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Development dysplasia of the hip from birth to six months
J T Guille1, P D Pizzutillo, G D MacEwen
1Department of Orthopaedic Surgery, MCP-Hahnemann School of Medicine, Philadelphia, PA, USA.
Insights
Early diagnosis and treatment of developmental dysplasia of the hip (DDH) are crucial for better outcomes. The Pavlik harness is a primary treatment for infants, with other methods used if reduction is unsuccessful.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Developmental Pediatrics
Background:
- Developmental dysplasia or dislocation of the hip (DDH) encompasses a range of hip abnormalities in growing children.
- DDH includes both congenital and developmental hip issues, distinct from solely congenital conditions.
Purpose of the Study:
- To emphasize the importance of early diagnosis and management of DDH.
- To outline the diagnostic and treatment strategies for DDH.
Main Methods:
- Clinical evaluation including history taking and physical examination.
- Advanced imaging techniques such as ultrasonography.
- Treatment modalities including the Pavlik harness, closed reduction, and surgical intervention.
Main Results:
- Early diagnosis and management improve treatment outcomes and reduce complications.
- The Pavlik harness is the primary treatment for infants not yet standing.
- Alternative treatments like closed or surgical reduction are necessary when the Pavlik harness is insufficient or contraindicated.
Conclusions:
- Timely diagnosis and appropriate management are essential for favorable outcomes in DDH.
- Treatment approaches for DDH vary based on the patient's age and the stability of hip reduction.
- The Pavlik harness is effective for early-stage DDH in infants, but other interventions are required for more severe or advanced cases.
Abstract:
The term "developmental dysplasia or dislocation of the hip" (DDH) refers to the complete spectrum of abnormalities involving the growing hip, with varied expression from dysplasia to subluxation to dislocation of the hip joint. Unlike the term "congenital dysplasia or dislocation of the hip," DDH is not restricted to congenital problems but also includes developmental problems of the hip. It is important to diagnose these conditions early to improve the results of treat- ment, decrease the risk of complications, and favorably alter the natural history. Careful history taking and physical examination in conjunction with advances in imaging techniques, such as ultrasonography, have increased the ability to diagnose and manage DDH. Use of the Pavlik harness has become the mainstay of initial treatment for the infant who has not yet begun to stand. If stable reduction cannot be obtained after 2 weeks of treatment with the Pavlik harness, alternative treatment, such as examination of the hip under general anesthesia with possible closed reduction, is indicated. If concentric reduction of the hip cannot be obtained, surgical reduction of the dislocated hip is the next step. Toward the end of the first year of life, the toddlerTs ability to stand and bear weight on the lower extremities, as well as the progressive adaptations and soft- tissue contractures associated with the dislocated hip, preclude use of the Pavlik harness.