This document discusses developmental dysplasia of the hip (DDH), also known as congenital hip dysplasia. DDH ranges from shallow acetabulum to complete hip dislocation. It is more common in females and breech babies. Clinical signs include leg length discrepancy, limited hip abduction, and Trendelenberg gait. Ultrasound is the best initial imaging method, using the alpha and beta angles to assess acetabular depth and femoral head position. X-rays become more useful after age 4-7 months as ossification centers appear. Early diagnosis and treatment are important to prevent long-term complications of DDH like osteoarthritis.
Rickets is a disease of growing bone caused by unmineralized bone matrix at the growth plates, occurring only in children before fusion of the epiphyses. It is caused by vitamin D disorders, calcium deficiency, renal losses, or phosphorous deficiency. Clinical features include failure to thrive, bowed legs, widened wrists and ankles, and bone pain. X-rays show widened growth plates and fraying and cupping of the metaphysis. Treatment involves high dose vitamin D and calcium supplementation.
This document discusses developmental dysplasia of the hip (DDH), including:
- The normal development of the hip joint and how DDH disrupts this.
- Risk factors for DDH including genetic, intrauterine, and clinical factors.
- Methods for diagnosing DDH including physical exam, ultrasound, and x-rays.
- Treatment options for DDH including the Pavlik harness, which is preferred as it allows reduction through flexion and abduction while preventing extension and adduction. Proper positioning and compliance are important for the Pavlik harness to be successful.
Developmental dysplasia of the hip (DDH) is a congenital or acquired deformation of the hip joint where the hips are dislocatable at birth. It can present as a complete hip dislocation, partial hip subluxation, or hip dysplasia. DDH has a higher incidence in females and is caused by generalized ligament laxity from maternal hormones. Clinical signs include asymmetry of skin folds, limping, or limited hip abduction. DDH is diagnosed through tests like the Barlow and Ortolani maneuvers or imaging like x-rays and ultrasound. Treatment depends on age but aims to flex and abduct the hips through methods like the Pavlik harness or hip spica cast.
Developmental dysplasia of the hip (DDH) is an abnormal development of the hip joint that can lead to pain and arthritis if not treated early. Risk factors include breech presentation and female gender. On physical exam, doctors check for hip instability, reduced abduction, and gait asymmetry depending on the patient's age. Treatment options range from hip abduction splints in infants to closed or open reduction in older patients. Septic arthritis is a bacterial infection of the joint that commonly affects knees, ankles, and hips in young children. It requires prompt evaluation, joint fluid analysis, and IV antibiotics to prevent joint destruction and long term complications.
Developmental dysplasia of the hip (DDH) is a spectrum of disorders involving instability or displacement of the femoral head from the acetabulum. DDH includes subluxation, where some contact remains between joint surfaces, and dislocation, where there is complete displacement. DDH is caused by ligamentous laxity, prenatal positioning, and postnatal positioning in extension. Treatment depends on age, with Pavlik harness for neonates, traction or closed reduction for ages 1-6 months, and closed or open reduction from 6-24 months. The goal is early reduction to allow acetabular remodeling and prevent complications like degenerative hip disease.
Transient synovitis, also known as irritable hip, is the most common cause of acute hip pain in children aged 3-8 years. It involves transient inflammation of the hip synovium that causes pain and limping. Symptoms include unilateral hip or groin pain and limping. Diagnosis is usually made after ruling out trauma and infection via x-rays and physical exam. Treatment focuses on rest, anti-inflammatory drugs, and recovery typically occurs within 2 weeks. Legg-Calvé-Perthes disease involves osteonecrosis of the femoral head and requires containment of the hip through bracing or surgery depending on the age and extent of involvement.
Congenital disorders are commonly screened by pediatricians and certain disorders like club foot needs early intervention to get satisfactory results .I have tried to present common disorders in neonates for early diagnosis.
- Recurrence of clubfoot deformity occurs in 10-30% of cases treated with the Ponseti method, most often due to noncompliance with brace wear. Relapse is most common around ages 3-4 and becomes extremely rare after age 7.
- Relapse patterns range from decreased ankle dorsiflexion to a fully rigid equinocavovarus deformity. Management depends on determining if the deformity is supple or rigid and which areas are affected.
- Common procedures for recurrence include recasting, tibialis anterior tendon transfer, and soft tissue releases or osteotomies of the hindfoot, midfoot, or forefoot as needed to address specific deformities. The
Rickets is a disease of growing bone caused by unmineralized bone matrix at the growth plates, occurring only in children before fusion of the epiphyses. It is caused by vitamin D disorders, calcium deficiency, renal losses, or phosphorous deficiency. Clinical features include failure to thrive, bowed legs, widened wrists and ankles, and bone pain. X-rays show widened growth plates and fraying and cupping of the metaphysis. Treatment involves high dose vitamin D and calcium supplementation.
This document discusses developmental dysplasia of the hip (DDH), including:
- The normal development of the hip joint and how DDH disrupts this.
- Risk factors for DDH including genetic, intrauterine, and clinical factors.
- Methods for diagnosing DDH including physical exam, ultrasound, and x-rays.
- Treatment options for DDH including the Pavlik harness, which is preferred as it allows reduction through flexion and abduction while preventing extension and adduction. Proper positioning and compliance are important for the Pavlik harness to be successful.
Developmental dysplasia of the hip (DDH) is a congenital or acquired deformation of the hip joint where the hips are dislocatable at birth. It can present as a complete hip dislocation, partial hip subluxation, or hip dysplasia. DDH has a higher incidence in females and is caused by generalized ligament laxity from maternal hormones. Clinical signs include asymmetry of skin folds, limping, or limited hip abduction. DDH is diagnosed through tests like the Barlow and Ortolani maneuvers or imaging like x-rays and ultrasound. Treatment depends on age but aims to flex and abduct the hips through methods like the Pavlik harness or hip spica cast.
Developmental dysplasia of the hip (DDH) is an abnormal development of the hip joint that can lead to pain and arthritis if not treated early. Risk factors include breech presentation and female gender. On physical exam, doctors check for hip instability, reduced abduction, and gait asymmetry depending on the patient's age. Treatment options range from hip abduction splints in infants to closed or open reduction in older patients. Septic arthritis is a bacterial infection of the joint that commonly affects knees, ankles, and hips in young children. It requires prompt evaluation, joint fluid analysis, and IV antibiotics to prevent joint destruction and long term complications.
