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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) Dysplasia of the Hip Dislocation 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.