The exact cause is unknown, risk factors include:Ĭlinical examination findings may include: In the United Kingdom, the incidence of Legg-Calve-Perthes disease is 7.8 per 100,000 children aged 0-14. Legg-Calve-Perthes disease (also called Perthes disease) causes i diopathic avascular necrosis of proximal femoral epiphysis in children. In a normal hip, Shenton’s line should be a smooth, curved connection from the lesser trochanter, along the femoral neck to the pubis, with no step-off (right). 8 In a normal hip, Hilgenreiner’s and Perkin’s lines should intersect at the corner of the femoral head (right). Key radiographic lines to check during Investigation for DDH. Most commonly affects the median circumflex femoral artery.įigure 3. Avascular necrosis: due to retrograde femoral head blood flow.Transient femoral nerve palsy with excessive flexion during Pavlik bracing.Greater than 18 months (or failure of closed reduction): operative management (open reduction and hip reconstruction).6 – 18 months (or failure of Pavlik harness): closed reduction and spica casting.Management of DDH depends on the age of the patient: 7 AP pelvic X-ray: should be performed in children greater than 4-6months old, when the femoral head ossification centre is visible (Figure 3).Ultrasound: can be performed in infants less than 4-6months old.Ortolani’s test is then used to confirm posterior dislocation of the hip joint.įor more information, see the Geeky Medics guide to performing a newborn baby assessment. If the hip is dislocatable the test is considered positive. If the hip is unstable, the femoral head will slip over the posterior rim of the acetabulum, producing a palpable sensation of subluxation or dislocation. The Ortolani and Barlow tests are used to screen babies for hip dysplasia.īarlow’s test is performed by adducting the hip (bringing the thigh towards the midline) whilst applying light pressure on the knee with your thumb, directing the force posteriorly. In older children (> 1 year), a Trendelenburg gait and toe walking may also be seen.įurther clinical findings at any age may include: In addition, screening examinations are performed as part of routine baby checks.įindings in 3-6-month-olds include leg length discrepancy and limitations in hip abduction due to contractures. If DDH is suspected, an examination of the hip should be undertaken. The incidence of DDH may be influenced by local child-rearing practices, as certain swaddling and baby-carrying techniques have been shown to correlate with a decline in this disorder. The exact cause of DDH is unknown but risk factors for DDH include: Due to the nature of how the baby sits in the womb, the left hip is more commonly affected. 4,5ĭDH is the most common abnormality in newborn infants. 3ĭDH is a disorder of abnormal development resulting in dysplasia and potential subluxation or dislocation of the hip secondary to capsular laxity and mechanical factors. Radiographic bony features of the pelvis and hip.
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