👶

DDH - Developmental Dysplasia of the Hip

“My goals of treatment are to have a stable, concentrically reduced hip to allow normal acetabular development to prevent degenerative joint disease. And my treatment is dependant on the age of the patient”

pavlik harness if a Flexion Abduction Orthoses, a dynamic splint which relies on the child kicking out to reduce to hip. used till 5 months. 3 pre-requisites - reducible, no contractures, no neuromuscular injury.

‣

What is DDH?

‣

Where is the deficiency in DDH?

‣

What are the risk factors?

‣

What are the other packing disorders? [Top to bottom]

‣

What is teratologic hip?

SCENARIO 1 = < 6 months [Q = PAVILK]

‣

How will you approach this patient?

‣

What physical exam? What signs?

‣

Till how old do barlow and ortolani test remain present?

‣

When is US accurate?

‣

What are the angles on US?

‣

How do you classify this Ultrasound?

‣

What lines do you look for on the XR? At what age do you do XR?

‣

What is your goal of treatment in patients with DDH regardless of age?

‣

What is a Pavlik harness?

‣

When will you institute the Pavlik harness?

‣

Is US screening for DDH a good screening test?

‣

What is the pre-requisite of a Pavilk harness? What are the contraindications?

‣

How do you apply the pavilk harness? Angles?

‣

What are the complications of pavlik harness? GIve me 4.

‣

How long do you wear it for?

‣

What is the age limit for Pavlik?

‣

When can we stop follow up?

‣

What if patient failed pavlik harness at 3 months or head irreducible?

SCENARIO 2 = 6-18 months/ Failed Pavlik [Q = Closed or Open reduction]

‣

Patient failed pavilk how will you assess?

‣

What is Ramsey Zone of Safety?

‣

What do you do after a closed reduction?

‣

When will you do adductor tenotomy? What are the risks of Adductor tenotomy?

‣

How to confirm reduction intra-op? Signs of unreduced hip on Arthrogram?

‣

How to confirm post reduction?

‣

What if close reduction fails? What is blocking it?

‣

How long do you keep in hip spica for?

‣

Which structure can you NOT release in reduction?

‣

What do you do with ligamentum teres?

SCENARIO 3 = > 18 months [Q = Open reduction]

‣

What clinical signs?

‣

What approaches for open reduction?

‣

Which approach will you use for which age?

‣

Age limits for reduction-only and require osteotomy?

SCENARIO 4 = > 2 years [Q = need osteotomies as remodelling is now limited]

‣

How do you do open reduction KIV osteotomy?

‣

How much to shorten?

‣

Does femoral shortening osteotomy increase AVN rates?

‣

What acetabular osteotomy will you do for this child?

‣

What are the risks of open reduction? How do you address it?

‣

What is Lorenz position?

‣

What are the features of AVN after DDH?

SCENARIO 5 = > 8 yo [Q = Salvage osteotomies]

‣

How does a neglected DDH present?

‣

What is the treatment principles for a neglected DDH after 8 yo?

‣

Classic XR Arjandas shows of bilateral neglected DDH?

‣

XR of DDH post salter osteotomy. thats why iliac crest looks funny as thats where the graft was taken.

SCENARIO 6 = Treated DDH

‣

How do you know if patient had previous pelvic osteotomies?