Xray hip normal vs abnormal4/10/2024 ![]() Table 1: Clinical Findings in DDH – Adapted from Clinical Features and Diagnosis of DDH, The differential diagnosis of hip instability in the infant includes proximal femoral focal deficiency, congenital coxa vera, infected hip leading to pathologic dislocation, muscle imbalance in children with cerebral palsy or myelomeningocele. Increasing adduction contracture of the hip Short leg limp, with toe-heel gait and out-toeing Limitation of hip abduction in 90° of flexionApparent shortening of femurLaterally rotated posture of lower limbsMarked asymmetry of leg creasesĮxcessive lumbar lordosisProminent greater trochanterGluteus medius lurchPositive Trendelenburg sign In decreasing frequency, patients present with pathology in the left hip, bilateral hips, and right hip.ĭiagnostic: Hip instability demonstrated by positive Ortolani or Barlow testsSuggestive: Asymmetric leg creases (inguinal, gluteal, thigh, popliteal), apparent shortening of the femurĪssociated findings: metatarsus adductus, clubfoot, torticollis, plagiocephaly, extension contractures of the knee Infants with DDH may be asymptomatic or symptomatic. Age at presentation, however, carries the largest impact on treatment options, remodeling ability, and thus final outcome. The clinical presentation of DDH depends upon the age at presentation and the severity of the abnormality (See Table 1). PresentationĬongenital DDH presents along a spectrum that can be classified as: acetabular dysplasia (no dislocation), subluxation or partial dislocation of the femoral head, or complete dislocation of the femoral head from the acetabulum. The estimated risk of DDH in girls without other risk factors is 1.9%. Girls with a positive family history have a risk of 4.4% while boys with a family history of DDH have a risk of only 0.9%. Boys with a breech presentation have a 2.6% risk. Girls with a breech presentation are at the highest risk with an estimated risk of 12%. Risk factors for DDH include female gender, breech presentation, and a positive family history of DDH. Other causes of DDH are by teratogens during the gestational period. The cause of DDH in most cases is unknown, but presumed to be multifactorial despite many competing theories that attempt to explain its etiology.ĭDH can however occur in association with other conditions such as Ehlers-Danlos, Down Syndrome and various forms of neuromuscular hip dysplasia. ![]() This laxity resolves in most cases and acetabulum goes on to develop normally. Laxity of the hip and immaturity of the development of the acetabulum is often detected in normal newborns in the first few weeks of life. Epidemiology and Risk FactorsĭDH affects one in one thousand live birthsand most commonly in occurs in otherwise healthy infants. This article outlines the epidemiology, risk factors, signs and symptoms, diagnosis, and treatment of DDH as well as its complications and differential diagnoses. Rather, the presence of an abnormal physical exam warrants immediate further investigation and possible intervention. Physical examination using the Barlow and Ortolani tests are frequently positive in individuals with DDH, however it is not pathognomonic for dysplasia/dislocation of the femoral head in the acetabulum. ![]() DDH refers to abnormal development of the hip where there is instability (dislocatability) of the hip and dysplasia (abnormal shape) of the acetabulum. Routine neonatal screening for developmental dysplasia of the hip (DDH) is very important in all newborns. Click for pdf: Abnormal hip exam Background ![]()
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