Congenital

Dislocation Of
The Hip
-sisybania-
Hip Joint

normal hip joint CDH

• CDH : Congenital Dislocation of the Hip
• DDH : Developmental Dysplasia of the Hip
Causes

• Hormonal
• Relaxin, oxytocin
• Familial
• Lig.laxity diseases
• Genetics
• Female 4 X male --- twins 40%
• Mechanical
• Pre natal (Breach , oligohydrominus ,
primigravida , twins)
• Post natal (Swaddling , strapping)
• Special test
• Galeazzi’s sign
• Ortolani test
• Barlow test
• Trendelenburgh sign
Galeazzi’s sign
Barlow and Ortolani

• Ortolani = femur flexed and adducted – abducted 90

• Barlow = hip dan knee flexed 90° – abducted fully
Trendelenburgh Test
Treatment: Neonatal hip instability
Unstable at 2 weeks:
§ Pavlik Harness
ú Dynamic, effective, safe
ilfeld orthosis

• Abduction orthosis
• Two thight cuff and
adjustable metal crossbar
• Effective to post operative
to maintain abduction
• As night splint
Von Rosen Orthosis

• H shape malleable splint

• Held hip at flexed and
abducted
 Legg-Calve-
Perthes Disease
(Necrosis of the
Femoral Head)
• Legg-Calve-Perthes disease (also known as Perthes disease) is
a rare condition in which the ball-shaped head of the thighbone
(femoral head) temporarily loses its blood supply. As a result,
the head of the thighbone collapses, and the area becomes
inflamed and irritated.
What are the stages of Legg-Calve-Perthes disease?
Phase 1: Necrosis

The blood supply to the

femoral head is disrupted,
causing the hip joint to become
inflamed, stiff, and painful.
Areas of the bone turn into
dead tissue (avascular
necrosis). In x-rays, the femoral
head appears less round. This
phase can last from several
months up to one year.
Phase 2: Fragmentation

The body “cleans up” the dead bone

cells and replaces them with new,
healthy bone cells. The femoral head
begins to remodel into a round shape
again, but the joint is still inflamed and
painful. This phase can last up to two
years.
Phase 3: Reossification

The femoral head continues to remodel

itself back into a round shape with new
bone once blood flow is restored. This
phase can last from one to three years.
Phase 4: Remodeling

Normal bone cells replace the new bone

cells, and the femoral head becomes
more of a mushroom shape than a ball.
This phase can last a few years as the
bone heals.
How is Legg-Calve-Perthes disease treated?

Surgical treatment for Legg-Calve-

Non-surgical approaches to treatment
Perthes disease
may include:
If non-surgical treatments prove
•activity restrictions
inadequate, your child may need
•anti-inflammatory medication
surgery to hold the head of the
•bed rest and traction
thighbone in the hip socket.
•casting or bracing to:
A pediatric orthopedic hip specialist
• hold the head of the
can perform a procedure known as a
thighbone in the hip socket
femoral osteotomy, which reorients
• permit limited joint
the way the femoral head fits inside
movement
the hip socket. In this procedure, the
• allow the thighbone to remold
femur is cut and rotated for better
itself into a round shape
alignment of the femoral head in the
•physical therapy, to keep the hip
hip socket. The bone is then secured
muscles strong and promote hip
with a metal plate and screws
movement
Slipped Upper Femoral Epiphysis