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Comprehensive Guide to Developmental Dysplasia of the Hip at Damascus Hospital

Learn all about Developmental Dysplasia of the Hip from Dr. Mhd Bashar Alboshi at Damascus Hospital. Definition, etiology, pathophysiology, clinical presentation across different age groups, imaging studies, treatment options, and more.

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Comprehensive Guide to Developmental Dysplasia of the Hip at Damascus Hospital

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  1. DEVELOPMENTAL DYSPLASIA OF THE HIP DAMASCUS HOSPITAL Dr.MHD BASHAR ALBOSHI

  2. Definition: • Developemental?!! DDH is a disorder that evolves over time. • The left hip> right hip. • bilateral hips> right hip alone.

  3. Etiology: • تداخل عدة عوامل مشتركة (1)الرخاوة الرباطية (2) ( الوضعية المقعدية داخل الرحم). Generalized familial hyperlaxity

  4. Etiology: • (3)وضعية البسط التام للوركين بعد الولادة. • (4)العرق: أعلى لدى القوقاز والأمريكان المحليين. أقل عند السود والأسيويين

  5. Associated Conditions • Torticollis (15% have DDH) • Metatarsus Adductus(1.5-10%have DDH)

  6. PATHOPHYSIOLOGY( NORMAL HIP DEVELOPMENT): The hyaline cartilage ( triradiate cartilages)

  7. Pathophysiology (secondary obstacles): • النسج الشحمية(pulvinar thickens). • الرباط المدور (متسمك ومتطاول) • الرباط المعترض( متضخم) • المحفظة(شكل الساعة الرملية) • Iliopsoas

  8. Fatty tissue(pulvinar thickens).

  9. Teres ligament (elongated and thickened) Docking the head

  10. dislocated subluxated • Labrum: Cartilaginous acetabular lip. • Neolimbus:a ridge of thickened articular cartilage

  11. Transverse ligament (hypertrophic)

  12. Hourglass shape of the capsule by the iliopsoas tendon

  13. Pathophysiology (secondary obstacles): progressive Shortened of pelvifemoral muscles

  14. Figure 15-17

  15. CLINICAL PRESENTATION(THE NEONATE): • Ortolani,s or Barlow,s sign • Sonographic morphology.

  16. CLINICAL PRESENTATION(THE NEONATE):

  17. CLINICAL PRESENTATION(THE NEONATE): Barlow Ortolani clunk

  18. CLINICAL PRESENTATION(THE INFANT): Limited Abduction Galeazzi Sign Hips 90degrees

  19. CLINICAL PRESENTATION(THE INFANT): Asymmetric Folds

  20. CLINICAL PRESENTATION(THE INFANT): recognize a bilateral dislocation. Klisic Test Anterior superior iliac spine Greater trochanter Dislocation Normal

  21. CLINICAL PRESENTATION(THE WALKING CHILD): • CLINICAL PRESENTATION • (THE WALKING CHILD) • FIG15-24

  22. Femoral Neck Anteversion

  23. IMAGING STUDIES(ULTRASOUND) identify a silent hip

  24. IMAGING STUDIES(ULTRASOUND) 15-28

  25. IMAGING STUDIES(ULTRASOUND) BASELINE: line of ilium which intersects the bony and the cartilaginous portions of the acetabulum. 15-29 • As the femoral head subluxates: • ALPHA angle • BETA angle

  26. IMAGING STUDIES(ULTRASOUND) The Ultrasound ( before 3 mo. ) Ilium Abductor M.

  27. IMAGING STUDIES(ULTRASOUND) TABLE15-2

  28. IMAGING STUDIES(RADIOGRAPHY)

  29. IMAGING STUDIES(RADIOGRAPHY) • عند الوليد الذي لديه DDHقد يظهر طبيعي على الصورة البسيطة. • عندما يصل لعمر 3-6 أشهر يظهر الخلع شعاعيا.

  30. IMAGING STUDIES(RADIOGRAPHY) Acetabulum • السقف( أكثر ميلانا) • التقعر(مسطح) • الجدار الانسي( متسمك) • إنقلاب أمامي شديد

  31. IMAGING STUDIES(RADIOGRAPHY)

  32. IMAGING STUDIES(RADIOGRAPHY) lateral broken

  33. IMAGING STUDIES(RADIOGRAPHY) • figure15-33 • Useful in newborns. • Decrease with age.

  34. IMAGING STUDIES(RADIOGRAPHY) • figure15-34

  35. IMAGING STUDIES(RADIOGRAPHY) • Figure15-35 • teardrop body: • Losees its convexity • Wider. • The presence of a teardrop at 6 months after reduction predicted a satisfactory outcome in 93% of hips.

  36. IMAGING STUDIES(Arthrography ) (1) عسر التصنع الخفيف (2)الخلع وتحت الخلع (3) الرد (4) إندخال النسج الرخوة labrum (5) (6)المراقبة أثناء العلاج

  37. Screening Criteria • all babies with the risk factors ultrasound + clinical examination

  38. TREATMENT • Neonate: Pavlic harness ((6 weeks)). • 1 to 6 months: Pavlic harness(( 6 weeks)) after hip reduces. • 6 to18 months: traction? • (1)Closed reduction(cast 3 months) • (2)Open reduction( unsuccessful closed reduction) • < 12 months (Medial approach) • > 12 months (anterolateral approach) • 18 to 24 months: Trial of closed reduction? • Orprimary open reduction(anterolateral approach) • (+/-A salter osteotomy ) • 24 months to 6 years: primary open reduction(anterolateral approach)+femoral shortening . ((+/-A salter osteotomy ))

  39. TREATMENT( NEONATE-6 MONTHS) • PAVLIK harness for 6 weeks after hip reduction • Hip flexion(120degrees).

  40. TREATMENT( NEONATE-6 MONTHS) • فحص سريري طبيعي عند وليد+ شذوذ على الإيكو-----إيكو بعد 6 أسابيع--- شذوذ---علاج • إذا حدث خلع بعد 3-4 أسابيع-------رد مغلق أو مفتوح.

  41. TREATMENT( 6-18 MONTHS) Skin traction for 2 – 3 weeks 90D

  42. TREATMENT( 6-18 MONTHS) open reduction if closed reduction is unsuccessful ! Closed reduction (spica cast for 3 mo.) >90D flextion abduction30-40D Internal rotation 10-15D

  43. TREATMENT(AFTER 18 MONTHS) Primary open reduction

  44. OPEN REDUCTION • Medial Approach: • ‌محاسنه: شق صغير,مواجهة الرد مباشرة. • مساوئه: ساحة رؤية ضيقة, لا يمكن إنجاز رأب المحفظة, أذية الشريان المنعطف الفخذي الأنسي. • Anterior approach: • ساحة رؤية أفضل, إنجاز رأب المحفظة

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