Topics Discussed: barlow test; galeazzi's test; hip dislocation, congenital; musculoskeletal system; ortolani's test; pavlik harness; pediatric hip examination.
Sections: Legg-Calvé-Perthes Disease, Slipped Capital Femoral Epiphysis, Transient Synovitis of the Hip, References.
Excerpt:"Developmental dysplasia of the hip (DDH) is a spectrum of disorders
of the developing hip. DDH evolves over time and presents in different
forms at different ages. DDH may not be detectable at birth, and
hence, the preferred term developmental and not congenital.
The American Academy of Pediatrics (AAP) defines DDH as a condition
in which the femoral head has an abnormal relationship to the acetabulum.1 Dislocation
is defined as complete displacement of a joint, with no contact
between the original articular surfaces. Subluxation is defined
as displacement of a joint with some contact remaining between the
articular surfaces. Dysplasia refers to abnormal or deficient development
of the acetabulum. A teratologic dislocation is a distinct condition
that occurs before birth, is generally nonreducible on physical
exam, and causes the hip to be stiff. Teratologic dislocations are
frequently associated with neuromuscular conditions, particularly
arthrogryposis and myelodysplasia, and treatment depends on the
underlying condition. The etiology of DDH is multifactorial, but a number of predisposing
factors have been identified, including ligamentous laxity, breech positioning,
and postnatal positioning. The maternal relaxin hormone, which allows
the maternal pelvis to expand, crosses the placenta and can induce
laxity in the child, an effect known to be stronger in females than
in males. The footling breech presentation (both hips flexed) is
associated with a 2% risk of DDH, and..."
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