developmental congenital dysplasia of the hip natural history and prevention levels l.
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Developmental (Congenital) Dysplasia of the Hip. Natural History and Prevention Levels.
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  1. 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

  2. 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.

  3. Clasification Dysplasia Typical Subluxation Developmental (Congenital) Dysplasia of the Hip Dislocation Teratologic

  4. Prepatogenic Period.Agent • Generalized ligamentous laxity increased by maternal estrogens and/or other hormones. • Genetic influences. • Multifactorial

  5. 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).

  6. 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).

  7. 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.

  8. 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

  9. 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.

  10. Patogenic Period.Subclinic Period. • Dislocation: femoral head is out of the acetabulum in supero lateral position.

  11. 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

  12. Patogenic Period.Complications. • Avascular necrosis of the femoral head • Redislocation • Residual subluxation • Acetabular dysplasia • Postoperative complications (wound infections)

  13. Patogenic Period.Sequelae. • Coxa vara • Coxa plana • Claudication

  14. 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

  15. 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.

  16. Secondary Prevention.Third Level.Timely Treatment. • Pavlik harness • Fredjka splint • Double and triple diapers are controversial

  17. 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.

  18. Tertiary Prevention.Fifth Level. • Excercise of hips and knees • Reducation of the gait

  19. 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.