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Developmental Dysplasia of Hip
- hip may be dislocatable
- hip may be outside acetabulum but reducible by manipulation
- most dislocatable hips stable within 3 weeks of birth
- persistent dislocation in 2 per 100,000 births
- more common in girls than boys
- more commonly in left than right
- 1/3 cases both hips affected
- familial tendency
- intrauterine malposition
- higher than usual incidence of breech presentation
- postnatal posture important
- more common in north american indians - legs tightly swaddled in
extension
- least common in Africans - wide abduction
Pathology
- acetabulum unusually shallow
- roof slopes too steeply
- femoral head slides out posteriorly
- joint capsules stretched
- maturation of acetabulum and femoral epiphysis is retarded
- femoral neck unduly anteverted
Clinical Features
Early
Later
- Unilateral
- assymetrical skin creases
- hip does not abduct fully
- leg slightly short and rotated externally
- Trendelenburg test positive
- Bilateral
- no assymetry
- waddling gait (may be mistaken for normal toddling)
- abnormally wide perineal gap
- abduction limited
Epidemiology
- incidence ~1%
- may be family history
- more common in
- females
- multiple births
- breech presentations
- cerebral palsy
Treatment
- 3-6 months old
- splinting for at least 3 weeks
- open reduction for failure of conservative management
Complications
- waddling gait / limp
- degenerative hip arthritis
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