Developmental dysplasia of the hip (DDH) is a spectrum of disorders involving instability or displacement of the femoral head from the acetabulum. DDH includes subluxation, where some contact remains between joint surfaces, and dislocation, where there is complete displacement. DDH is caused by ligamentous laxity, prenatal positioning, and postnatal positioning in extension. Treatment depends on age, with Pavlik harness for neonates, traction or closed reduction for ages 1-6 months, and closed or open reduction from 6-24 months. The goal is early reduction to allow acetabular remodeling and prevent complications like degenerative hip disease.
Transient synovitis, also known as irritable hip, is the most common cause of acute hip pain in children aged 3-8 years. It involves transient inflammation of the hip synovium that causes pain and limping. Symptoms include unilateral hip or groin pain and limping. Diagnosis is usually made after ruling out trauma and infection via x-rays and physical exam. Treatment focuses on rest, anti-inflammatory drugs, and recovery typically occurs within 2 weeks. Legg-Calvé-Perthes disease involves osteonecrosis of the femoral head and requires containment of the hip through bracing or surgery depending on the age and extent of involvement.
Congenital disorders are commonly screened by pediatricians and certain disorders like club foot needs early intervention to get satisfactory results .I have tried to present common disorders in neonates for early diagnosis.
- Recurrence of clubfoot deformity occurs in 10-30% of cases treated with the Ponseti method, most often due to noncompliance with brace wear. Relapse is most common around ages 3-4 and becomes extremely rare after age 7.
- Relapse patterns range from decreased ankle dorsiflexion to a fully rigid equinocavovarus deformity. Management depends on determining if the deformity is supple or rigid and which areas are affected.
- Common procedures for recurrence include recasting, tibialis anterior tendon transfer, and soft tissue releases or osteotomies of the hindfoot, midfoot, or forefoot as needed to address specific deformities. The
This document provides information from orthopaedic surgeon Dr. David Slattery about assessing and diagnosing hip conditions in young adults and adolescents. It details Dr. Slattery's background and experience, common hip pathologies and their clinical presentations. It also provides examples of clinical cases involving femoral acetabular impingement, hip dysplasia, and slipped capital femoral epiphysis and the examinations and investigations used to diagnose these conditions.
Blount's disease, also known as tibia vara, is a progressive orthopedic condition that causes bowing of the legs in children. It results from a growth disturbance in the proximal medial tibial growth plate. The deformity includes varus alignment of the knees, internal tibial torsion, and leg length discrepancy. Radiographs show a characteristic wedging and irregularity of the proximal medial tibial epiphysis. Treatment depends on age and severity, ranging from bracing to corrective osteotomies. Congenital metatarsus adductus is another common pediatric foot deformity involving inward twisting of the forefoot. It is often mild and resolves with stretching, but more severe cases may require
This document summarizes Legg-Calvé-Perthes disease, a childhood hip disorder characterized by temporary loss of blood supply to the femoral head. It describes the disease stages including initial sclerosis, fragmentation as new bone forms, and healing. Risk factors include age 4-8 years and delayed bone age. Symptoms include limping and pain. Treatments aim to contain the femoral head through bracing or surgery to prevent joint damage. Prognosis depends on age and deformity, with older children and severe deformity having worse outcomes.
Management of Develpmental Dysplasia of the HipDrkabiru2012
Developmental dysplasia of the hip (DDH) is a spectrum of hip pathology ranging from instability to dislocation that is present at or shortly after birth. DDH has an incidence of 1 in 1000 live births and is more common in females. Risk factors include breech presentation and a family history. Pathological changes in DDH progress from instability to deformity of the hip joint as the child grows. Treatment ranges from observation to bracing to closed or open reduction depending on the severity. Early identification and treatment lead to the best outcomes, while late or untreated cases can result in residual dysplasia or hip degeneration.
Developmental dysplasia of the hip (DDH) is a spectrum of hip disorders that can occur from conception to skeletal maturity. It most commonly affects females and risk factors include genetic predisposition, breech positioning, and hormonal influences. Clinical features include limb asymmetry and limited hip movement. Diagnosis involves clinical tests and imaging like ultrasound or X-rays. Management depends on age, with splinting often used for young infants and closed or open reduction with spica casting for older children. Complications can include limping, osteoarthritis, or avascular necrosis if left untreated.
Congenital club foot is a rigid deformity present at birth characterized by equinus, hind foot varus, midfoot cavus, and forefoot adduction. It has multiple potential etiologies including genetic and environmental factors. Pathoanatomically, there is rotatory subluxation of the talocalcaneonavicular joint complex with talus plantarflexion and hind foot inversion. Higher Pirani scores, which assess midfoot and hindfoot contractures, are associated with greater treatment challenges including more casts and higher rates of tendon release procedures. Imaging can help evaluate severity and assess for atypical or syndromic cases.
This document describes the anatomy of the hip joint, including the ball-and-socket configuration of the femoral head articulating with the acetabulum. It further discusses hip dysplasia, noting that it results from an abnormal developmental relationship between the femur and acetabulum. Risk factors for hip dysplasia include genetic and intrauterine environmental factors. Ultrasound is useful for evaluating the hip joint before ossification occurs, using static and dynamic techniques to assess morphology and stability.
This document discusses common pediatric disorders of the lower extremity, including developmental dysplasia of the hip (DDH), Legg-Calve-Perthes disease, slipped capital femoral epiphysis, knee deformities like bowing and knock-knees, clubfoot, and flat feet. For DDH, it describes methods for detection in newborns, including the Ortolani and Barlow tests, and treatments like Pavlik harnesses or surgery. For knee issues, it provides guidance on when bowing or valgus deformities require intervention versus allowing for natural resolution. Treatment methods for clubfoot including serial casting are also outlined.
Developmental dysplasia of the hip (DDH) refers to abnormal development of the hip joint during infancy. It ranges from mild hip instability to complete dislocation. Risk factors include breech positioning, family history, and neuromuscular disorders. Diagnosis is made through clinical examination and imaging studies like ultrasound and x-rays. Treatment depends on the severity and may include closed or open reduction and casting or bracing. Complications can include degenerative joint disease, leg length discrepancy, and back pain if left untreated.
MedicYatra provides the safe Genu Valgum (Knock knee) treatment and Surgery at its affiliate & trusted hospitals & clinics in various metro cities of India, like Mumbai, Delhi, Bangalore, Chennai, Pune etc.Our Associate Board certified doctors are extensively trained and vastly experienced and have performed hundreds of such cases at our state of the art JCI accredited hospitals & Clinics. Our aim is to provide you the best of the services at the most affordable costs. Don't forget to say hi at info@medicyatra.com
Jose Austine- Evaluation of Developmental Dysplasia of HipJose Austine
Developmental dysplasia of the hip (DDH) is a spectrum of disorders involving abnormal development of the hip joint that can present at different ages. It results from excessive laxity of the hip capsule allowing the femoral head to dislocate from the acetabulum. Clinical assessment involves tests like Barlow's and Ortolani's to evaluate hip stability in infants. Imaging plays an important role, with ultrasonography being very sensitive for detecting abnormalities in young infants. Left untreated, DDH can progress to permanent hip dislocation. Early detection and treatment are important to prevent long-term complications.
