Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.
-
Upload
ernest-patterson -
Category
Documents
-
view
216 -
download
0
Transcript of Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.
![Page 1: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/1.jpg)
Quality Education for a Healthier Scotland
Multidisciplinary
Developmental Dysplasia of the Hip
![Page 2: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/2.jpg)
Quality Education for a Healthier Scotland
Multidisciplinary
“Developmental dysplasia of the hip”
Dysplasia Subluxation Dislocated
![Page 3: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/3.jpg)
Quality Education for a Healthier Scotland
Multidisciplinary
The aim of treatment
A normal hip
![Page 4: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/4.jpg)
Quality Education for a Healthier Scotland
Multidisciplinary
Natural history
Hip arthritis in early adulthood
![Page 5: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/5.jpg)
Quality Education for a Healthier Scotland
Multidisciplinary
Early diagnosis
Treatment success high
Treatment late cases
Less successful
More surgery
More complications
![Page 6: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/6.jpg)
Quality Education for a Healthier Scotland
Multidisciplinary
How common is DDH?
Clinically unstable hips – 1 in 64 babies
![Page 7: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/7.jpg)
Quality Education for a Healthier Scotland
Multidisciplinary
Scottish Needs Assessment Program Report July 1993
Number of late cases not reduced by neonatal screening
Possible increase in number of late presenting cases
![Page 8: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/8.jpg)
Quality Education for a Healthier Scotland
Multidisciplinary
National Screening Committee recommendations
All babies must be screened by clinical examination Ultrasound if clinical abnormality or risk factors
Clinically abnormal hips should be seen by a specialist
![Page 9: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/9.jpg)
Quality Education for a Healthier Scotland
Multidisciplinary
National Screening Committee (cont.)
Second hip check before 8 weeks
Personal Child Health Record lists signs and symptoms suggesting DDH
If DDH suspected, referral to someone with the appropriate expertise
![Page 10: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/10.jpg)
Quality Education for a Healthier Scotland
Multidisciplinary
Clinical examination “24-hour check”
Five points: History of risk factors Leg length difference Groin/buttock creases Range of abduction Tests of stability
![Page 11: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/11.jpg)
Quality Education for a Healthier Scotland
Multidisciplinary
Point 1 – History of risk factors
Breech presentation
Family history of DDH
Abnormalities of the lower limbs, e.g. clubfoot
Torticollis
![Page 12: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/12.jpg)
Quality Education for a Healthier Scotland
MultidisciplinaryLook
Point 2 - Leg length difference
Hips and knees flexed
Check level of knees – should be level
If not level then refer
Point 3 - Labial or groin folds and buttock creases
(Reprinted from Jones: Hip Screening of the Newborn – A Practical Guide, 1998, with permission from Elsevier.)
![Page 13: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/13.jpg)
Quality Education for a Healthier Scotland
Multidisciplinary
Move
Point 4 - Range of abduction
Point 5 - Tests of stability
Barlow
Ortolani
Restricted abduction and asymmetrical groin folds
![Page 14: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/14.jpg)
Quality Education for a Healthier Scotland
Multidisciplinary
Instability tests
In Out
Stable Normal Fixed dislocation
Unstable Barlow + Ortolani +
![Page 15: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/15.jpg)
Quality Education for a Healthier Scotland
MultidisciplinaryResting position
Test one hip at a timeHip and knee flexedFinger on greater trochanterStabilise pelvisCompare sidesTake your time, be gentle
![Page 16: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/16.jpg)
Quality Education for a Healthier Scotland
MultidisciplinaryClinical tests
Barlow test
Abnormal if femur moves Backwards relative to the fixed pelvis
Test for a located but dislocatable hip
![Page 17: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/17.jpg)
Quality Education for a Healthier Scotland
MultidisciplinaryClinical tests 2
Ortolani testPositive if greater trochanter moves forwards as hip locates Hip is Out, but can be reducedTests for a dislocated but reducible hip
![Page 18: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/18.jpg)
Quality Education for a Healthier Scotland
MultidisciplinaryBarlow & Ortolani
![Page 19: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/19.jpg)
Quality Education for a Healthier Scotland
Multidisciplinary
Examining infants hips - can it do harm?
