Developmental Hip Dysplasia
Embryology - 15 Jun 2024 Expand to Translate |
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LB74 Structural developmental anomalies of pelvic girdle
ICD-11 beta - LB74 |
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LB74 Structural developmental anomalies of pelvic girdle |
Exclusions - Clicking hip (MG40)
This is the beta version of the future ICD-11 classification code. |
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ICD-10 |
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ICD-10 Q65 Congenital deformities of hip Excl.: clicking hip (R29.4)
This is the current ICD-10 classification code. |
Q65 Congenital deformities of hip
Excl.: clicking hip (R29.4)
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Introduction
Developmental hip dysplasia (DH, developmental dysplasia of the hip, congenital hip dislocation, acetabular dysplasia). Note that both the current ICD-10 and future ICD-11 code exclude "clicking hip" (MG40). Development of the pelvis, acetabulum and femur are complex processes involving ongoing ossification, joint and ligament development. This condition is an extremely common issue usually detected in the early (less than 1 year) clinical examination of the skeleton.
Features include:
- Instability: 1:60 at birth; 1:240 at 1 wk: Dislocation untreated; 1:700
- congenital instability of hip, later dislocates by muscle pulls or gravity
- familial predisposition female predominance
- Growth of femoral head, acetabulum and innominate bone are delayed until the femoral head fits firmly into the acetabulum
X-Ray Hip Dysplasia | X-Ray Hip Dysplasia and renal agenesis[1] |
Some Recent Findings
More recent papers |
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This table allows an automated computer search of the external PubMed database using the listed "Search term" text link.
More? References | Discussion Page | Journal Searches | 2019 References | 2020 References Search term: Developmental Hip Dysplasia <pubmed limit=5>Developmental Hip Dysplasia</pubmed> |
Textbooks
- The Developing Human: Clinically Oriented Embryology (8th Edition) by Keith L. Moore and T.V.N Persaud - Moore & Persaud Chapter 15 the skeletal system
- Larsen’s Human Embryology by GC. Schoenwolf, SB. Bleyl, PR. Brauer and PH. Francis-West - Chapter 11 Limb Dev (bone not well covered in this textbook)
- Before we Are Born (5th ed.) Moore and Persaud Chapter 16,17: p379-397, 399-405
- Essentials of Human Embryology Larson Chapter 11 p207-228
Neural Exam
Newborn Tone
The following video shows the newborn assessment of lower extremity newborn tone, but also includes testing of the hips.
<html5media height="400" width="500">File:Newborn n 09.mp4</html5media> | This 5-day-old infant is in the alert, quiet state.
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Newborn Neural Exam Movies |
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| <html5media height="300" width="320">File:03mo 05.mp4</html5media>
Barlow Test
(Barlow maneuver) A clinical term to describe a physical examination of the newborn for developmental dysplasia of the hip (DDH). The examiner adducts the hip (bringing the thigh towards the midline) while applying light pressure on the knee, directing the force posteriorly. A positive sign is the hip being dislocatable, if the hip can be popped out of socket with this test. This test is then combined with the Ortolani test (maneuver).
The test is named after Thomas Barlow (1845 – 1945) a British royal physician.
Ortolani Test
(Ortolani maneuver) A clinical term to describe a physical examination of the newborn for developmental dysplasia of the hip (DDH). This is a test for posterior dislocation of the hip. Using the examiner's thumb, abduct the infant's leg, while using the examiner's index finger to place anterior pressure on the greater trochanter. A positive sign is a distinctive 'clunk' which can be heard and felt as the femoral head relocates anteriorly into the acetabulum, usually becomes negative after 2 months of age. This test is combined with the Barlow test (maneuver).
The test is named after Marino Ortolani, the test developer in 1976.
Acetabular Index
This clinical measurement is based upon radiograph analysis of the acetabular inclination before ossification of the triradiate cartilage. The index is defined as the angle between Hilgenreiner's line and a line from the inferior margin of the iliac bone through the acetabular bony rim.
Triradiate cartilage is the Y-shaped growth plate region within the hip that does not complete ossification postnatally in humans until 14 - 16 years of age.
X-ray Landmarks
- Hilgenreiner's line - a horizontal line drawn between the two triradiate cartilage centers of the hips, defines a horizontal plane and an approximation to flexion axis of the hips.
- Perkin's line - a perpendicular line to the horizontal line drawn at the edge of the boney part of the acetabular socket.
- Shenton's line - an oval that traces the lower pubis contour, that should smoothly continue on to trace the lower edge of the neck of the femur.
Abduction Splints
There is variable evidence for the use of abduction splinting during onset of walking in children on the maturation of mild dysplastic hips.[3]
References
- ↑ <pubmed>20388228</pubmed>
- ↑ <pubmed>17300775</pubmed>
- ↑ 3.0 3.1 <pubmed>15958160</pubmed>| BMC Pediatr.
Reviews
<pubmed>28583152</pubmed> <pubmed>25865812</pubmed> <pubmed>28574172</pubmed> <pubmed>23723265</pubmed> <pubmed>23126391</pubmed> <pubmed>25591184</pubmed>
Articles
<pubmed></pubmed> <pubmed>26528350</pubmed> <pubmed></pubmed> <pubmed></pubmed>
Search PubMed
Search Pubmed: Developmental Hip Dysplasia
Additional Images
Terms
- preaxial - referring to the lateral (radial) aspect of the upper limb, and the medial (tibial) aspect of the lower limb.
- postaxial - referring to the medial ( ulnar) aspect of the upper limb, and the lateral (fibular) aspect of the lower limb.
Glossary Links
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Cite this page: Hill, M.A. (2024, June 15) Embryology Developmental Hip Dysplasia. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Developmental_Hip_Dysplasia
- © Dr Mark Hill 2024, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G