Congenital Dislocation of Hip (CDH) occurs classically due to
Small femoral head epiphysis
Abnormal angle of femoral neck
Hypertrophied ligamentum teres
Developmental Acetabular dysplasia
Ans. d (Developmental Acetabular dysplasia) (Ref. Baily and Love 24th ed., Fig. 27.34)DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH)# This term is more accurate than the older congenital dislocation of the hip (CDH) because it includes dislocation along with other less severe forms, all of which have in common a dysplasia or natural shallowness of the acetabulum. The femoral neck is usually anteverted.Aetiology# A family history of DDH increases the risk up to 30 times.# The condition is five times more common in girls.# The left side is affected more commonly than the right.# Breech presentation, especially the extended position, firstborn children and caesarean section are associated with increased neonatal instability, possibly through restricted foetal movement.# Finally, it may be association with neuromuscular disease conditions and skeletal dysplasia.Diagnosis# Neonate- Clinical Barlow and Ortolani tests: The baby should be relaxed and the hips flexed to 90 degree. It is possible to reduce a dislocated hip by abduction and gentle forward pressure (Ortolani) or dislocate an unstable hip by adduction and gentle backward pressure (Barlow). In both cases a soft clunk is felt as the hip reduces or dislocates.The specificity of clinical neonatal examination is 100% (no false positives). However, its sensitivity is much lower.- Ultrasonography is most valuable test. It can detect not only displacement of the femoral head but also varying degrees of dysplasia.- X-rays are not generally reliable until approximately the age of 3 months.# Adult- Pain is again the usual complaint and X-rays may now show degenerative change as well as dysplasia.# Rx:Infant.Traction and surgery are not indicated. The hips can usually be reduced (Ortolani) and should then be held in a harness or splint for about 8 weeks.A baby, for example, aged 6 monthsWould usually require preliminary traction followed by closed reduction augmented by soft-tissue release (psoas and/or adductor).Toddler and young childwith age, open reduction along with femoral or innominate osteotomy will be required.Adolescent or young adultThose presenting with a painful dysplastic hip may require surgery. A realignment of the joint through pelvic or femoral osteotomy is only appropriate if there is a congruous hip joint. Otherwise (i.e., subluxation) the acetabulum has to be augmented by other means, for example shelf arthroplasty.
Congenital Dislocation of Hip (C.D.H.)