Management of Neglected Cases of Developmental Dysplasia of the HIP "DDH"
Amr Mahmoud Hassan;
Abstract
Neglected cases of developmental dysplasia of hip (DDH) are generally difficult to treat satisfactorily.
Progress in ultrasound imaging gave developmental hip dysplasia a greater prominence in recent years.
The pathologic changes in the newborn are predominantly related to a shallow acetabulum, laxity of the capsule, and soft-tissue interposition. Older children exhibit more advanced changes in both the soft tissues and the osseous architecture.
Cases of developmental dysplasia of hip (DDH) presented after walking age usually treated surgically.
Treatment of cases presented after walking age consists of open reduction and usually femoral shortening.
Decision making of pelvic osteotomies according to stability test used to determine the need for a concomitant osteotomy.
The choice of pelvic osteotomy depends on the patient’s age and skeletal maturity, the morphology of the hip joint, and the severity of the dysplasia. For patients between ( 1-4y) , an innominate (Salter), Pemberton or Dega osteotomy could be used.
The ideal osteotomy to correct hip dysplasia will enlarge the contact area between the acetabulum and the femoral head and bring the centre of rotation of the hip medially without risking the blood supply to the joint.
The advantage of Salter osteotomy is that it is well understood procedure and easy to perform once the principles are learned.
Salter osteotomy is referred as a complete osteotomy because it disturbs the integrity of the posterior column of the pelvis . On the other hand, Pemberton and Dega osteotomies preserve posterior column and hence referred as incomplete osteotomies.
Salter osteotomy hinges on the symphysis pubis and does not change either the shape or capacity of the acetabulum.
Pemberton osteotomy is technically difficult and there is a higher risk of premature closure of triradiate cartilage since osteotomy hinges on the posterior limb of the triradiate cartilage.
Avascular Necrosis (AVN) is a major cause of long-term disability after the treatment of DDH.
AVN occurs when excessive pressure is applied for an extended period of time to the femoral head, occluding its vascular perfusion
The most common cause of AVN is immobilization in a position that places excessive pressure on the femoral head, such as extreme abduction or internal rotation.
Progress in ultrasound imaging gave developmental hip dysplasia a greater prominence in recent years.
The pathologic changes in the newborn are predominantly related to a shallow acetabulum, laxity of the capsule, and soft-tissue interposition. Older children exhibit more advanced changes in both the soft tissues and the osseous architecture.
Cases of developmental dysplasia of hip (DDH) presented after walking age usually treated surgically.
Treatment of cases presented after walking age consists of open reduction and usually femoral shortening.
Decision making of pelvic osteotomies according to stability test used to determine the need for a concomitant osteotomy.
The choice of pelvic osteotomy depends on the patient’s age and skeletal maturity, the morphology of the hip joint, and the severity of the dysplasia. For patients between ( 1-4y) , an innominate (Salter), Pemberton or Dega osteotomy could be used.
The ideal osteotomy to correct hip dysplasia will enlarge the contact area between the acetabulum and the femoral head and bring the centre of rotation of the hip medially without risking the blood supply to the joint.
The advantage of Salter osteotomy is that it is well understood procedure and easy to perform once the principles are learned.
Salter osteotomy is referred as a complete osteotomy because it disturbs the integrity of the posterior column of the pelvis . On the other hand, Pemberton and Dega osteotomies preserve posterior column and hence referred as incomplete osteotomies.
Salter osteotomy hinges on the symphysis pubis and does not change either the shape or capacity of the acetabulum.
Pemberton osteotomy is technically difficult and there is a higher risk of premature closure of triradiate cartilage since osteotomy hinges on the posterior limb of the triradiate cartilage.
Avascular Necrosis (AVN) is a major cause of long-term disability after the treatment of DDH.
AVN occurs when excessive pressure is applied for an extended period of time to the femoral head, occluding its vascular perfusion
The most common cause of AVN is immobilization in a position that places excessive pressure on the femoral head, such as extreme abduction or internal rotation.
Other data
| Title | Management of Neglected Cases of Developmental Dysplasia of the HIP "DDH" | Other Titles | علاج الحالات المهملة للخلع التكوينى لمفصل الفخذ | Authors | Amr Mahmoud Hassan | Issue Date | 2015 |
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