Developmental dysplasia of the hip

• Uneven gluteal folds
• DDH refers to abnormalities of the developing hip that include dislocation, subluxation, and dysplasia of the hip joint
• The femoral head has an abnormal relationship with the acetabulum
• Frank dislocation off the hip may occur
• Dysplasia refers to an acetabulum that is shallow or slipping instead of cup shaped
• Can effect both hips or one
• Risk factors: family history, female gender, logograms (low amniotic fluid or breech birth, congenital musculoskeletal deformity
• Previously undiagnosed older children may complain of hip pain
• Physical assessment: assess for asymmetry of thigh and gluteal folds, unequal knee height, limitation of hip abduction
• physical assessment: positive Trendelenburg sign: note pelvis/hip drops when leg is raised
• physical assessment: feel "clunk" when adduction and depression of femur dislocates hip(Barlow test). Assess for "clunk" when the dislocated hip is abducted and relocated (Ortolani signs)
• Therapeutic management: goal is to maintain hip joint in reduction to so that the femoral head and acetabulum can develop properly
• Therapeutic management: infants younger than 6 months may be treated with a Pavlov harness, 4month-2year-old pt often require closed reduction
• therapeutic management: traction may be used initially, hip spica cast worn for 12 weeks maintains reduction of the hip, child would wear brace following cast removal
• Hip spica cast: hard covering over the waist, hips, and legs that prevents movement of the hips. A bar between the legs strengthens the cast. An opening ninth genital area allows normal urine and bowel elimination.