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CDH Nomenclature and Screening Programs in Infants: An Orthopedic Overview

Learn about Congenital Dislocation of the Hip (CDH) nomenclature, radiology, causes, key risk factors, screening programs, and treatment approaches in infants. Understand the importance of early detection and treatment for better outcomes.

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CDH Nomenclature and Screening Programs in Infants: An Orthopedic Overview

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  1. Dr. ABDULMONEM ALSIDDIKY , MD , SSCO. Assistant Professor & Consultant pediatric Ortho.& Spinal Deformities KSU,KKUH Riyadh , Saudi Arabia CDHCONGENITALDISLOCATION OF THE HIP

  2. Nomenclature • CDH :Congenital Dislocation of the Hip • DDH :Developmental Dysplasia of the Hip

  3. NORMAL PELVIS

  4. Normal hip Dislocated hip

  5. Patterns of disease • Dislocated • Dislocatable • Sublaxated • Acetabular dysplasia

  6. Radiology • After 6 months: reliable

  7. Causes (multi factorial) Unknown • Hormonal • Relaxin, oxytocin • Familial • Lig.laxity diseases • Genetics • Female 4 X male --- twins 40% • Mechanical • Pre natal • Post natal

  8. Mechanical causes • Pre natal • Breach , oligohydrominus , primigravida , twins • (torticollis , metatarsus adductus ) • Post natal • Swaddling , strapping

  9. Infants at risk • Positive family history: 10X • A baby girl: 4-6 X • Breach presentation: 5-10 X • Torticollis: CDH in 10-20% of cases • Foot deformities: • Calcaneo-valgus and metatarsus adductus • Knee deformities: • hyperextension and dislocation

  10. Infants at risk When risk factors are present • The infant should be reviewed • Clinically • radiologically

  11. Clinical examination • The infant should be • quiet • comfortable

  12. Look: • External rotation • Lateralized contour • Shortening • Asymmetrical skin folds • Anterior – posterior

  13. Move • Limited abduction

  14. Special test • Galiazzi • Ortolani , Barlow test • Trendelenburgh sign • Limping ( waddling gait if bilateral)

  15. Special test Galiazzi test

  16. Special test Ortolani test

  17. Special test Barlow test

  18. Special test Trendelenburgh sign

  19. Screening programs • Clinical screening proven to be effective • Performed by trained personnel • Must be dynamic • Repeated with periodic examination • U/S screening is controversial

  20. Investigations • 0-3 months U/S • > 3months X-ray pelvis AP + abduction

  21. U/S Screening • Incidence of hip stability declines rapidly to 50% within the first week of neonatal life. • Better to delay U/S screening

  22. U/S - Problems • Too sensitive: • Detects a lot of hip abnormalities, most of which would develop normally if left alone • Operator-dependant

  23. Radiology • Early infancy: not reliable

  24. Radiology • After 2-3 months: more reliable

  25. Radiology • After 2-3 months: more reliable 39o 27o

  26. Radiology • After 2-3 months: more reliable Von Rosen view in out in out out in

  27. Radiology • After 2-3 months: more reliable out in

  28. Radiology • After 6 months: reliable

  29. Radiology • After 6 months: reliable

  30. Treatment - Aims • Obtain concentric reduction • Maintain concentric reduction • In a non-traumatic fashion • Without disrupting the blood supply to femoral head

  31. Treatment • Method depends on age • The earlier started, the easier it is • The earlier started, the better the results are • Should be detected EARLY

  32. Treatment • Birth – 6m • Pavlik harness or hip spica • 6-12 m: • Closed reduction under GA and hip spica • 12 - 18 m: • Open reduction • 18 – 24 m: • Open reduction and Acetabuloplasty • 2-8 years: • Open reduction, Acetabuloplasty, and femoral shortening • Above 8 years: • Open reduction, Acetabuloplasty cutting all three pelvic bones, and femoral shortening

  33. Treatment: Neonatal hip instability • Most resolve spontaneously • Can initially wait • Avoid adduction swaddle • Apply double diapers – to bring back!! • See at 2weeks of age

  34. Treatment: Neonatal hip instability Unstable at 2 weeks: • Double / Triple diapers: inadequate • Gives illusion that patient is “in treatment” while wasting valuable time

  35. Treatment: Neonatal hip instability Unstable at 2 weeks: • Pavlik Harness • Dynamic, effective, safe

  36. Treatment: 6-12 m • Initially non-operative closed reduction UGA and immobilization in hip spica cast • Position: • Avoid sever abduction • Avoid frog position • Must obtain stable concentric reduction, otherwise needs surgery

  37. Treatment: 6-12 m • Possibly closed reduction • Stable and concentric reduction • Possibly open reduction • Unstable or un-concentric reduction • Arthrography-guided

  38. Treatment: 6-12 m • Arthrography-guided Closed Reduction

  39. Treatment: 6-12 m Arthrography-guided Closed Reduction Acceptable Too lateralized

  40. Treatment: 18-24 m • Open reduction – surgery • Possibly: Acetabuloplasty

  41. Treatment: Above 2 years • Open reduction, and • Acetabuloplasty, and • Femoral shortening

  42. Acetabuloplasties • Many types

  43. Treatment • Birth – 6m • Pavlik harness or hip spica • 6-12 m: • Closed reduction under GA and hip spica • 12 - 18 m: • Open reduction • 18 – 24 m: • Open reduction and Acetabuloplasty • 2-8 years: • Open reduction, Acetabuloplasty, and femoral shortening • Above 8 years: • Open reduction, Acetabuloplasty cutting all three pelvic bones, and femoral shortening

  44. CDH - Summary • Complex multi-factorial, endemic disease • Health education and Drs. awareness • Screening programs are needed • Learning proper examination methods • Identify at risk groups • Efficient referral system • Proper management by specialized Drs

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