cdh c ongenital d islocation of the h ip
DESCRIPTION
Dr. ABDULMONEM ALSIDDIKY , MD , SSCO. Assistant Professor & Consultant pediatric Ortho.& Spinal Deformities KSU,KKUH Riyadh , Saudi Arabia . CDH C ONGENITAL D ISLOCATION OF THE H IP. Nomenclature. CDH : Congenital Dislocation of the Hip - PowerPoint PPT PresentationTRANSCRIPT
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Dr. ABDULMONEM ALSIDDIKY , MD , SSCO.
Assistant Professor & Consultant pediatric Ortho.& Spinal Deformities
KSU,KKUH Riyadh , Saudi Arabia
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Nomenclature
CDH : Congenital Dislocation of the Hip DDH : Developmental Dysplasia of the Hip
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NORMAL PELVIS
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Normal hip Dislocated hip
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Patterns of disease
Dislocated Dislocatable Sublaxated Acetabular dysplasia
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Radiology
After 6 months: reliable
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Causes (multi factorial)
Hormonal Relaxin, oxytocin
Familial Lig.laxity diseases
Genetics Female 4 X male --- twins 40%
Mechanical Pre natal Post natal
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Mechanical causes
Pre natal Breach , oligohydrominus , primigravida , twins
(torticollis , metatarsus adductus )
Post natal Swaddling , strapping
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Infants at risk
Positive family history: 10X A baby girl: 4-6 X Breach presentation: 5-10 X Torticollis: CDH in 10-20% of cases Foot deformities:
Calcaneo-valgus and metatarsus adductus Knee deformities:
hyperextension and dislocation
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Infants at risk
When risk factors are present
The infant should be reviewed Clinically radiologically
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Clinical examination
The infant should be quiet comfortable
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Look: External rotation Lateralized contour Shortening Asymmetrical skin folds
Anterior – posterior
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Move Limited abduction
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Special test Galiazzi Ortolani , Barlow test Trendelenburgh sign Limping ( waddling gait if bilateral)
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Special test
Galiazzi test
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Special test
Ortolani test
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Special test
Barlow test
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Special test
Trendelenburgh sign
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Screening programs
Clinical screening proven to be effective
Performed by trained personnel Must be dynamic
Repeated with periodic examination
U/S screening is controversial
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Investigations
0-3 months U/S
> 3months X-ray pelvis AP + abduction
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U/S Screening
Incidence of hip stability declines rapidly to 50% within the first week of neonatal life.
Better to delay U/S screening
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U/S - Problems
Too sensitive:Detects a lot of hip abnormalities, most of which
would develop normally if left aloneOperator-dependant
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Radiology Early infancy: not reliable
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Radiology After 2-3 months: more reliable
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Radiology After 2-3 months: more reliable
27o 39o
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Radiology
After 2-3 months: more reliable
in out
in out
Von Rosen view
in out
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Radiology After 2-3 months: more reliable
in out
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Radiology After 6 months: reliable
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Radiology After 6 months: reliable
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Treatment - Aims
Obtain concentric reduction Maintain concentric reduction In a non-traumatic fashion Without disrupting the blood supply to femoral
head
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Treatment
Method depends on age The earlier started, the easier it is The earlier started, the better the results are
Should be detected EARLY
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Treatment Birth – 6m
Pavlik harness or hip spica 6-12 m:
Closed reduction under GA and hip spica 12 - 18 m:
Open reduction 18 – 24 m:
Open reduction and Acetabuloplasty 2-8 years:
Open reduction, Acetabuloplasty, and femoral shortening Above 8 years:
Open reduction, Acetabuloplasty cutting all three pelvic bones, and femoral shortening
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Treatment: Neonatal hip instability
Most resolve spontaneouslyCan initially wait
Avoid adduction swaddleApply double diapers – to bring back!!See at 2weeks of age
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Treatment: Neonatal hip instability
Unstable at 2 weeks: Double / Triple diapers: inadequate
Gives illusion that patient is “in treatment” while wasting valuable time
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Treatment: Neonatal hip instability
Unstable at 2 weeks: Pavlik Harness
Dynamic, effective, safe
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Treatment: 6-12 m Initially non-operative closed reduction UGA and
immobilization in hip spica cast
Position: Avoid sever abduction Avoid frog position
Must obtain stable concentric reduction, otherwise needs surgery
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Treatment: 6-12 m Possibly closed reduction
Stable and concentric reduction
Possibly open reduction Unstable or un-concentric reduction
Arthrography-guided
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Treatment: 6-12 m Arthrography-guided Closed Reduction
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Treatment: 6-12 mArthrography-guided Closed Reduction
Too lateralized Acceptable
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Treatment: 18-24 m
Open reduction – surgery
Possibly: Acetabuloplasty
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Treatment: Above 2 years
Open reduction, and Acetabuloplasty, and Femoral shortening
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Acetabuloplasties
Many types
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Treatment Birth – 6m
Pavlik harness or hip spica 6-12 m:
Closed reduction under GA and hip spica 12 - 18 m:
Open reduction 18 – 24 m:
Open reduction and Acetabuloplasty 2-8 years:
Open reduction, Acetabuloplasty, and femoral shortening Above 8 years:
Open reduction, Acetabuloplasty cutting all three pelvic bones, and femoral shortening
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CDH - Summary Complex multi-factorial, endemic disease Health education and Drs. awareness Screening programs are needed Learning proper examination methods Identify at risk groups Efficient referral system Proper management by specialized Drs
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Examples
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