DDH - Developmental Dysplasia of the Hip

Topic

Paeds Ortho

Podcast

Updated

“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.

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What is DDH?

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Where is the deficiency in DDH?

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What are the risk factors?

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

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What is teratologic hip?

SCENARIO 1 = < 6 months [Q = PAVILK]

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How will you approach this patient?

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What physical exam? What signs?

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Till how old do barlow and ortolani test remain present?

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When is US accurate?

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What are the angles on US?

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How do you classify this Ultrasound?

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

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

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What is a Pavlik harness?

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When will you institute the Pavlik harness?

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Is US screening for DDH a good screening test?

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

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How do you apply the pavilk harness? Angles?

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

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How long do you wear it for?

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What is the age limit for Pavlik?

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When can we stop follow up?

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

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

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Patient failed pavilk how will you assess?

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What is Ramsey Zone of Safety?

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What do you do after a closed reduction?

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

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

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How to confirm post reduction?

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What if close reduction fails? What is blocking it?

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How long do you keep in hip spica for?

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Which structure can you NOT release in reduction?

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What do you do with ligamentum teres?

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

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What clinical signs?

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What approaches for open reduction?

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Which approach will you use for which age?

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Age limits for reduction-only and require osteotomy?

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

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How do you do open reduction KIV osteotomy?

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How much to shorten?

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Does femoral shortening osteotomy increase AVN rates?

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What acetabular osteotomy will you do for this child?

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

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What is Lorenz position?

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What are the features of AVN after DDH?

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

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How does a neglected DDH present?

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

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Classic XR Arjandas shows of bilateral neglected DDH?

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

SCENARIO 6 = Treated DDH

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How do you know if patient had previous pelvic osteotomies?