Developmental Dysplasia of the Hip (DDH)

Causes:

• Intrauterine malpositioning.
• Genetic factors
• Maternal hormones.
• Post-natal postural influence (hence rare in India)

Complications:

• Recurrence of dislocation
• Incomplete reduction
• Avascular necrosis of femoral head
• Residual deformity of hip joint
• Late onset of premature osteoarthritis

Clinical Features:

• Clunks are sensations felt when femoral head dislocates with Barlow maneuver or relocates with Ortolani maneuver

Diagnosis:

X-ray findings

1. Shenton's line should be continuous.
2. Acetabular index more vertical (closer to 90).

Treatment:

Depends on age.

1. Newborn - 3 months

• Pavlick harness
• manipulative reduction
• hip spica cast

2. 3-6 months

• Pavlick harness
• Manipulative reduction
• Hip spica cast
• Ooccasionally open reduction necessary.

3. 6-12 months

• pre-reduction traction, open or closed reduction, hip spica cast