Associated risk factors in children Associated risk factors in children who had late presentation of DDHwho had late presentation of DDH

Professor Freih Abu Hassan

Professor Akram Shannak

University of Jordan

Associated risk factors in children Associated risk factors in children who had late presentation of DDHwho had late presentation of DDH

J Child Orthop, (2007(

Developmental Dysplasia of the Hip (DDH) .

A spectrum of disorders Unstable, Subluxed, Dislocated hip or Dysplastic hip

Klisic, JBJS (Br) 1989

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@

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Clinical examination

(Ortolani’s & Barlow’s tests)

Plays a considerable role in the diagnosis of unstable or dislocated hips, in the first 3 m.

But not in dysplastic hips (DDH) Hensinger, JPO 1995

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-Harmful, Done once-Used with USS !!!!!

اخلع اخلع اخلع اخلع

DDH

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= 10-20 in 1000 instability (+ve Barlow’s).= 60% stabilize in 1st week.= 90% stabilize in 9 weeks.

1-2 in 1000 live births 1-2 in 1000 live births DDH at 9w. DDH at 9w.

Neonatal Instability

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Factors commonly associated with (DDH)

Female, First child,

Family history,

Frank breech,

Fetal anomalies.

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Limitation of hip abduction

Galeazzi’s sign

Clinical Findings over 3m

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Asymmetry groin & thigh folds

Traditionally, radiological exam. has been used in Dx. of DDH.

In the last two 3 decades USS has been used as the best method in children <6m.

Gerscovich, Skeletal Radiol 1997.

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Dezateux etal, Arch Dis Child. 2003

Using USS detected > cases, > children being treated

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Roovers etal, Arch Dis Child. 2005.

Unfavorable treatment outcomes have also been shown from R/ of unaffected children with a false +ve diagnosis

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A well-centered AP pelvic radiograph is a sensitive & useful technique for Dx & R/ of DDH in children >3 months .

Broughton etal, JBJS-B, 1989O'Brien etal, Ir Med J. 1990

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Flexion

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The purpose of our study.

To assess the role of = Clinical exam.

= Risk factors = Plain pelvic radiograph

in the Dx of late DDH in young infants.

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Centered AP pelvic radiograph was used as the final Dx method, as all cases presented above the age of

3mAbduction 300 ,

Internal rotation 150

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370 Child diagnosed as(DDH(, 581 Hips involved.

311 girls59 boys.

3-7m (3.44 m(

1999-2006The University of Jordan

In Girls

40.5% )126( Unilateral 59.5% )185( Bilateral

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In Boys

56% )33( Unilateral 44% )26( Bilateral.

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Acetabular index angle is the most consistent radiographic parameter for assessment of DDH in children

above 3 months old.

Scoles, etal JPO. 1987

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All our cases had an AI angle of > 300.

300

The upper limit of normal.

Tachdjian's Pediatric Orthopedics )2002( O'Brien etal, Ir Med J. 1990

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Grades of dysplasia

= Mild AI angle )300 – 340(

= Moderate AI angle )350 – 390(

= Severe > 390.

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Total of 740 hips evaluated clinically & radiologically,

581 hips were confirmed to have DDH.

= 71% were Mild dysplasia = 21% Moderate dysplasia

= 7.9% Severe dysplasia

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1.37% positive Ortolani test.

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Jordan Literature

F: M Ratio 5:1 4-8:1

Family History 28.3% 10-28%

First Born 34% 50%

Breech 2% 20%

Feet anomalies 2.2% 1.5% - 39%

Torticollis 0.6% 2-12%

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Endogenous estrogens producedby the female infant transient increase in ligamentous laxity in the perinatal period caused by highlevels of circulating maternal hormones

Why female?

MacLennan, etal Acta Obstet Gynaecol Scand -1997

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34% Vs 50%Related to the tight effects of an unstretched primigravid uterus and abdominal wall, with subsequent effects on fetal limb position and hip joint development through the intrauterine crowding effect

Herring JA (2002) Tachdjian’s pediatric orthopedics

Why first-born babies ?

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0204060

80100120140

Number of children

Site of skin folds

Figure-1:Pattern of skin folds

Short groin

Long groin

Short thigh

Long thigh

Normal

36% 37%

5.4% 5%

16.6%

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0 50 100 150 200 250

Number of children

Side

Figure-4: Sidedness in DDH

right

left

bilateral57%

23.5%

19.5%

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Jordan Literature

Left side 23.5% 60%

Right side 19.5% 20%

Bilateral 57% 20%

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ConclusionThe University of Jordan

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والسل م عليكم ورحمة ال وبركاته