Developmental Dysplasia of the hip (DDH)

It is a condition that children maybe born with. The signs include :- The leg on the side of the dislocated hip may appear shorter. The leg on the side of the dislocated hip may turn outward. The folds in the skin of the thigh or buttocks may appear uneven. The space between the legs may look wider than normal. Parents note difference during diaper change. It is mostly painless. If not discovered and treated early, child has painless limping gait and severe weakness of hip abductors on the same side. Hence early detection is essential.

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Just to elaborate further There is a lever mechanism in the hip. The fulcrum is femoral head Once it is dislocated the lever fails The dislocated femoral head on weight bearing move up and down The abductor mechanism fail leading to dipping of opposite pelvis This all lead to trendelenberg gait in unilateral hip dislocation In bilateral cases the gait is described as duck like wadding The hip abductors become short and weak because of failure of lever mechanism. Clinical suspicion may arise at birth or soon later by mothers noting something different Clinical examination help in detection Ortolani or the provocative manuer of Barlow is used. Usg will detect empty acetabulum Xray in unossified bones is interpreted by certain lines Perkins line Hilgen Reiner's line Acetabular index Tear drop shadow Position of proximal femur metaphysis medial side etc. There are many guidelines for treatment At birth using large diapers or pavlic harness will achieve reduction and maintain it. After 6 weeks hip spica in flexion and abduction can be given Surgical reduction is done in little older children Procedure vary with age Now congenital dislocation of hip is called developmental dysplasia It means acetabulum can be dysplastic and femoral head small Leading to easier dislocation

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Plus barlows n ortolanis test .usg of hip joints to confirm .

Yes Sir, but it is preferable that examiner performing ortolani and Barlow is experienced... Also parents may misinterpret what happened.. So if the other signs are seen , then xray is best bet. There is an app called Hipscreen that interprets the xray also... Reference https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-016-0867-4 Thank you.
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