Congenital Dislocation of Hip (CDH) occurs classically due to
Ans. d (Developmental Acetabular dysplasia) (Ref. Baily and Love 24th ed., Fig. 27.34)DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH)# This term is more accurate than the older congenital dislocation of the hip (CDH) because it includes dislocation along with other less severe forms, all of which have in common a dysplasia or natural shallowness of the acetabulum. The femoral neck is usually anteverted.Aetiology# A family history of DDH increases the risk up to 30 times.# The condition is five times more common in girls.# The left side is affected more commonly than the right.# Breech presentation, especially the extended position, firstborn children and caesarean section are associated with increased neonatal instability, possibly through restricted foetal movement.# Finally, it may be association with neuromuscular disease conditions and skeletal dysplasia.Diagnosis# Neonate- Clinical Barlow and Ortolani tests: The baby should be relaxed and the hips flexed to 90 degree. It is possible to reduce a dislocated hip by abduction and gentle forward pressure (Ortolani) or dislocate an unstable hip by adduction and gentle backward pressure (Barlow). In both cases a soft clunk is felt as the hip reduces or dislocates.The specificity of clinical neonatal examination is 100% (no false positives). However, its sensitivity is much lower.- Ultrasonography is most valuable test. It can detect not only displacement of the femoral head but also varying degrees of dysplasia.- X-rays are not generally reliable until approximately the age of 3 months.# Adult- Pain is again the usual complaint and X-rays may now show degenerative change as well as dysplasia.# Rx:Infant.Traction and surgery are not indicated. The hips can usually be reduced (Ortolani) and should then be held in a harness or splint for about 8 weeks.A baby, for example, aged 6 monthsWould usually require preliminary traction followed by closed reduction augmented by soft-tissue release (psoas and/or adductor).Toddler and young childwith age, open reduction along with femoral or innominate osteotomy will be required.Adolescent or young adultThose presenting with a painful dysplastic hip may require surgery. A realignment of the joint through pelvic or femoral osteotomy is only appropriate if there is a congruous hip joint. Otherwise (i.e., subluxation) the acetabulum has to be augmented by other means, for example shelf arthroplasty.
Small femoral head epiphysis
Abnormal angle of femoral neck
Hypertrophied ligamentum teres
Developmental Acetabular dysplasia
Congenital Dislocation of Hip (C.D.H.)