Developmental Displasia of the HIP (DDH)

Developmental Dislocation of the Hip (DDH) or congenital

pelvic dislocation is an orthopedic deformity obtained
immediately before or at birth.
This condition varies from minimal shift to lateral to
complete dislocation from femoral head out of acetabulum.
Epidemiology
Pelvic instability ranges from 5 - 20% of 1,000 live births and
most will stabilize after 3 weeks and only 1-2% remain unstable.
Congenital pelvic dislocation is seven times more common in
women than in men, the left hip joint is more frequently affected and
only 1–5% are bilateral.
This disorder is more common in Americans and Japanese and is
rarely found in Indonesians.
Etiology

1. Genetic factors
The underlying genetic disposition also affects even a 10-fold
increase in the frequency of pelvic dysplasia in children whose parents
also experience hip dysplasia (DDH) compared with those whose
parents did not experience DDH.
2. Teratogenic
Teratogens are any factors or ingredients that can cause or
increase the risk of a congenital disorder. Radiation, certain drugs and
toxins are teratogens.
3. Nutrition
Maintaining fetal health is not only done by avoiding teratogens, but also by
consuming good nutrition. One of the substances that are important for fetal growth is folic
acid. Folic acid deficiency can increase the risk of spina bifida or other neural tube disorders.
Because spina bifida can occur before a woman realizes that she is pregnant, every woman
of childbearing age should consume at least 400 micrograms / day of folic acid.
4. Hormonal factors
That is, high levels of estrogen, progesterone and relaxin in the mother in the last
few weeks of pregnancy can worsen ligament looseness in the baby. This can explain the
scarcity of instability in premature babies,
5. Physical factors in the uterus
In the womb, the baby is submerged by amniotic fluid which is also a protector
against injury. The abnormal amount of amniotic fluid can cause or indicate a congenital
abnormality.
Clinical manifestations

• Look at the baby's legs long next

• There is an unbalanced baby thigh fold
• When a child is able to walk, then the way becomes unbalanced
Diagnosis
1. Clinical manifestations
2.Some checks
A. Test barlow
A maneuver that aims to test DDh by removing the femoral head
from the acetabulum by adducting the baby's leg and examining the
thumb on the groin
Positive when removing the femoral head, it feels palpable by
the examiner's thumb and a click is heard
B.Uji Ortolani
In this test the medial part of the baby's thigh is held with the
thumb and the fingers are placed on the trochanter major, the hip is
reflected to 90 degrees and is slowly reduced
• Positive if there is a click when the major trochanter is pressed into
and feels the head that was out when the barlow test enters the
acetabulum
C. Mark gaeleazzi
• When lying down and knees folded, both knees should be the same
height. if there is a pelvic dislocation, the knee in the affected leg will
look lower.
D. Tes Tradelenberg
• Children are told to stand one leg in turn. when standing on a DDH (+)
foot, the pelvic abductor muscle (away from the body line) will be
seen. Normally the pelvic muscle will maintain its position to remain
straight
 suporting investigation
• Ultrasound
Used for ages <6 months because the reinforcement is not
perfect (the bone is still in the form of cartilage), so that if examined by
X-ray the results are radiolucent
• RONTGEN
performed for ages> 6 months is used to diagnose dislocations
and subsequently for treatment monitoring.
Treatment
Conservative
An easy treatment for preventing congenital hip dislocation is to wrap
the baby extension and abduct from the hip. This condition will increase HIP
stability physiologically
If the baby has hip instability, the pelvic harness is applied.
Closed reduction can be done on infants aged 2-18 months with barlow
maneuver or ortholani maneuver is very effective for optimizing the position of
the hip joint.
At the age of 18 months - 5 years, conservative management is usually
very hard to do effectively to get maximum results
Surgical therapy
Open surgery is performed on children aged over 2 years after
conservative management does not produce optimal stability conditions.

Complications
• CDH complications are redislocation, hip stiffness, infection, blood
loss, and femoral head necrosis

Prognosis
• Prognosis is good if detected early and immediately treated if not, can
cause complications