Karteikarten
PHS302 - Developmental Dysplasia of the Hip (DDH)
Karten in diesem Stapel (31)
- 1Hip Anatomy Blood supply Capsular ligaments Type of joint Features of the HOFanastamosis - supplies HOF
ligaments are tight in IR + extn
Type: Ball and Socket
HOF
- spherical in shape
- pit = fovea
- ligamentum teres -> transverse acetabular ligament - 2Hip Anatomy Features of the AcetabulumAcetabulum
- C Shaped
- inferior = transverse acetabular ligament
- articular cartilage
- rim = acetabular labrum (deepens acetabulum/adds stability) - 3Hip Anatomy Musclesabductors - greater trochanter
psoas - lesser trochanter
adductors - medial/proximal femur - 4DDH Epidemiology(L) hip = 65% of cases
(in-utero - fetus against mother's sacrum => increased addn of the hip)
bilateral dysplasia = 20% of cases
(commonly identified late due to symmetry as both hips involved and no instability) - 5Capsular laxitycan occur during delivery or post natally
subluxation = contact with the acetabulum
dislocation = no contact with the acetabulum
- reducable (can be put back in socket)
- irreducable (cannot be put back in socket) - 6DDH Capsular changescapsular stretch (hourglass shape)
psoas stretched (across waist of hourglass)
ligamentum teres is loose
morphological change of shape - more ovoid
acetabular shape change - lat lying HOF
tight adductors - 7Acetabular Dysplasiaisolated incidence vs related to DDH
change of shape => more shallow
HOF not properly in socket
may spontaneously improve
may not dislocate
some not dx until later in life sec. to OA changes - 8DDH EpidemiologyDDH affects 1:1000 live births
instability in 1:100 live births
if present at birth usu due to contracted mm
cause = SB, Arthrogryposis
- teratological - 9DDH - Presentation at 6/52assymetry of leg posture
shortened leg
uneven thigh and gluteal fold
decreased abduction - 10DDH Reasons for late diagnosispersistent and progressive laxity - true missed hip (always lax - not dx at ax)
posturing - misshapen acetabulum sec to playing on one side only
Plagiocephaly - addn of opposite hip (acetabular dysplasia) =>
"Developmental Dysplasia" - 11DDH Risk Factorsgirls > boys
family history of DDH
breech position in utero
intrauterine packaging problems - 12DDH Risk Factors Females80% of cases are female
maternal hormones => increased laxity
increased risk if 1st degree relative is affected - 13DDH Risk Factors Breech position in uterocauses capsular stretching sec to
- increased flexn of hips
- limitation of hip ROM
=> Acetabular Dysplasia
(shallow, dish shaped aetabulum) - 14DDH Risk Factors Intrauterine Packaging Problemsdecrease in space in utero can => DDH
- first pregnancy
- oligohydramnios (low level of amniotic fluid)
- multi pregnancy i.e., twins, triplets etc
hyper extension of knees - 15More Intrauterine Packaging Problemsfoot deformities
plagiocephaly (flattening of head)
torticollis (turning of neck)
post natal wrapping => DDH
(if wrapped with legs extended) - 16Hip Examination1. keep the infant warm and speak calmly
2. keep the infant relaxed and fed
3. position feet towards mum
4. stand square to infant
5. infant should be undressed from waist down
6. order of Ax:
- hip instability (Barlow/Ortolani Tests)
- assymmetry
- general features - 17Hip Examination Hip Instability / Dislocation Barlow Test (Features)provocative test
one hand stabilizes the pelvis
other hand "cups" opposite knee and takes into flxn
adduct flexed hip to 10-20 deg
apply backward pressure
+ve instability = gliding sensation felt
repeat 2-3 times - 18Hip Examination Hip Instability / Dislocation Ortolani Test (Features)aim - see if can reduce dislocated hip
flex both hips and knees to 90deg
fingers "cupping" HOF
as hip is abducted "lift" HOF into acetabulum
+ve test = hear a "clunk", hip dislocates and leg "shortens"
NOTE: clicks are not clunks (-ve). They are gen from ligaments and are usu innocent - 19Hip Examination Asymmetrydue to: soft tissue contractures - previous tests not as reliable
asymmetry presentation:
- asymetrical creases (not a dx by itself)
- shortening of limb
- limitation of abduction - 20Hip Examination Shortening of Limb (features)inreased gluteal fold
"bunching up" of mm
dislocation of subluxation
+ve Galeazzi Test (see next slide) - 21Hip Examination Galeazzi Testflex bilat hips to 90deg
neutral abdn/addn
measure level of knees
+ve = asymmetry of gluteal fold
pelvis MUST be level - 22Hip Examination Limitation of Abductionmost sensitive
flex hips to 90deg + abduct
measure ROM and resistance
do slowly and gradually as can be uncomfortable - 23General Examination General pathologies linked with DDH 1Dysmorphism
- Downs Syndrome
- Arthogryposis
- Larsen Syndrome - 24General Examination General pathologies linked with DDH 2Other conditions:
- Plagiocephaly
- Torticollis
- Scoliosis
- Spina Bifida
- Knee hyperextension
- Calcaneovalgus
- Metatarsus Adductus
- Congenital Talipes Equinovarus (CTEV) - 25Early Diagnosis vs Late Diagnosis (6/52 to Walking)later dx => poorer outcome and diff Rx
dx < 6/52 = obs, bracing, usu resolves
dx > 3/12 = soft tissue changes and adaptations evident, diff to relocate hip, requires hip spica
dx > walking stage = adaptive changes well established, open reduction and osteotomy usu req'd. Dec ability to create a "normal" hip - 26Early Diagnosis vs Late Diagnosis (Adolescence and Adulthood)dx in adolescence + adulthood = dysplasia and disability usu universal > 4 yrs, altered mechanics sec. to changes in soft tissue and joint =>
- fatigue
- pain
- antalgic gait pattern
- OA (=> THR) - 27Examination Timeline1st year of life
screening until 3.5 years
essential time points:
- birth
- 1/52 at home visit, then
- 2, 4, 8 weeks, then
- 4, 8, 12 months
then as required - 28Investigations UltrasoundU/S
- < 6/52
- screening
- monitoring
- safe
- requires specialist in paediatric ultrasound - 29Investigations RadiographyRadiograph
- > 6/52
- monitoring
- requires specialist in paediatric radiography - 30When to referevidence of risk factors
abnormal examination (or +ve tests)
send referral with a Victorian Perinatal Data Collection Notification Form with status as confirmed / unconfirmed - 31DDH - Safe Wrapping What is it? Risks? Methods?What is it?
way of wrapping to ensure safe, happy, comfortable baby
Risks?
too tight, wrapped with straight hips
legs should move freely
1st 3/12 = increased risk of DDH
Methods?
- diamond
- square
- pouch
Informationen
- Beschreibung
- Flashcards to show anatomy, clinical presentation and relevant tests with regards to Developmental Dysplasia of the Hip
- Erstellt von
- Louise Weir
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