This document discusses lower limb alignment abnormalities and their evaluation and management. It describes genu varum and valgus deformities of the knee as well as coxa vara and valgus deformities of the hip. It outlines how to describe the location of deformities, identify physiological vs pathological knee deformities based on measurements, and evaluate patients presenting with knee deformities. Common causes of pathological deformities are discussed along with associated radiographic findings. Surgical management options including epiphysiodesis for immature patients and osteotomies for mature patients are described for correcting varus and valgus deformities of the knee and hip.
- Physiological variations in children such as intoeing, out-toeing, bowing of the legs, and flat feet are common and usually resolve on their own without intervention. Conditions that suggest an abnormality include asymmetry, limitation of movement, or progressive deformity.
- Intoeing is most commonly caused by femoral anteversion or tibial torsion in young children and resolves by age 8 in 95% of cases. Out-toeing can be due to femoral retroversion or external tibial torsion.
- Genu varum is normal in infants under 18 months while genu valgum peaks between 3-4 years and also typically resolves by age 7 without intervention.
Congenital talipes equino varus (CTEV), also known as clubfoot, is a congenital deformity of the foot where the foot is twisted inward and downward. The causes are mostly unknown but may be genetic, mechanical pressure in the womb, or issues with calf muscle development. Clinically, the foot appears smaller, turned inward and downward. Treatment depends on severity but may include manipulation, casting, soft tissue releases, tendon transfers and osteotomies. Splint
Developmental dysplasia of the hip (DDH) is a spectrum of hip disorders presenting at different ages. It results from excessive hip joint laxity causing failure to maintain the femoral head in the acetabulum. In infants, DDH can cause hip instability or dislocation detectable on examination or imaging. Over time, untreated dysplasia can lead to a poorly formed acetabulum and permanent hip dislocation. Physical exam findings vary by age but may include a positive Ortolani or Barlow sign in infants, limited hip abduction, leg length discrepancy, and Trendelenburg gait in older children.
Blount's disease is a developmental condition characterized by a disturbance of orderly bone growth in the upper tibia. This results in a varus deformity of the knee. It is more common in obese children who start walking early and has been linked to hereditary factors. Radiographs show a widened growth plate medially with beaking of the metaphysis. Treatment depends on age and severity but may include bracing, corrective osteotomies, or hemiepiphysiodesis in more severe cases. Complications can include recurrence of deformity or nerve palsies. Proper treatment can prevent long term osteoarthritis.
This document discusses developmental dysplasia of the hip (DDH), also known as congenital hip dysplasia. DDH ranges from shallow acetabulum to complete hip dislocation. Risk factors include breech presentation and family history. Diagnosis involves clinical tests like Barlow and Ortolani in newborns and ultrasound or x-ray in older infants. Treatment depends on age and includes Pavlik harness in newborns, closed or open reduction and casting in infants, and osteotomies if needed in older children. Complications can include avascular necrosis. Proper screening and treatment can prevent long term issues from untreated DDH.
This document provides information from orthopaedic surgeon Dr. David Slattery about assessing and diagnosing hip conditions in young adults and adolescents. It details Dr. Slattery's background and experience, common hip pathologies and their clinical presentations. It also provides examples of clinical cases involving femoral acetabular impingement, hip dysplasia, and slipped capital femoral epiphysis and the examinations and investigations used to diagnose these conditions.
Blount's disease, also known as tibia vara, is a progressive orthopedic condition that causes bowing of the legs in children. It results from a growth disturbance in the proximal medial tibial growth plate. The deformity includes varus alignment of the knees, internal tibial torsion, and leg length discrepancy. Radiographs show a characteristic wedging and irregularity of the proximal medial tibial epiphysis. Treatment depends on age and severity, ranging from bracing to corrective osteotomies. Congenital metatarsus adductus is another common pediatric foot deformity involving inward twisting of the forefoot. It is often mild and resolves with stretching, but more severe cases may require
This document summarizes Legg-Calvé-Perthes disease, a childhood hip disorder characterized by temporary loss of blood supply to the femoral head. It describes the disease stages including initial sclerosis, fragmentation as new bone forms, and healing. Risk factors include age 4-8 years and delayed bone age. Symptoms include limping and pain. Treatments aim to contain the femoral head through bracing or surgery to prevent joint damage. Prognosis depends on age and deformity, with older children and severe deformity having worse outcomes.
Management of Develpmental Dysplasia of the HipDrkabiru2012
Developmental dysplasia of the hip (DDH) is a spectrum of hip pathology ranging from instability to dislocation that is present at or shortly after birth. DDH has an incidence of 1 in 1000 live births and is more common in females. Risk factors include breech presentation and a family history. Pathological changes in DDH progress from instability to deformity of the hip joint as the child grows. Treatment ranges from observation to bracing to closed or open reduction depending on the severity. Early identification and treatment lead to the best outcomes, while late or untreated cases can result in residual dysplasia or hip degeneration.
Developmental dysplasia of the hip (DDH) is a spectrum of hip disorders that can occur from conception to skeletal maturity. It most commonly affects females and risk factors include genetic predisposition, breech positioning, and hormonal influences. Clinical features include limb asymmetry and limited hip movement. Diagnosis involves clinical tests and imaging like ultrasound or X-rays. Management depends on age, with splinting often used for young infants and closed or open reduction with spica casting for older children. Complications can include limping, osteoarthritis, or avascular necrosis if left untreated.
Congenital club foot is a rigid deformity present at birth characterized by equinus, hind foot varus, midfoot cavus, and forefoot adduction. It has multiple potential etiologies including genetic and environmental factors. Pathoanatomically, there is rotatory subluxation of the talocalcaneonavicular joint complex with talus plantarflexion and hind foot inversion. Higher Pirani scores, which assess midfoot and hindfoot contractures, are associated with greater treatment challenges including more casts and higher rates of tendon release procedures. Imaging can help evaluate severity and assess for atypical or syndromic cases.
This document describes the anatomy of the hip joint, including the ball-and-socket configuration of the femoral head articulating with the acetabulum. It further discusses hip dysplasia, noting that it results from an abnormal developmental relationship between the femur and acetabulum. Risk factors for hip dysplasia include genetic and intrauterine environmental factors. Ultrasound is useful for evaluating the hip joint before ossification occurs, using static and dynamic techniques to assess morphology and stability.
