Which of the following is true about DDH -
Ans. is 'b' i.e., Limbs are in adduction, internal rotation and flexion in old children Development dysplasia of hip (Congenital dislocation of hip)* Development dysplasia of hip is defined as partial or complete displacement of the femoral head from the acetabular cavity since birth, i.e. subluxation or dislocation of the hip since birth.* Caucasions and Native Americans have higher incidence as compared to Black & Asians.Risk factors for DDH/CDH (Remember 4Fs 1HO)* Females* First borns* Familial:- DDH is found in families* Faulty intrauterine position (Breech presentation)* Hormone induced laxity* OligohydramnionPathology in DDH* Following changes are seen in dislocated hipi) The femoral head is dislocated upward and laterally. Its bony nucleus appears late and its development is retarded, therefore head is small.ii) Femoral neck is excessively anterverted.iii) Acetabulum is shallow), with a steep sloping roof (This is considered to be the primary pathology).iv) Ligamentumteres is hypertrophied.v) Fibro-cartilaginous labrum of the acetabulum (limbus) may be folded into the cavity of the acetabulum (inverted limbus)vi) Capsule of the hip joint is stretched.vii) Muscles, around the hip, especially the adductors, undergo adaptive shortening.Clinical features of DDH* Girls are affected six times as often as boys. In one third of cases, bilateral affection occurs. Unless it is speciallylooked for in infancy - as it always should be - abnormality may not be noticed until the child begins to walk. The clinical findings in older child are :-i) Limitation of abduction and external rotationii) Limb is in adduction, internal rotation & flexioniii) Asymmetrical thigh foldiv) Higher buttock fold on the affected side.v) Galeazzi's sign : The level of the knees are compared in a child lying with hip flexed to 70deg and knees flexed. There is a lowering of the knee on the affected sidevi) Ortolani's test may be positive.vii) Trendelenbug's test is positive : This test is performed in an older child. The child is asked to stand on the affected side. The opposite ASIS (that of the normal side) dips down .viii) The limb is short and slightly externally rotated. There is lordosis of the lumbar spine.ix) Telescopy positive : In a case of a dislocated hip, it will be possible to produce an up and down piston- like movement at the hip. This can be appreciated by feeling the movement of the greater trochanter under the fingers.x) A child with unilateral dislocation exhibits a typical gait in which the body lurches to the affected side as the child bears weight on it (Trendelenburg's gait). In a child with bilateral dislocation, there is alternate lurching on both side (waddling gait).xi) There is compensatory genu valgum as patient tries to keep the foot out (to compensate adduction at hip).
Male gender is a risk factor
Limbs are in adduction, internal rotation and flexion in old children
Femur neck is retroverted
Ligamentumteres is atrophied
Congenital Dislocation of Hip (C.D.H.)