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DEVELOPMENTAL DYSPLASIA OF THE HIP

DEVELOPMENTAL DYSPLASIA OF THE HIP. DAMASCUS HOSPITAL. Dr.MHD BASHAR ALBOSHI. Definition:. Developemental?!! DDH is a disorder that evolves over time. The left hip > right hip . bilateral hips > right hip alone. Etiology:. تداخل عدة عوامل مشتركة (1) الرخاوة الرباطية

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DEVELOPMENTAL DYSPLASIA OF THE HIP

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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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