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CDH CONGENITAL DISLOCATION OF THE HIP

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Dr. ABDULMONEM ALSIDDIKY , MD , SSCO. Assistant Professor & Consultant pediatric Ortho.& Spinal Deformities KSU,KKUH Riyadh , Saudi Arabia – PowerPoint PPT presentation

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Title: CDH CONGENITAL DISLOCATION OF THE HIP


1
CDHCONGENITAL DISLOCATION OF THE HIP
  • Dr. ABDULMONEM ALSIDDIKY , MD , SSCO.
  • Assistant Professor Consultant
  • pediatric Ortho. Spinal Deformities
  • KSU,KKUH
  • Riyadh , Saudi Arabia

2
Nomenclature
  • CDH Congenital Dislocation of the Hip
  • DDH Developmental Dysplasia of the Hip

3
NORMAL PELVIS
4
  • Normal hip
  • Dislocated hip

5
Patterns of disease
  • Dislocated
  • Dislocatable
  • Sublaxated
  • Acetabular dysplasia

6
Radiology
  • After 6 months reliable

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Causes (multi factorial)
Unknown
  • Hormonal
  • Relaxin, oxytocin
  • Familial
  • Lig.laxity diseases
  • Genetics
  • Female 4 X male --- twins 40
  • Mechanical
  • Pre natal
  • Post natal

9
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

12
Infants at risk
  • When risk factors are present
  • The infant should be reviewed
  • Clinically
  • radiologically

13
Clinical examination
  • The infant should be
  • quiet
  • comfortable

14
  • Look
  • External rotation
  • Lateralized contour
  • Shortening
  • Asymmetrical skin folds
  • Anterior posterior

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  • Move
  • Limited abduction

17
  • Special test
  • Galiazzi
  • Ortolani , Barlow test
  • Trendelenburgh sign
  • Limping ( waddling gait if bilateral)

18
Special test
Galiazzi test
19
Special test
Ortolani test
20
Special test
Barlow test
21
Special test
Trendelenburgh sign
22
Screening programs
  • Clinical screening proven to be effective
  • Performed by trained personnel
  • Must be dynamic
  • Repeated with periodic examination
  • U/S screening is controversial

23
Investigations
  • 0-3 months U/S
  • gt 3months X-ray pelvis AP abduction

24
U/S Screening
  • Incidence of hip stability declines rapidly to
    50 within the first week of neonatal life.
  • Better to delay U/S screening

25
U/S - Problems
  • Too sensitive
  • Detects a lot of hip abnormalities, most of which
    would develop normally if left alone
  • Operator-dependant

26
Radiology
  • Early infancy not reliable

27
Radiology
  • After 2-3 months more reliable

28
Radiology
  • After 2-3 months more reliable

39o
27o
29
Radiology
  • After 2-3 months more reliable

Von Rosen view
in
out
in
out
out
in
30
Radiology
  • After 2-3 months more reliable

out
in
31
Radiology
  • After 6 months reliable

32
Radiology
  • After 6 months reliable

33
Treatment - Aims
  • Obtain concentric reduction
  • Maintain concentric reduction
  • In a non-traumatic fashion
  • Without disrupting the blood supply to femoral
    head

34
Treatment
  • Method depends on age
  • The earlier started, the easier it is
  • The earlier started, the better the results are
  • Should be detected EARLY

35
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

36
Treatment Neonatal hip instability
  • Most resolve spontaneously
  • Can initially wait
  • Avoid adduction swaddle
  • Apply double diapers to bring back!!
  • See at 2weeks of age

37
Treatment Neonatal hip instability
  • Unstable at 2 weeks
  • Double / Triple diapers inadequate
  • Gives illusion that patient is in treatment
    while wasting valuable time

38
Treatment Neonatal hip instability
  • Unstable at 2 weeks
  • Pavlik Harness
  • Dynamic, effective, safe

39
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

40
Treatment 6-12 m
  • Possibly closed reduction
  • Stable and concentric reduction
  • Possibly open reduction
  • Unstable or un-concentric reduction
  • Arthrography-guided

41
Treatment 6-12 m
  • Possibly closed reduction
  • Stable and concentric reduction
  • Possibly open reduction
  • Unstable or un-concentric reduction
  • Arthrography-guided

42
Treatment 6-12 m
  • Arthrography-guided Closed Reduction

43
Treatment 6-12 m
  • Arthrography-guided Closed Reduction

Acceptable
Too lateralized
44
Treatment 18-24 m
  • Open reduction surgery
  • Possibly Acetabuloplasty

45
Treatment Above 2 years
  • Open reduction, and
  • Acetabuloplasty, and
  • Femoral shortening

46
Acetabuloplasties
  • Many types

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48
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

49
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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57
THANKS
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