DEVELOPMENTAL DYSPLASIA OF HIP (DDH)
( just to familiar with DDH )
(brief overview)
INTRODUCTION
Developmental dysplasia of hip (DDH) is a condition in which one side or both hip joint is not in normal place that is acetabulum at birth .. usually the condition is noticed when a child start walk with limping or disturb gait .
RISK FACTORS :
Breech positioning, Positive family history , female more affected than male child .
DIAGNOSIS ;
Physical examination ..
1. Ortolani maneuver..(dislocated hip )but can be reduced.
2. Barlow maneuver..(dislocable hip) reduced but can be dislocated.
Investigations.
1.Ultrasound till 06 months of age is investigation of choice for DDH .
2.Xray pelvis with hip joints after 04-06 months of age .
TREATMENT ..
1.Pavlik harness ( a kind of brace ) is used up to 06 months of age .
Serial ultrasound is done to see the improvement guided by alpha and beta angles .
2.Close reduction with POP cast .. After 06 months of age close reduction and POP CAST is applied under anesthesia . cast is changed every 4-6 weeks for 2-3 times .
3.Open reduction (surgery)..
Failed close reduction leads to open reduction usually at and after 18 months of age.
STEPS OF SURGRY..(not important for every one)
1 .Percutaneous Adductor tenotomy
2. Through anterior approach
3. Apophysis incised at iliac crest
4. Sartorius dissected from ASIS
5. Iliopsoas tenotomy done ..special care should be taken to safeguard femoral nerve
6. Rectus femoris tenotomy ..repair should be done at the end .
7. Capsulotomy
8. Ligamentum teres removal (that guides to true acetabulum)
9. Pulvinar removal
10. Tranverse ligament dissection
11. Femur de-rotation osteotomy
12 .Salter osteotomy ( most commonly done osteotomy to improve acetabular index i.e acetabular roof )
13 .Capsullorhaphy
14. Hip Spica application for 2-3 months with 4-6 weeks interval .
Conclusion ;
DDH is treatable disease with early diagnosis an when timely managed . Results of surgery is better with early surgery at 2 yrs of age . with growing age muscles gets contracted , surgery results decreased .
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