
• ganz

29. Salters osteotomy

30. >8years
• A combination of osteotomies femoral and
pevis
• Total hip replacement

31. complications
• Loss of reduction
• Avn
• Residual acetabular dysplasia
• Osteo arthritis

32. That’s all
my show
this
time… • Any doubts???
(mail me;krrish5622@gmail.com)