CONGENITAL DISLOCATION OF HIP

                                    Congenital dislocation of hip (CDH) / Developmental dysplasia of hip (DDH).

Risk factors  : - i)       Faulty intrauterine position.

a.       Breach position

b.      Oligohydramnios

v  Seen due to intrauterine crowding phenomenon and there fore associated with Torticollis and Metatarsus adductus. 

ii)      First born child as the Primigravida uterus and abdominal muscles are unscratched and subject the fetus to prolonged periods of abnormal positioning.

                           iii)     Female child

                           iv)     Familial

                           v)      Caucasians and native Americans > Blacks & Asians

Clinical presentation : - i)     Abduction of hip (esp. in flexion) is limited

                                          ii) Asymmetrical thigh folds

                                          iii) Short limb as shown by

v  Higher buttock folds

v  GALLEAZI / ALLIS SIGN : Lowering of knee on offected side in a lying child with hips and knees flexed.

iv) TRENDELENBERG’S TEST : -  Positive leading to lurching / trendelenberg gait in unilateral cases

                                          v) TELESCOPY TEST : -  Positive

                                          vi) VASSCULAR SIGN OF NARATH : -  Positive  

DIAGNOSTIC TESTS FOR INFANTS : -

1. BARLOW’S STEST : -

1^st part – in position of 90⁰ flexion of hips and knees, now the hip is adducted and pushed and this will lead to dislocation of hip. [B. Ad. D]

2^nd part – now the hip is abducted and pulled and which will cause ‘clunk’ indicating reduction of hip.

2. ORTOLANI’S TEST : - It is similar to 2^nd part of Barlow’s test.

RADIOLOGICAL FEATURES : -  

In von rosen’s view following parameters are noted

1)      PERKIN’S LINE : - Vertical line drown at the outer border of acetabulum

2)      Hilgenreiner’s line : - Horizontal line drown at the level of tri-radiate cartilage.

3)      Shenton’s line : - Smooth curve formed by inferior border of neck of femur with superior margin of obturator foramen

4)      Acetabular Index : - Normally < 30⁰

5)      CE angle of wiberg : Normal value = 15⁰ - 30⁰

1.            Normally the head lies in the lower and inner quadrant formed by two lines (Perkin’s and hilgenreiner’s) In DDH, the head lies in outer and upper quadrant.

2.            Broken shenton’s are

3.            Delayed appearance & retarded development of ossification of head of femur.

4.            Sloping acetabulum

5.            Superior and lateral displacement of femoral head.

6.            Inferior capsule of hip assumes hourglass shape and may prevent successful closed reduction

Clinical presentation of bilateral D.D.H.

1.      Duck waddling gait / Sailor’s gait / Bilateral lurching gait.

2.      Lordosis :  Noticeable in bilateral cases and is often presenting complaint

3.      Legas appear too short for the body

4.      Perineal space is broadened with unduly prominent trochaenters and broad and flat buttocks

5.      Klisic test : -  Can recognize bilateral CDH, in which the examiner places the third finger over great trochaenter and index finger over ASIS. An imaginary liver drawn between these fingers should point to umbilicus. When the hip is dislocated the more proximal greater trochaenter causes the line to point about half way between the umbilicus and pubis.

6.      In bilateral cases, trendelenberg’s sign is positive on both sides and shenton’s are is broken bilaterally.