CONGENITAL DISLOCATION OF THE HIP

1
CONGENITAL DISLOCATION OF THE HIP

• Prepared By
• Dr. MOHSEN A. GHAFFAR
• Consultant Orthopaedic Surgery
• Ibn Sina National College
• Al Jedaani Group Of Hospitals

2

• Terminology
• The term congenital is replaced by
  developmental because
• not all cases are evident at birth, and also
  postnatal factors contribute in production of hip
  instability and subsequent dislocation .

3
Etiology

• Multifactorial
• -Mechanical Factors all factors which
  tighten the space
• available for the fetus in the uterus,
  like contracted pelvis
• or tight unstretched uterine and abdominal
  musculature
• which prevents free movement of the fetus.
• -Hormonal Factors maternal estrogens are
  increased before
• delivery to relax the pelvic muscles , this
  leads to laxity of the capsule and instability
  of the hip.
• -Postnatal environmental Factors some
  people have traditional habits of wraping the
  babies in positions which do not secure the
  femoral head inside the acetabulum

4
Pathology

• At the time of birth , the joint capsule is
  distended and elastic.
• After delivery the , the femoral head is loose
  within the joint
• and free to fall out of the acetabulum . At
  this early stage the
• shape of the head and acetabulum and soft
  tissues is very close
• to normal , so if the head is maintained
  within the acetabulum
• for few weeks , the joint will return to its
  normal configuration
• and become stable.
• If the dislocation is allowed to persist for long
  time, the bone
• and soft tissues undergo adaptive changes ,
  and the dislocation
• is difficult to be reduced . The
  pathological changes may be in
• the acetabulum (shallow acetabulum) , or
  the femoral head
• neck, capsule and ligamentum teres ( lax ,
  redundant)
• Congenital dislocation of the hip occurs in a
  posterolateral and proximal direction

5
(No Transcript)
6
Clinical Diagnosis

• New Born
• The mother may complain of asymmetric position
  of
• lower limbs or lack of normal movement of
  one side .
• The most reliable methods for diagnosis are
• -Ortolani Test (Reduction Test),if the hip
  is dislocated,
• the femoral head can be returned into the
  acetabulum ,
• by abducting the hips and pushing the thighs
  anteriorly
• (ve sign ).
• -Barlow Test ( Dislocation Test) , if the
  hip is unstable
• ( dislocatable) , it can be pushed
  posteriorly out of the acetabulum after flexing
  and adducting the thigh

7
(No Transcript)
8
(No Transcript)
9

• Older Infants Children
• -Limping during walking .
• In case of bilateral hip dislocation , waddling
  gait .
• -Shortening of affected lower limb, skin and
  subcutaneous tissue are bunched up , extra skin
  folds are observed
• -Allis or Galeazis sign (shortening of affected
  thigh when
• The knees are flexed ) .
• -Telescoping or Pistoning test (with the hip
  flexed, pushing
• The thigh posteriorly no resistance is
  encountered )
• -Trendlenburg test ( if the patient is
  standing on the affected side ,pelvic tilt is
  observed)

10
(No Transcript)
11
(No Transcript)
12
(No Transcript)
13
(No Transcript)
14
(No Transcript)
15
Radiographic Diagnosis

• Newborn
• In the first few days of life radiological
  diagnosis is almost always negative
• After the age of 6 months pathological changes
  are evident
• - Shallow acetabulum ( Acetabulum Index),
  avarage 22-27 deg.
• - Short Neck (Increased angle of
  antivervsion)
• - Shentons Line
• - Shoemakers Line
• - Lateral migration of trochanter
• - Delayed ossification of the head

16
(No Transcript)
17
(No Transcript)
18
(No Transcript)
19
(No Transcript)
20
(No Transcript)
21
Treatment

• The aim of treatment is to bring back the femoral
  head into
• the acetabulum and maintain this position .
• Line of treatment depends on the age of the
  patient and type of pathology .
• Under the age of 3 monthes conservative
  treatment, simply by putting the hip in abduction
  to keep the head within the acetabulum .
• From3monthes to 2years traction is needed to
  overcome contraction of soft tissues
• Above 2 years surgical treatment is needed , it
  depends on the pathology

22
(No Transcript)