This document discusses common pediatric disorders of the lower extremity, including developmental dysplasia of the hip (DDH), Legg-Calve-Perthes disease, slipped capital femoral epiphysis, knee deformities like bowing and knock-knees, clubfoot, and flat feet. For DDH, it describes methods for detection in newborns, including the Ortolani and Barlow tests, and treatments like Pavlik harnesses or surgery. For knee issues, it provides guidance on when bowing or valgus deformities require intervention versus allowing for natural resolution. Treatment methods for clubfoot including serial casting are also outlined.
Developmental dysplasia of the hip (DDH) refers to abnormal development of the hip joint during infancy. It ranges from mild hip instability to complete dislocation. Risk factors include breech positioning, family history, and neuromuscular disorders. Diagnosis is made through clinical examination and imaging studies like ultrasound and x-rays. Treatment depends on the severity and may include closed or open reduction and casting or bracing. Complications can include degenerative joint disease, leg length discrepancy, and back pain if left untreated.
MedicYatra provides the safe Genu Valgum (Knock knee) treatment and Surgery at its affiliate & trusted hospitals & clinics in various metro cities of India, like Mumbai, Delhi, Bangalore, Chennai, Pune etc.Our Associate Board certified doctors are extensively trained and vastly experienced and have performed hundreds of such cases at our state of the art JCI accredited hospitals & Clinics. Our aim is to provide you the best of the services at the most affordable costs. Don't forget to say hi at info@medicyatra.com
Jose Austine- Evaluation of Developmental Dysplasia of HipJose Austine
Developmental dysplasia of the hip (DDH) is a spectrum of disorders involving abnormal development of the hip joint that can present at different ages. It results from excessive laxity of the hip capsule allowing the femoral head to dislocate from the acetabulum. Clinical assessment involves tests like Barlow's and Ortolani's to evaluate hip stability in infants. Imaging plays an important role, with ultrasonography being very sensitive for detecting abnormalities in young infants. Left untreated, DDH can progress to permanent hip dislocation. Early detection and treatment are important to prevent long-term complications.
This document discusses lower limb alignment abnormalities and their evaluation and management. It describes genu varum and valgus deformities of the knee as well as coxa vara and valgus deformities of the hip. It outlines how to describe the location of deformities, identify physiological vs pathological knee deformities based on measurements, and evaluate patients presenting with knee deformities. Common causes of pathological deformities are discussed along with associated radiographic findings. Surgical management options including epiphysiodesis for immature patients and osteotomies for mature patients are described for correcting varus and valgus deformities of the knee and hip.
- Physiological variations in children such as intoeing, out-toeing, bowing of the legs, and flat feet are common and usually resolve on their own without intervention. Conditions that suggest an abnormality include asymmetry, limitation of movement, or progressive deformity.
- Intoeing is most commonly caused by femoral anteversion or tibial torsion in young children and resolves by age 8 in 95% of cases. Out-toeing can be due to femoral retroversion or external tibial torsion.
- Genu varum is normal in infants under 18 months while genu valgum peaks between 3-4 years and also typically resolves by age 7 without intervention.
Congenital talipes equino varus (CTEV), also known as clubfoot, is a congenital deformity of the foot where the foot is twisted inward and downward. The causes are mostly unknown but may be genetic, mechanical pressure in the womb, or issues with calf muscle development. Clinically, the foot appears smaller, turned inward and downward. Treatment depends on severity but may include manipulation, casting, soft tissue releases, tendon transfers and osteotomies. Splint
Developmental dysplasia of the hip (DDH) is a spectrum of hip disorders presenting at different ages. It results from excessive hip joint laxity causing failure to maintain the femoral head in the acetabulum. In infants, DDH can cause hip instability or dislocation detectable on examination or imaging. Over time, untreated dysplasia can lead to a poorly formed acetabulum and permanent hip dislocation. Physical exam findings vary by age but may include a positive Ortolani or Barlow sign in infants, limited hip abduction, leg length discrepancy, and Trendelenburg gait in older children.
Blount's disease is a developmental condition characterized by a disturbance of orderly bone growth in the upper tibia. This results in a varus deformity of the knee. It is more common in obese children who start walking early and has been linked to hereditary factors. Radiographs show a widened growth plate medially with beaking of the metaphysis. Treatment depends on age and severity but may include bracing, corrective osteotomies, or hemiepiphysiodesis in more severe cases. Complications can include recurrence of deformity or nerve palsies. Proper treatment can prevent long term osteoarthritis.
This document discusses developmental dysplasia of the hip (DDH), also known as congenital hip dysplasia. DDH ranges from shallow acetabulum to complete hip dislocation. Risk factors include breech presentation and family history. Diagnosis involves clinical tests like Barlow and Ortolani in newborns and ultrasound or x-ray in older infants. Treatment depends on age and includes Pavlik harness in newborns, closed or open reduction and casting in infants, and osteotomies if needed in older children. Complications can include avascular necrosis. Proper screening and treatment can prevent long term issues from untreated DDH.
This document discusses developmental dysplasia of the hip (DDH), which refers to dysplasia of the hip joint that develops during fetal life or infancy. It can range from shallow acetabulum to complete hip dislocation. DDH is more common in females and risk factors include breech presentation and family history. Treatment depends on age, with Pavlik harness used in infants under 6 months and hip spica casting for older infants and children under 2 years. The goal of treatment is to reduce the femoral head in the acetabulum and allow normal hip joint development.
Developmental dysplasia of the hip (DDH) is a partial or complete displacement of the femoral head from the acetabular cavity present since birth. Risk factors include being female, a first born, or having a family history. Clinical features in infants include positive Ortolani's and Barlow's tests, while features in older children and adults include a waddling gait, limb length discrepancy, and decreased hip range of motion. Radiographs are used to assess parameters like the acetabular index and femoral head position to diagnose and monitor DDH at various stages.
Developmental dysplasia of the hip (DDH) is a spectrum of hip dysplasia that ranges from shallow acetabulum to subluxation to complete dislocation. It is more common in females and affects the left hip more often than the right. Risk factors include breech birth position, torticollis, and a family history. Symptoms may include leg length discrepancy, uneven skin folds, limping, or limited mobility. Diagnosis involves clinical examination including Ortolani's and Barlow's maneuvers as well as imaging like ultrasound and x-rays. Treatment options include use of a Pavlik harness or von Rosen splint for younger infants or surgical reduction and spica casting for older children.
This document provides information on developmental dysplasia of the hip (DDH). It discusses the definition, causes, incidence, clinical findings, pathology, diagnosis through imaging like ultrasound and X-rays, and treatment approaches for different age groups from newborns to older children. Key tests like Barlow, Ortolani and imaging classifications including Graf are outlined. The main treatment mentioned is use of Pavlik harness for young infants, while older infants may require traction and closed reduction or open reduction if closed fails.
