Approach to Case of Developmental Dysplasia of HIP

Teaching Points : 

— > This is an AP pelvic radiograph showing a dislocated left hip and dysplastic acetabulum.

Shenton’s line is broken and the femoral head lies lateral and superior to the inferiomedial quadrant (made by the intersection of Perkin’s and Hilgenreiner’s lines).

–> How would you proceed in you management from here?

** I would take a full history and examine the child.
There may be risk factors for developmental dysplasia of the hip (DDH) including positive family history and/or decreased intrauterine space ,first born,breech, oligohydramnios (associated packaging problems).
**More importantly I would be looking to see if there were any underlying neuromuscular conditions such as spina bifida, arthrogryphosis, or cerebral palsy.
**Examination may reveal a Trendelenberg gait,leg length discrepancy, fixed flexion deformity as well as reduced abduction of the left hip, which is the most consistent and reliable clinical sign of this condition.
** I would organize an examination under anaesthesia (EUA) and arthrogram to delineate the anatomyof the acetabulum, soft tissues, and proximal femur.
** It would be unlikely that this hip would reduce closed.
** Blocks to reduction would include: an inverted limbus; elongated ligamentum teres; hour-glassconstriction of the capsule; psoas tendon and pulvinar.
** Indications for open reduction include: failureof closed reduction; an unstable reducible hip, or soft tissue interposition preventing a congruent reduction.

 –> What open operative approaches would you use to reduce this hip?

I would use a modified anterior (ilio-femoral) approach to the hip.
I would place my skin incisionparallel and distal to the iliac crest, passing 2 cm distal to the anterior superior iliac spine (ASIS) and extending medially within the groin skin crease.
I would identify and protect the lateral cutaneous nerve of the thigh and then distally I would develop the internervous plane between tensor fascia lata (superior gluteal nerve) and sartorius (femoral nerve).


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