HSS spring hip dysplasia

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HSS spring hip dysplasia
2013-04-29 22:12:58
HSS spring hip dysplasia

HSS spring hip dysplasia
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  1. hip dysplasia
    deficit in formation of hip joint ... problem in the fem head, acetabulum, or both
  2. normal angle of inclination
  3. where is the dome of cartilage thickest in the hip
    at full extension
  4. coxa vara and valga?
    • vara < 125 (now the greater trochanter juts out more)
    • valga > 125 angle of inclination
  5. congential hip dislocation vs congen dislocatable hip
    dislocated at birth vs in place at birth but dislocates when stressed
  6. congenital subluxatable hip
    hip is in place but dislocates partially when stressed
  7. acetabular dysplasia
    hip socket is shallow and remains shallow = unstable hip
  8. developmental dysplasia or dislocation of hip
    cases that have apparently normal hips at birth but dev problems in first year of life
  9. frequency of hip dysplasia
    • 0.4% of births
    • most common in 1st born girls
  10. risk factors for hip dysplasia
    • fam hx
    • breech pos
    • other "packaging problems" - clubfoot or torti
    • Down's syndrome
    • oligohydramnios (lack of intrauterine fluid)

    it's on the L more than R side
  11. sx of hip dysplasia
    • hip click /Ortolani or Barlow test
    • tight adductors
    • nonsymmetrical groin or butt skin creases
    • ER
    • legs seem diff lengths
    • no pain
  12. diff dx for hip dysplasia
    • infatile coxa vara
    • pathological dislocation
    • poliomyelitis (viaral disease affects nervew w evidence of paralysis)
    • neuromuscular disorder
  13. using technology to dx displasia -- what tools when?
    • sonography at 6 weeks
    • ultrasound at 6 months
    • x-ray > 8 months
  14. Ortolani maneurver
    gentle upward force is applied while hip is abducted - yr looking for a click
  15. Barlow maneurver
    gentle downward force is applied while hip is adducted -- looking for a click
  16. Galeazzi sign
     supine, bend knees, feet flat, see if one knee is lower -- I think the higher one is dislocated
  17. remodelling potential for hip dysplasia, by age
    • neonate - birth -4 weeks -- awesome
    • 0-4 yo - exellent
    • 4-8 yo -moderate
    • >8 - zippo

    so treat asap

    faovorable remodeling occurs when fem head is concentricaly and congruently seated in acetabulum
  18. Pavlik harness
    • use < 4-6 months
    • for hip abd and flex
    • it reduces the hop joint space
    • worn 23-24 hrs /day, for 6-8 weeks, then ween of to 12 hrs/day for 6 weeks
  19. when to do closed reduction surgery, when to do open?
    • closed > 6 months
    • open > 1 yr

    spica cast after either
  20. if failed pavlik harness, closed, and open reduction surgery, what to do?
    pelvic and/or femoral osteotomy to realign the hip
  21. risks of untreated DDH (dsyplasia)
    • OA as early adduls
    • 50% of hip replacements may be due to DDH
  22. risks of surghery for DDH
    • infection
    • AVN