Developmental dysplasia of the hip (DDH) is a condition where the hip joint is not properly formed or does not properly develop during fetal life or infancy. It ranges from shallow hip sockets to partial or complete dislocation of the hip joint. The goals of treatment are to reduce the femoral head into the acetabulum and maintain a concentric reduction to allow for normal hip development. Treatment depends on the age of presentation and severity, and may include use of a Pavlik harness, hip spica cast, closed or open surgical reduction, and osteotomies. Early diagnosis and treatment generally lead to better outcomes.
Developmental dysplasia of the hip (DDH) is a condition where the hip joint is not properly formed or does not properly develop during fetal life or infancy. It ranges from shallow hip sockets to partial or complete dislocation of the hip joint. The goals of treatment are to reduce the femoral head into the acetabulum and maintain a concentric reduction to allow for normal hip development. Treatment depends on the age of presentation and severity, and may include use of a Pavlik harness, hip spica cast, closed or open surgical reduction, and osteotomies. Early diagnosis and treatment generally lead to better outcomes.
1. Developmental dysplasia of the hip (DDH) refers to dysplasia or dislocation of the hip joint that develops during fetal life or infancy. It can range from shallow acetabulum to partial or complete dislocation.
2. Risk factors include female sex, breech presentation, family history, and swaddling practices that restrict hip movement. Screening involves clinical examination and ultrasound of newborns and infants.
3. Treatment depends on age and severity but aims to reduce the femoral head and maintain the reduction to allow for normal hip development. Options include Pavlik harness, hip spica casting, and surgery.
1. Developmental dysplasia of the hip (DDH) refers to dysplasia or dislocation of the hip joint that develops during fetal life or infancy. It can range from shallow acetabulum to partial or complete dislocation.
2. Risk factors include female sex, breech presentation, family history, and swaddling practices that restrict hip movement. Screening involves clinical tests and ultrasound imaging to detect abnormalities.
3. Treatment depends on age and severity but generally aims to reduce the femoral head and maintain the reduction through devices like Pavlik harness or hip spica casting. Surgical intervention may be needed for older patients or failed non-surgical treatment.
1. Developmental dysplasia of the hip (DDH) refers to dysplasia or dislocation of the hip joint that develops during fetal life or infancy. It can range from shallow acetabulum to partial or complete dislocation.
2. Risk factors include female sex, breech presentation, family history, and swaddling practices that restrict hip movement. Screening involves clinical examination and ultrasound of newborns and infants.
3. Treatment depends on age and severity but aims to reduce the femoral head and maintain the reduction to allow for normal hip development. Options include Pavlik harness, hip spica casting, and surgery.
This document discusses developmental dysplasia of the hip (DDH), formerly known as congenital dislocation of the hip. DDH is a spectrum of pathology in the development of the immature hip joint, ranging from mild dysplasia to frank dislocation. Risk factors include increased joint laxity, female sex, breech presentation, tight intrauterine space, and family history. Diagnosis involves physical examination maneuvers in infants and imaging like ultrasound and x-rays in older children. Treatment depends on age, with harnesses and casting for young infants and open reduction and casting for older children. Complications can include avascular necrosis, redislocation, and residual deformities.
This document discusses developmental dysplasia of the hip (DDH), including its etiology, presentation, diagnosis and treatment. Key points include:
- DDH is a spectrum of hip disorders presenting at different ages, including subluxation, acetabular dysplasia and dislocation.
- Risk factors include ligamentous laxity, breech positioning, and postnatal positioning with hips in extension.
- Clinical diagnosis involves the Ortolani and Barlow tests for instability in infants. Imaging includes ultrasound and x-rays.
- Left untreated, DDH can progress from instability to dislocation and eventual osteoarthritis. Treatment aims to prevent this progression.
Developmental dysplasia of the hip (DDH) is a condition where the femoral head has an abnormal relationship with the acetabulum. The document discusses the normal development of the hip joint, pathoanatomy and clinical presentation of DDH, as well as methods of diagnosis including imaging and treatment options depending on the age of presentation. Treatment in infants less than 6 months involves the Pavlik harness to obtain and maintain reduction of the hip to allow for normal development.
Developmental Dysplasia of Hip final.pptxsudarshan731
This document provides information on Developmental Dysplasia of the Hip (DDH), including its definition, risk factors, diagnosis, and management approaches. DDH is a spectrum of abnormalities where the hip joint does not properly form during development before or after birth. Risk factors include breech positioning and female sex. Diagnosis involves clinical examination and imaging like ultrasound and x-rays. Management is based on age and severity, ranging from harness treatment in infants, to closed or open reduction and casting in older children, and osteotomies or salvage procedures in older children and adults. The goal is early diagnosis and treatment to reduce dislocation and prevent complications like avascular necrosis.
This document discusses developmental dysplasia of the hip (DDH). It begins with an introduction to DDH, covering the etiology, normal hip development, pathoanatomy, clinical presentation, investigations, treatment, and complications. Key points include that DDH has multifactorial causes, involves abnormalities in the femoral head's relationship to the acetabulum, and is diagnosed through physical exams and imaging tests like ultrasound and x-rays. Left untreated, DDH can lead to secondary pathological changes in hip structure and function.
This document discusses developmental dysplasia of the hip (DDH). It begins by defining DDH and providing epidemiological data on incidence. It then covers normal hip development, risk factors, clinical presentation, imaging findings, and management approaches. For newborns, treatment focuses on stabilizing unstable hips or reducing dislocated hips using a Pavlik harness, which places the hips in flexion and abduction. The success rate of the Pavlik harness in newborns is reported to be 85-95%.
This document discusses development dysplasia of the hip (DDH), including its presentation, risk factors, diagnosis, natural history, and treatment. DDH includes a spectrum of disorders like subluxation, dislocation, and acetabular dysplasia. Risk factors include breech presentation, female sex, and family history. Clinical examination involves assessing range of motion and stability tests. Radiographs and ultrasound are used for diagnosis. Without treatment, DDH can progress to osteoarthritis, but early detection and treatment can help prevent long-term issues.
