Developmental (Congenital) Dysplasia of the Hip. Natural History and Prevention Levels.

1
Developmental (Congenital) Dysplasia of the
Hip.Natural History and Prevention Levels.

• Nicolas Padilla
• Professor of Pediatrics
• School of Nursing and Obstetrics of Celaya
• University of Guanajuato

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Definition

• It is a lost of the relationships between hip
  joint components.
• Occurs in neonatal period.
• 1 of each 6 newborn have hip instability.
• Incidence of true hip dislocation is 2-5/1000
  live births.

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Clasification
Dysplasia
Typical
Subluxation
Developmental (Congenital) Dysplasia of the Hip
Dislocation
Teratologic
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Prepatogenic Period.Agent

• Generalized ligamentous laxity increased by
  maternal estrogens and/or other hormones.
• Genetic influences.
• Multifactorial

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Prepatogenic Period.Host.

• gt Female sex (5-71) to hip dislocation
• gt Male sex to dysplasia.
• 20 of DDC associated with congenital
  abnormalities (congenital muscular torticolis,
  metatarsus adductus).

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Prepatogenic Period.Environment

• Macro environment.
  Incidence increased during winter in
  Mexico.
• Maternal environment.
  First-born
  
• Micro environment.
  Breech position (with the hips flexed and the
  knees extended).

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Primary Prevention.First Level.Health Promotion.

• Community should know the risk factors.
• Better distribution of medical centres,
  especially in rural areas.
• To promote perinatal and postnatal care for
  health care professionals.

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Primary Prevention.First Level.Specific
Protection.

• To avoid hold the baby by the ankles.
• To avoid extraction of the newborn with traction
  of groins or tights.
• To avoid dressing the newborn with extension and
  adduction of the hips.
• Always check the hips of babies in each visit to
  pediatrician

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Patogenic Period.Subclinic Period.

• Dysplasia is a progressive process.
• Teratologic dislocation is accompanied by other
  serious malformations as neuromuscular disorder
  (myelodysplasia, arthrogryposis multiplex
  congenita).
• Subluxable hip has ligamentous laxity and it is
  possible to move the femoral head without
  dislocated.

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Patogenic Period.Subclinic Period.

• Dislocation femoral head is out of the
  acetabulum in supero lateral position.

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Patogenic Period.Clinic Period.

• Barlow test
• Ortolani test
• Galeazzi
• Limitation of hip abduction
• Peter-Baden sign
  (Asymetry of tight folds)
• Compared transmission of the sound tests

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Patogenic Period.Complications.

• Avascular necrosis of the femoral head
• Redislocation
• Residual subluxation
• Acetabular dysplasia
• Postoperative complications (wound infections)

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Patogenic Period.Sequelae.

• Coxa vara
• Coxa plana
• Claudication

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Secondary Prevention.Third Level.Precocious
Diagnosis.

• Clinic diagnosis
  Clinical maneuvers
• Ultrasonographic diagnosis
  It is of first election in lesser of 4 months
  of age
  It is used Grafs scale with
  dynamic and static test

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Secondary Prevention.Third Level.Precocious
Diagnosis.

• Radiologic diagnosis
  It is not useful if the head femoral is not
  evident.
  Anteroposterior and AP in abduction. Hilgenreiner
  line, angle of Winberg, Shenton line.
  

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Secondary Prevention.Third Level.Timely
Treatment.

• Pavlik harness
• Fredjka splint
• Double and triple diapers
  are controversial

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Secondary Prevention.Fourth Level.Limitation of
Damage.

• Treatment of complications is surgical and the
  patients should be treated by expert.
• Patients should be checked monthly, then each six
  months, until adult life.

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Tertiary Prevention.Fifth Level.

• Excercise of hips and knees
• Reducation of the gait

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References

• Padilla N, Figueroa RC. Pruebas de transmision
  del sonido en el diagnostico de la luxacion de
  cadera en el neonato. Rev Mex de Pediatr 199663
  265-8.
• Padilla N, Figueroa RC. Displasia congenita de
  la cadera. Historia natural y sus niveles de
  prevencion. Rev Mex de Pediatr 199158337-45.
• Padilla N, Figueroa RC. Diagnostico de luxacion
  congenita de cadera mediante la transmision
  comparada del sonido. Rev Mex de Pediatr. Rev Mex
  de Pediatr 199259149-51.