Developmental Hip Dysplasia
|Embryology - 21 Jul 2019 Expand to Translate|
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- 1 LB74 Structural developmental anomalies of pelvic girdle
- 1.1 Introduction
- 1.2 Some Recent Findings
- 1.3 Textbooks
- 1.4 Neural Exam
- 1.5 Barlow Test
- 1.6 Ortolani Test
- 1.7 Acetabular Index
- 1.8 Abduction Splints
- 1.9 References
- 1.10 Additional Images
- 1.11 Terms
- 1.12 External Links
- 1.13 Glossary Links
LB74 Structural developmental anomalies of pelvic girdle
This skeletal abnormality is described alternately as developmental hip dysplasia (DDH, developmental dysplasia of the hip, congenital hip dislocation, acetabular dysplasia, subluxation of the hip joint). 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 one of the most common skeletal congenital anomalies usually detected in the early (less than 1 year) clinical examination of the musculoskeletal function. Currently the American Academy of Pediatrics recommends that all newborns be clinically examined for developmental hip dysplasia initially and then at every health supervision visit until the child walks normally.
- 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 "Developmental dysplasia of the hip (DDH) occurs in 3-5 of 1000 live births and is associated with known risk factors. In most countries, formal practice for early detection of DDH entails the combination of risk factor identification and physical examination of the hip, while the golden standard diagnostic instrument is hip ultrasonography (US)....Of the 115,918 infants born during the study period, 67,491 underwent at least one hip US. Of these, 60.6% were female, mean age at performance: 2.2 months. Of those who underwent US, 625 (0.93%) were treated with a Pavlik harness: 0.24% of the male infants and 1.60% of the female infants (p < 0.001). ...Current pattern of hip US utilization for early detection of DDH resembles universal screening more closely than selective screening."|
Some Recent Findings
|More recent papers|
This table allows an automated computer search of the external PubMed database using the listed "Search term" text link.
Search term: Developmental Hip Dysplasia
<pubmed limit=5>Developmental Hip Dysplasia</pubmed>
- 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
The following examination movies relate more to normal neurological development and muscle tone, but they do also show the movement of the hip at different postnatal ages.
|This 5-day-old infant is in the alert, quiet state.
3 Months Tone
|Neural Exam Movies|
(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 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.
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.
The ultrasound screening method is often called the "Graf method and classification".
Measures by ultrasound:
- bony rim
- bony acetabular roof modelling (α-angle)
- cartilaginous roof (β- angle)
- Links: Ultrasound
X-ray screening has been generally replaced by ultrasound. Below are some of the radiographic 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.
There is variable evidence for the use of abduction splinting during onset of walking in children on the maturation of mild dysplastic hips.
- Goldberg MJ. (2001). Early detection of developmental hip dysplasia: synopsis of the AAP Clinical Practice Guideline. Pediatr Rev , 22, 131-4. PMID: 11283326
- Acién P, Galán F, Manchón I, Ruiz E, Acién M & Alcaraz LA. (2010). Hereditary renal adysplasia, pulmonary hypoplasia and Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome: a case report. Orphanet J Rare Dis , 5, 6. PMID: 20388228 DOI.
- Lee WC, Gera SK & Mahadev A. (2018). Developmental dysplasia of the hip: why are we still operating on them? A plea for institutional newborn clinical screening. Singapore Med J , , . PMID: 29774363 DOI.
- Wilf-Miron R, Kuint J, Peled R, Cohen A & Porath A. (2017). Utilization of ultrasonography to detect developmental dysplasia of the hip: when reality turns selective screening into universal use. BMC Pediatr , 17, 136. PMID: 28583152 DOI.
- Windhagen H, Thorey F, Kronewid H, Pressel T, Herold D & Stukenborg-Colsman C. (2005). The effect of functional splinting on mild dysplastic hips after walking onset. BMC Pediatr , 5, 17. PMID: 15958160 DOI.
Wilf-Miron R, Kuint J, Peled R, Cohen A & Porath A. (2017). Utilization of ultrasonography to detect developmental dysplasia of the hip: when reality turns selective screening into universal use. BMC Pediatr , 17, 136. PMID: 28583152 DOI.
Miller SD, Juricic M, Hesketh K, Mclean L, Magnuson S, Gasior S, Schaeffer E, O'donnell M & Mulpuri K. (2017). Prevention of hip displacement in children with cerebral palsy: a systematic review. Dev Med Child Neurol , 59, 1130-1138. PMID: 28574172 DOI.
Jackson JC, Runge MM & Nye NS. (2014). Common questions about developmental dysplasia of the hip. Am Fam Physician , 90, 843-50. PMID: 25591184
Guille JT, Pizzutillo PD & MacEwen GD. (2000). Development dysplasia of the hip from birth to six months. J Am Acad Orthop Surg , 8, 232-42. PMID: 10951112
McAllister DA, Morling JR, Fischbacher CM, Reidy M, Murray A & Wood R. (2018). Enhanced detection services for developmental dysplasia of the hip in Scottish children, 1997-2013. Arch. Dis. Child. , , . PMID: 29436408 DOI.
Search Pubmed: Developmental Hip Dysplasia
- Barlow test - (Barlow maneuver) clinical physical newborn examination where 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.
- Ortolani test - (Ortolani maneuver) clinical physical newborn examination 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.
- 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.
External Links Notice - The dynamic nature of the internet may mean that some of these listed links may no longer function. If the link no longer works search the web with the link text or name. Links to any external commercial sites are provided for information purposes only and should never be considered an endorsement. UNSW Embryology is provided as an educational resource with no clinical information or commercial affiliation.
- OMIM - Developmental Dysplasia Of The Hip 1 | Developmental Dysplasia Of The Hip 2
- International Hip Dysplasia Institute
- Imaging Queensland
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Cite this page: Hill, M.A. (2019, July 21) Embryology Developmental Hip Dysplasia. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Developmental_Hip_Dysplasia
- © Dr Mark Hill 2019, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G