Developmental dysplasia of the hip (DDH) refers to a spectrum of abnormalities where the femoral head is not properly seated in the acetabulum. DDH can range from mild dysplasia to complete dislocation. Predisposing factors include breech positioning, female sex, and family history. Diagnosis involves clinical examination of the Ortolani and Barlow signs in infants as well as ultrasound and x-rays. Treatment goals are reduction and maintenance of reduction to allow joint development. For infants under 6 months, the Pavlik harness is most commonly used and aims to maintain flexion and abduction of the hip. Success rates are high if used full-time for 6 months, monitoring progress regularly with examination and ultrasound.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
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STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7
Developmental dysplasia of hip
1. Subject seminar
SRI SIDDHARTHA MEDICAL COLLEGE,TUMKUR
DEVELOPMENTAL DYSPLASIA OF HIP
CHAIRPERSON: PROF. & HOD Dr. Kiran Kalaiah
MODERATOR: PROF. & HOD Dr. Kiran Kalaiah
SPEAKER: Dr. G. ARUN SIVA RAM
2. Definition :
• Dysplasia of the hip that develop during fetal life or in infancy.
• It ranges from dysplasia of the acetabulum (shallow acetabulum) to
subluxation of the joint to complete dislocation.
• The old name was ‘‘congenital dysplasia of the hip (CDH).’’ The name
has changed to indicate that not all cases are present at birth and that
some cases can develop later on during infancy and childhood
5. INCIDENCE
• Most newborn screening studies suggest that some degree of hip
instability can be detected in 1/100 to 1/250 babies, actual dislocated
or dislocatable hips are much less common, being found in 1-1.5 of
1000 live births.
• There is marked geographic and racial variation in the incidence of
DDH.
• More inidence of DDH IN Sweden,Yugoslavia and Canada.
6. ETIOLOGY:
• A positive family history for DDH is found in 12-33% of affected
patients.
• DDH is more common among female patients (80%). This is thought
to be due to the greater susceptibility of female fetuses to maternal
hormones such as relaxin, which increases ligamentous laxity
• Primigravida.
• Breech presentation(2-3%).
• Oligohydramnios ,primi gravida and large baby ( crowding
phenomenon ).
• Adduction and Extension postnatally.
8. • The left hip is the most commonly affected hip
• In the most common fetal position, this is the hip that is usually
forced into adduction against the mother’s sacrum.
• Girls are affected 5 times more than boys.
9. TYPES
• DDH is classified into two major groups :
• Typical and teratologic .
• Typical DDH occurs in otherwise normal patients or those without
defined syndromes or genetic conditions.
• Teratologic hip dislocations usually have identifiable causes such as
arthrogyposis or a genetic syndrome and occur before birth.
15. NEONATE
• Exam one hip at a time
• Baby must be quiet
• Barlow’s sign: provocative maneuver
• Ortolani’s sign: reduces hip
• Other signs not helpful in newborn
16. NEWBORN
Usually asymptomatic and must be screened by special maneuvers
1) Barlow test.
It is a provocative test that attempts to dislocate an unstable hip.
- Flexion ,adduction, posteriorly
- . – “Clunk”
17. The Barlow test for developmental dislocation of the hip in a
neonate.A, With the infant supine, the examiner holds both of the
child's knees and gently adducts one hip and pushes posteriorly.B,
When the examination is positive, the examiner will feel the femoral
head make a small jump (arrow) out of the acetabulum (Barlow's sign).
When the pressure is released, the head is felt to slip back into place.
18. ORTOLANI TEST
It is a maneuver to reduce a recently dislocated hip.
• Flexion, abduction, anteriorly.
• We can`t use X-rays because the acetabulum and proximal femur are
cartilaginous and wont be shown on X-ray.
• US is the best method to Dx.
19. • The Ortolani test for developmental dislocation of the hip in a
neonate.A, The examiner holds the infant's knees and
gently abducts the hip while lifting up on the greater trochanter with
two fingers.B, When the test is positive, the dislocated femoral head
will fall back into the acetabulum (arrow) with a palpable (but not
audible) “clunk” as the hip is abducted (Ortolani's sign). When the hip
is adducted, the examiner will feel the head redislocate posteriorly.
20. CLINICAL MANIFESTATION- INFANT
• As the baby enters the 2nd and 3rd months of life, the soft tissues
begin to tighten and the Ortolani and Barlow tests are no longer
reliable.
• Shortening of the thigh, the Galeazzi sign , is best appreciated by
placing both hips in 90 degrees of flexion and comparing the height of
the knees, looking for asymmetry
21. • The most diagnostic sign is Ortolani’s limitation of abduction.
• Abduction less than 60 degrees is almost diagnostic.
• X-rays after the age of 3 months can be helpful esp. after the
appearance of the ossific nucleus of the femoral head
• US is 100% diagnostic.
22. INFANT PRESENTATION
• Skin fold asymmetry
• Limited hip abduction
•
• Unequal femoral lengths (Galeazzi’s sign)
• (Flex both hips and one side shows apparent femoral shortening)
27. After walking age
• Trendelenberg gait
• Leg length discrepancy
• Increased lumbar lordosis in Bilateral dislocation
• –Klisic test positive
28. • The examiner places the middle finger over the greater trochanter,
and the index finger on the anterior superior iliac spine.A, With a
normal hip, an imaginary line drawn between the two fingers points
to the umbilicus.B, When the hip is dislocated, the trochanter is
elevated and the line projects halfway between the umbilicus and the
pubis.
31. Screening
• All neonates should have a clinical examination for hip instability
• Risk factors :
– breech presentation – family history
– torticollis
– oligohydramnios
– metatarsus adductus
32. Imaging
• Xray femur head ossify at 4-7 months
• Usg
• Ct
• Mri
• arthrogram
33. Radiograph
• It is not reliable in early stages of DDH but new born screening may
reveal severe acetabular dysplasia or teratological dislocation.
• as child grows soft tissue become contracted and radiographs
become more helpful in diagnosis.
• Most common used lines of reference are vertical line of Perkins and
horizontal line of Hilgenreiner, both used to assess the position of
femoral head.
34. Von rosen view
• In this view both hips are Abducted, Internally Rotated and Extended.
• Line is drawn along femoral shaft, which intersect acetabulum.
• In dislocated hip, it crosses above the acetabulum.
35. Von rosen view
• AP X-ray: hip in 45°abduction and IR describes the longitudinal
relationship between long axis of femur and acetabulum
36. Xray
Horizontal line of Hilgenreiner:
drawn between upper ends of tri-radiate
cartilage of the acetabulum.
Vertical line of perkins:
drawn from the lateral edge of the acetabulum vertical to horizontal line.
4 quadrants:
Normal hip: the ossification center of the femoral
hip lower medial quadrant.
Dislocated hip: upper lateral quadrant.
37. Perkin line is through lateral margin of
acetabulum
• While hilgenreiner line is through triradiate cartilage.
• Shenton line is curved line that begins at lesser trochanter, goes upto
femoral neck, and connect with line along inner margin of pubis.
• In normal hip, medial beak of femoral metaphysis lies in lower inner
quadrant produced by junction of Perkin and hilgenreiner lines.
