Congenital dysplasia of the hip Developmental dysplasia of the hip (DDH), also known as developmental hip dislocation, is the most common hip disorder in pediatric orthopedics and is more common in girls. DDH includes hip dislocation, subluxation and acetabular dysplasia. Acetabular dysplasia is characterized by an immature, shallow acetabulum, which can lead to subluxation or complete dislocation of the femoral head. A subluxation is when the femoral head is displaced from its normal position but remains partially covered by the acetabulum. Complete dislocation of the hip is when there is no connection between the articular surface of the femoral head and the acetabulum. Risk factors for this condition are: girls, first births, multiple births; those with a family history; fetal malposition, such as breech, low amniotic fluid; having a plantar inversion deformity of the foot or myotubular neck; and incorrect swaddling – candle wrapping. The general physical examination of infants routinely 3 months of age or younger is referred to Ortolani
The clinical presentation varies according to the age of the child, the degree of dislocation, unilateral or bilateral onset, etc. Asymmetry of the thigh skin pattern does not necessarily mean congenital hip dysplasia, and vice versa. Children under 6 months of age: X-rays are limited in confirming the diagnosis of DDH
in newborns is limited due to the fact that the femoral head does not ossify until 4 to 6 months after birth.
This is because the femoral head does not ossify until 4 to 6 months after birth. Ultrasound images have become the most common and useful method in the analysis of hip disorders, especially in infants under 6 months of age. This is because it allows visualization of anatomical changes in the femoral head and acetabular cartilage]. Ultrasonography is sensitive to hip position, acetabular development and hip instability and is more accurate than radiographs. This technique can be used as a screening tool for the first examination of the hip in newborns, as well as for screening infants with DDH
risk factors for DDH and for treatment monitoring in cases with a clear diagnosis of DDH.
It is also used to screen infants for risk factors for DDH and to monitor treatment in cases with a clear diagnosis of DDH. Ultrasound images can also be used to prevent overtreatment of neonatal hip dysplasia that has been corrected. In determining the development of acetabular cartilage, confirming the diagnosis of acetabular subluxation, and documenting acetabular reversibility and stability, it is important for the treatment of children diagnosed with DDH.
The treatment process for children with DDH is of great interest. Ultrasonography offers significant advantages over other imaging techniques because the examiner is able to visualize the cartilage component of the hip without exposure to ionizing radiation. Neonates and children younger than 6 months Diagnosis is best made in the neonatal period and treatment is immediate upon detection. The Pavlik dressing is most commonly used and has a 95% recovery rate in Ortolani’s sign positive hips; the Pavlik dressing is suitable for children with DDH up to 6 months of age and has a greater than 50% failure rate in those older than 6 months. The Pavlik dressing should be reviewed weekly for 3 weeks prior to treatment and ultrasound should be performed, and if the hip is repositioned and stable, the review period should be extended until the ultrasound is normal. Complications of Pavlik dressing include downward dislocation of the hip joint, femoral nerve and brachial plexus nerve palsy, ischemic necrosis of the femoral head, etc. Children from 6 months to 18 months of age In children of this age, subluxation or dislocation of the hip should be treated by closed reduction or incisional reduction as the treatment of choice, or by bracing in cases of acetabular dysplasia. Closed resetting must be performed under basic anesthesia, and if intraoperative arthrography shows satisfactory and stable resetting, human position cast fixation should be given, requiring hip flexion at 100-110° and abduction not more than 60°, excessive abduction cast and brace fixation may easily cause ischemic necrosis of the femoral head; if closed resetting is unsatisfactory or unstable, hip incisional resetting should be done, generally simple hip incisional If the closed repositioning is satisfactory or stable, then the hip needs to be repositioned by hip arthrotomy, usually by simple hip arthrotomy plus human plaster fixation; after the plaster fixation, the hip joint is repositioned by fluoroscopy in the operating room. Before discharge, review the orthopantomogram of the hip joint, and if necessary, CT or MRI examination to understand the reset situation. Ultrasound examination can be used for part of the review after discharge to reduce the number of X-ray examinations. Usually, the hip is fixed in plaster for about 3 months and then replaced with a brace for about 3 months. The potential for acetabular development after closed or incisional resurfacing is great and can last for 4 to 8 years after resurfacing, and most children with DDH do not require a second acetabular or femoral surgery. Most children with DDH between 18 months and 8 years of age have poor acetabular developmental potential and require a pelvic osteotomy at the same time as hip resurfacing. Shortening, de-rotation and inversion osteotomy are required for children with high dislocation, high post-reduction joint pressure, large anterior tilt and neck stem angle. For children older than 4 years of age, a triple pelvic osteotomy can be performed for complicated cases such as re-dislocation after surgery. The choice of the specific surgical procedure will depend on the pathological changes of the hip joint, the age of the child and other factors. For children over 8 years of age, Pemberton, Dega, triple pelvic osteotomy can be performed unilaterally before the Y-chondral closure, and Ganz pelvic osteotomy can be performed if the Y-chondral closure is closed. Chiari pelvic osteotomy is a kind of palliative surgery and can be performed with good results in some children.