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Developmental Congenital Dysplasia of the Hip

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

• Generalized ligamentous laxity
  increased by maternal estrogens
  and/or other hormones.
• Genetic influences.
• Multifactorial
   Prepatogenic Period.
          Host.
• > Female sex (5-7:1) to hip
  dislocation
• > Male sex to dysplasia.
• 20% of DDC associated with
  congenital abnormalities
  (congenital muscular torticolis,
  metatarsus adductus).
     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).
     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.
       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
         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.
    Patogenic Period.
    Subclinic Period.

• Dislocation: femoral head is
  out of the acetabulum in
  supero lateral position.
     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
         Patogenic Period.
          Complications.

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

• Coxa vara
• Coxa plana
• Claudication
      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 Graf’s scale with dynamic
  and static test
     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.
 Secondary Prevention.
     Third Level.
      Timely Treatment.

• Pavlik harness
• Fredjka splint
• Double and triple diapers
  are controversial
    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.
   Tertiary Prevention.
       Fifth Level.


• Excercise of hips and knees
• Reducation of the gait
              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
  1996;63: 265-8.
• Padilla N, Figueroa RC. Displasia congenita de
  la cadera. Historia natural y sus niveles de
  prevencion. Rev Mex de Pediatr 1991;58:337-45.
• Padilla N, Figueroa RC. Diagnostico de luxacion
  congenita de cadera mediante la transmision
  comparada del sonido. Rev Mex de Pediatr. Rev
  Mex de Pediatr 1992;59:149-51.

				
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