38. Dimensions H and D are measured to quantify proximal
and lateral displacement of the hip and are most useful
when the head is not ossified.
Acetabular index and the medial gap
39. Acetabular index:
angle between horizontal line of hilgenreiner and the line between the
two edges of the acetabulum.
normal hip 20 to 30*
dilocated or dysplastic hip ≥ 30*
Shenton’s line:
semicircle between femoral neck and upper arm of obturator foramen,
in dislocated hip this line is broken.
40. Acetabular index
The acetabular index is the angle between a line drawn along the margin of the acetabulum and
Hilgenreiner's line; it averages 27.5 degrees in normal newborns and decreases with age.
41. Centre edge angle
• It is useful to measure hip position.
• It is formed at the junction of Perkin line with line that connects
lateral margin of acetabulum to the center of femoral head.
• In children 6-13 yr. old, >19 degree is considered normal.
• • In children >=14 yr. old, >25 degree is considered normal.
44. AP X-ray
Lateral:wall of acetabulum
Medial:lesser pelvis
Inferior :acetabular notch
Appears between 6-23 mo
[delayed in DDH]
45. It significans is in the pronosis
• Hips in which teardrop appears within 6 months of reduction have
better outcome than in which it appears late.
• 4 types have been noted:-
• Open , closed , crossed and reversed.
• Also be describe as U- or V- shaped.
• V-shaped associated with poor outcome.
46. Diagnosis
1. ULTRA SOUND
• In the Graf technique, the transducer is placed over the greater
trochanter, which allows visualization of the ilium, the bony
acetabulum, the labrum, and the femoral epiphysis
• The angle formed by the line of the ilium and a line tangential to the
boney roof of the acetabulum is termed the α angle and represents the
depth of the acetabulum.
• Values > 60 degrees are considered normal, and those < 60 degrees
imply acetabular dysplasia.
47. • The β angle is formed by a line drawn tangential to the labrum and
the line of the ilium; this represents the cartilaginous roof of the
acetabulum.
• A normal β angle is < 55 degrees, as the femoral head subluxates, the
β angle increases.
48.
49.
50.
51. • In DDH , alpha angle decreases and beta angle increases, depending
upon femoral head subluxation.
• Depending upon alpha angle measurment he proposed a
classification system
53. MRI
• It gives excellent anatomical visualization of infant hip.
• Kashiwagi and associates proposed classification of hips with DDH.
• Group 1 hips had sharp acetabular rim, all were reducible with Pavlik
hareness.
• Group 2 hips had a rounded acetabular rim and almost all are
reducible with Pavlik hareness.
54. Group 3 hips have inverted acetabular rim,
and none was reducible with hareness.
• MRI findings includes :-
• Widening of iliac bone,
• Lateral drift of superior and posterior portions of acetabular floor,
• Overgrowth of acetabular cartilage,
• Convexity of posterior portion of cartilage
55. TREATMENT
Is divided in 5 age – related groups
1) newborn ( birth to 6 months old )
2) infant ( 6 to 18 months old )
3) toddler ( 18 to 36 months old )
4) child ( 3 to 8 yrs. Old )
5) adolescent and young adult ( > 8 yrs. Old )
56.
57. BIRTH TO SIX MONTHS
Triple-diaper technique
– Prevents hip adduction
– “Success” no different in some untreated hips
Pavilk harness (1944)
– Experienced staff*
– Very successful
– Allows free movement within confines of restraints
58. • Pavlik harness :- is used in first 6 months , shows excellent result in t/t
of DDH.
• It is dynamic flexion-abduction orthosis.
• c/I in children who are crawling or fixed soft tissue contracture, or
teratological dislocation present.
• After application, radiograph is taken and confirm the reduction. Hip
is placed in flexion of 110 and abduction to occur by gravity itself .
59. PELVIC HARNESS
Indications
• Fully reducible hip
• Child not attempting to stand
Close regular follow-up (every 1-2 weeks) • For imaging and
adjustments
Duration
• Childs age at hip stability + 3 months
60. APPLICATION
• A:The chest halter is applied. The shoulder straps on the halter should
cross in the back. B:The leg stirrup straps are applied
C:The attachment for the anterior (flexor) stirrup straps should be
located at the anterior axillary line
• D:posterior (abduction) stirrup straps should be attached over the
scapula. The position should be set to hold the hip in 90° of flexion
with the posterior straps limiting adductionto prevent dislocation.
61. How long pavlik harness should be continued
• After closed reduction and application of pavlik hareness. Patient is
follow up in every 1-2 weeks.
• At this time, hip stability is checked.
• Pavlik hareness is discontinued 6 weeks after clinically hip stability is
obtained.
• To weaning of up to 2 hrs. per week until brace is worn at night time.
62. Persistent dislocation of hip
• May be present after application of pavlik hareness , 4 basic pattern is
observed
• Superior, inferior , lateral and posterior.
• If present following manuvre should be done
• Superior – additional flexion is required,
• Inferior – flexion should be decreased,
• Lateral – closed observation to see for direction of femoral neck
towards triradiate cartilage.
63. Head may be gradually reduce and dock into
the acetabulum.
• Persistent posterior dislocation is difficult to treat. As tight hip
adductor muscle are present.
• If any of this persistent dislocation present for more than 3 to 6
weeks, pavlik hareness should be discontinued.
• t/t includes closed or open reduction and casting.
64. Pavlik Harness
FAILURES:
– Poor parent compliance
– Improper use by the physician
• Inadequate initial reduction
• Failure to recognize persistent dislocation
65. COMPLICATION
Avascular necrosis
• Forced hip abduction
• Safe zone (abd/adduction and flexion/extension)
Femoral nerve palsy
• Hyperflexion
*Be aware of Pavlik Harness Disease
*Follow until skeletal maturity
66. OTHER SPLINT
• Ilfeld and von rosen splint have high rate of success with fewer
complication but not superior to pavlik hareness.
• Frejka pillow and triple diaper are not used because of high rate of
AVN.
67.
68.
69.
70. Treatment:6 months-2 years
• AIM: obtain & maintain concentric reduction without damaging
femoral head
• Closed / open reduction
• Femoral shortening & innominate osteotomy may be needed
• pre op traction ??
