cdh congenital dislocation of the hip - aliah university · 2020. 4. 19. · a congenital hip...
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CDH
Congenital Dislocation of the
Hip
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CDH/DDH
• CDH Congenital Dislocation of the Hip
• DDH Developmental Dysplasia of the Hip
• CDH Congenital Dysplasia of the Hip
• CHD Congenital Heart Disease !
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Definition
Is a condition in which the Head of the Femur
is improperly seated in the acetabulum of
the pelvis.
NOT A malformation arising during the
period of organogenesis
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A congenital hip dislocation is an abnormal
formation of the hip joint that is present at birth.
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•Lt. hip is
most
commonly
affected
but B/L
involvement
occurs in
>50% cases
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Dysplasia and Subluxation
• radiologically difference between subluxated and
dysplastic hip is disruption of Shenton’s line
– subluxation: line disrupted, head is superiorly,
superiolaterally or laterally
displaced from the medial wall
– dysplasia: line is intact
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Shenton’s line
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EtiologyMulti-factorial :
•Physical – ligament laxity
•Genetic – female >6-8 times
than male
•Mechanical - Prenatal :Breech position Oligohydramnious Primigravida
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Diagnosis : Neonatal
ExaminationLOOK :
•Wide perineum
( in bilateral )
•External rotation attitude
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ExaminationLOOK :
• Asymmetric thigh
foldsanteriorposterior
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CDH
Clinical Examination• Look :
Shortening ( not in neonates ) of affected
leg - in supineGalleazi sign
flex both hips and one side shows
apparent femoral shortening
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CDH
ExaminationFEEL :
• Empty groin
• Weak Femoral pulse
• Inability to abduct the
hip fully
• Posterior bulging of
femoral head
• Positive Trendelenburg’s sign –
downward felt of pelvis on affected side
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Neonatal Examination
Positive Ortolani sign – forced
abduction of hip causes a clicking
sound
Feel a Clunk
Hear a click
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Positive Barlow’s test – holding the
hips & knees at 90degree angle of flexion, a
backward pressure is applied while
adducting hips. The femur head is felt
slipping out of the acetabulum posteriorly
with a click sound indication the test is
positive.
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CDH
Clinical Examination
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CDH
Clinical Examination
The Walking Child
• unilateral / bilateral (waddling)
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X ray, CT Scan, MRI, Arthogram
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CDH
Treatment• Method depends on Age
• The earlier started, the easier the treatment
• The earlier started, the better the results
• Should be detected EARLY
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Treatment• Birth to 6 months :
Pavlik harness or hip spica cast
• 6 months – 12 months :
closed reduction
• 12 months – 18 months :
possible closed / possible open reduction
• Above 18 months :
open reduction and ? Acetabuloplasty
• Above 2 years :
open reduction,acetabulplasty, and femoral osteotomy
• Above 8 years :
open reduction,acetabulplasty , and femoral osteotomy
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Pavlik Harness• Chest strap at nipple line
• shoulder straps set to hold
cross strap at this level
• anterior strap flexes hip 100-
110 degrees
• posterior strap prevents
adduction and allow
comfortable abduction
• safe zone arc of abduction and
adduction that is between
redislocation and comfortable
unforced abduction
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Treatment
Hip instability in the neonatal
period
Most resolve spontaneously
• Observation
• Pavlik harness
• (Double /triple diapers ??)
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CDH
Treatment
Hip instability in the neonatal
period
Double / Triple Diapers• Often inadequate : therefore inappropriate
• Gives illusion patient is in “treatment” while wasting valuable time
• Most hip instability improves spontaneously in early infancy , giving this ineffective management credit
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Treatment - Birth – 6 months
Pavlik harness
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Treatment - Birth – 6 months
Other Devices- Frejka pillow
- Craig
- Von Rosen splint
Soft abduction
splints:
Not good enough
Rigid abduction
splints:
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• Initially non operative – closed reduction
• Reduction under anesthesia and immobilization in
hip spica cast
Treatment
6 – 12 months
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Treatment - 12 – 18 months• Possibly closed reduction !!
when hip stable
• Probably open reduction
when hip unstable
• Arthrography guided: closed reduction
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Treatment
Above 18 months
• Open reduction
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Treatment
Above 3 years
• Open reduction
• And acetabulplasty
• And femoral shortening
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Nursing • Assessment
• General care
• Manipulation / physiotherapy
• Psychological support
• Nutrition
• Maintenance of skin integrity
• Prevention of complications of immobility
• Pre/post op care
• Follow up/rehabilitation
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Complications
• Loss of range of motion
• Leg length discrepancies
• Early osteoarthritis
• Femoral nerve palsy
• Recurrent dislocation/unstable hip
• Iatrogenic complications
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EtiologyMulti-factorial :
•Physical – ligament laxity
•Genetic – female >6-8 times
than male
•Mechanical - Prenatal :Breech position Oligohydramnious Primigravida
Prevention ??
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Prevention