71. Traction
• Pre-reduction traction was considered essential to reduce the
incidence of AVN and to enable the surgeon to obtain a closed
reduction
Salter et al 1969
Gage & winter 1972
Morel et al 1975
Langenskiold & Paavilainen 2000
• “The need for traction has been challenged by a number of studies
showing that hips can be safely reduced without preliminary traction”
Weinstein & Ponsetti 1979 Kahle et al 1990
Quinn et al 1994
• Current reccomendation: No traction
72. Closed reduction
• Stable: if leg could be adducted 30° from max abduction & extend to
below 90°
• Unstable: if wide abduction or more than 10 or 15 degrees of internal
rotation is required to maintain reduction
75. Arthrography
• An arthrogram obtained at the time of reduction is very helpful for
evaluating the depth and stability of the reduction
• Width of the medial dye pool to asses lateralisation
77. Open Reduction...!!
• Unable to achieve closed reduction
• Widening of the joint space
• Unstable reductions
• Loss of reduction on follow up
• Advanced age
78. Open reduction can be performed by
• Anterior
• Anteromedial
• Medial approach
• Anterior approach :- pathology in the anterior and lateral aspect of
hip can be easily reached and pelvic osteotomy can be easily
performed.
93. 2years and older
• For child 2 -3 years of age, during open reduction acetabular
coverage if insufficient warrants reorientation osteotomy
• If coxa valga with excessive anteversion, VDRO may be done.
• Children > 3 years usually need an acetabular procedure
• Femoral shortening is essential part of it’s management. In past , child
is put on skeletal traction but result of shortening are better and
morbidity is less.
94. Open reduction with femoral shortening
• Pressure leads to risk of AVN
• Better results than preoperative traction in older children with less
morbidity
95. When to do??
• Anticipated increased pressure on reduced femur head
• Recommended in child > 2yrs.
• distract the joint few millimeter per operatively
• Judge the tightness of soft tissues after reduction
• irreducible dislocation
96. How much shortening?
• Pre op: bottom of the femoral head to the floor of the acetabulum (a
to b)
• amount of overlap is noted after osteotomy • Tension of the soft
tissue
Derotation usually combined
• leaving 15 to 20 degrees of anteversion
101. Salter Single Innominate
•Age –18 months –6 years
•Requires concentrically reduced hip
–Open reduction at same time is possible
–Iliopsoas and adductor tenotomies often required
•Covers antero-later alacetabular deficiency
–Up to 15 degree of acetabular index corrected
102. Salter osteotomy
• Osteotomy: transverse & perpendicular to ilaic axis from just above
AIIS to sciatic notch
• Symphysis pubis :a flexible hinge for acetabular redirection to cover
anterolateral insuffiency in a concentrically reduced hip
103. Salter
• Anterior approach to acetabulum
–Exposing inner and outer ilium
–Expose hip capsule if reduction needed
–Transverse osteotomy is done just above acetabulum
• Sciatic notch to Ant.Inf.iliac Spine
–Rotate on pubic symphysis in antero-lateral direction –Hold correction
with bone graft wedge & K-wires
114. Pemberton acetauloplasty
•Age –18 months –10 years
•Requires reduced hip
•Decreases acetabular volume
–Remodeling of acetabulum required
•Corrects >15 degree of Acetabular index •Reduces antero-lateral
acetabular defects
–Cuts altered to cover more anteriorly or laterally
115. • Anterior Approach -Exposure as for Salter
–Cut inner and outer table with small osteotome
• – osteotomy 1cm above AIIS, staying 1 cm above capsule
–Do not cut through to sciatic notch
–Lever through the cut until coverage is acceptable •(Levers on tri-
radiate cartilage)
• –Hold correction with bone graft wedge
116.
117. Dega acetabuloplasty
•Similar to Pemberton
•Larger posterior hinge
–Hinges on horizontal tri-radiate limb
•Less inner table osteotomized for more lateral coverage
(More inner table –more anterior coverage)
118. • This is incomplete
involves osteotomy of anterior and middle portion of inner cortex of
ilium , leaving a intact hinge posteriorly consisting of intact
posteromedial iliac cortex and sciatic notch.
• At this osteotomy site , bone graft is placed.
123. If more anterior coverage desired ,inner cortex cut more If
more lateral coverage desired, inner cortex cut less
Intact postero-m,ediaql cortical hinge
124. A larger graft is inserted anteriorly. The posterior graft
should be smaller in order not to loosen the anterior graft.
125. GANZ OSTEOTOMY
Larger corrections all directions(correction not limited by
sacro-pelvic ligaments)
Blood supply preserved
Shape of true pelvis unaltered
Technically demanding
126. Steel Triple Innominate Osteotomy
• Age –Skeletally mature
•Requires congruent hip joint
•Divides ilium, ischium and superior ramus –Acetabulum is
rotationally free –Indicated when other osteotomies not possible
•Rotates to cover any acetabular defect
127. •Multiple incision technique
–Posteriorly between gluteus and hamstrings
•Allows osteotomy of ischium
–Anteriorly freeing medial attachments
•Allows Salter and superior ramus osteotomy
–Rotate acetabulum as desired
•Avoid externally rotating
–Bone graft wedge is fixed as per Salter type
128. • • Ischium, superior pubic ramus and ilium superior to acetabulum all
are divided and acetabulum is repositioned and stabilized by bone
graft and pins.
129.
130. Salvage or Shelf procedures
• Chiari and Staheli osteotomies
– Requires capsular metaplasia
– Pain is the main indication
– Used in Treatment of chronic hip pain in adolescents
131. Staheli Shelf Procedure
•Age –older child to skeletal maturity
•Salvage operation
•Indicated for non-concentric hips
•Augments supero-lateral deficency
–Slotted bone graft placed over capsule deepening the acetablum
132. Chiari Medial Displacement
•Age –skeletally mature
•Salvage operation only
–Used when no other osteotomy possible
–Possible with subluxed hip
•Covers well laterally
–Anterior and posterior augmentation may be necessary
•May be useful in other conditions
–Coxamagna, OA in dysplasichips
133. •Anterior approach –as per Salter
–Identify superior extent of capsule
–Cut from AIIS to notch following capsule curve
•Angle osteotome10-20* cephlad
–Displace distal fragment medially 50-100%
•Ensure complete head coverage
•Leg abduction, hinges on pubic symphysis
142. Complications of Treatment
• Worst complication is disturbance of growth in proximal femur
including the epiphysis and physeal plate
• commonly referred to as AVN however, no pathology to confirm this
• may be due to vascular insults to epiphysis or physeal plate or
pressure injury
• occurrs only in patients that have been treated and may be seen in
opposite normal hip
143. Necrosis of Femoral Head
• Extremes of position in abduction ( greater 60 degrees ) and
abduction with internal rotation
• compression on medial circumflex artery as passes the iliopsoas
tendon and compression of the terminal branch between lateral neck
and acetabulum
• “ frog leg position “ uniformly results in proximal growth disturbance
145. • extreme position can also cause pressure necrosis onf epiphyseal
cartilage and physeal plate
• severin method can obtain reduction but very high incidence of
necrosis
• multiple classification systems with Salter most popular