“Over enthusiastic or repeated clinical examination may provoke instability”
Take your time, be gentle
Lowry et al (2005) Archives of Diseases in Childhood 90 (6): 579-81
![Page 20: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/20.jpg)
Quality Education for a Healthier Scotland
Multidisciplinary
Barlow positive Incidence?
• 15 to 20/1000 Barlow positive • Many resolve without treatment • Decision to treat may be delayed• Need careful watching
![Page 21: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/21.jpg)
Quality Education for a Healthier Scotland
Multidisciplinary
Ortolani positive. Incidence?
• 1 to 2/1000 Ortolani positive• Most will need treatment• Some centres splint from birth • Careful follow up
![Page 22: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/22.jpg)
Quality Education for a Healthier Scotland
Multidisciplinary
‘Teratologic' or fixed dislocation
• Dislocated irreducible hip• Dislocation before birth• Association with arthrogryposis or myelomeningocele • Surgery usually required
![Page 23: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/23.jpg)
Quality Education for a Healthier Scotland
MultidisciplinaryBaby Hippy
‘Life-like’ model of a female newborn Barlow positive hipOrtolani positive hip Expensive and delicate ++
![Page 24: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/24.jpg)
Quality Education for a Healthier Scotland
MultidisciplinaryClinical examination “24-hour check”
Five points:
History of risk factorsLeg length differenceGroin/buttock creasesRange of abductionTests of stability
BarlowOrtolani
Questions?
![Page 25: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/25.jpg)
Quality Education for a Healthier Scotland
MultidisciplinaryThe unstableneonatal hip
• What happens to them?• Hip can become normal• Progress to subluxation • Progress to dislocation• Remain located but remain dysplastic
We cannot tell which will get better on their own - they need watched
![Page 26: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/26.jpg)
Quality Education for a Healthier Scotland
Multidisciplinary
Controversies in DDH
• The natural history not completely understood • Effectiveness of treatment not clear• Screening – Who? How? When?• Why are we still missing so many?
![Page 27: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/27.jpg)
Quality Education for a Healthier Scotland
MultidisciplinaryClinical examination
• Not universally successful• Failed to eliminate late presentations• Dysplasia may not be detectable • Detection improves when performed by a limited number
of experienced examiners
![Page 28: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/28.jpg)
Quality Education for a Healthier Scotland
MultidisciplinaryMissed?
•Some are missed•Others present late•Importance of 6-week and 36-month checks•Late signs
–Limp–Leg length difference–Restricted abduction
Age 5 years: bilateraldislocations
![Page 29: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/29.jpg)
Quality Education for a Healthier Scotland
Multidisciplinary
Hip screening with ultrasound
Options
Universal screening
Screening of high risk babies
![Page 30: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/30.jpg)
Quality Education for a Healthier Scotland
MultidisciplinaryUniversal U/Sscreening
• Difficult to organise• High number of immature hips – rescan• Expensive• ?Cost effective• Conclusion – not proven, although some very impressive
results
![Page 31: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/31.jpg)
Quality Education for a Healthier Scotland
Multidisciplinary
Selective U/Sscreening
• Only high risk and clinically abnormal hips• Consultant radiologists and dedicated sonographer• ? Effectiveness• Manageable
![Page 32: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/32.jpg)
Quality Education for a Healthier Scotland
Multidisciplinary
X-ray examination
X-rays before 4 months of age unreliable
Very important in older children for diagnosis and monitoring of treatment
Dislocation age 15 months.
![Page 33: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/33.jpg)
Quality Education for a Healthier Scotland
MultidisciplinaryLate signs of DDH
Asymmetric abduction
Leg length discrepancy
DDH must be excluded
![Page 34: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/34.jpg)
Quality Education for a Healthier Scotland
MultidisciplinaryTreatment
Abduction splint – Pavlik, von Rosen
Monitoring for hip development and complications
![Page 35: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/35.jpg)
Quality Education for a Healthier Scotland
Multidisciplinary
How not to examine a baby’s hips!
![Page 36: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/36.jpg)
Quality Education for a Healthier Scotland
MultidisciplinaryThank you.
Any questions?
![Page 37: Quality Education for a Healthier Scotland Multidisciplinary Developmental Dysplasia of the Hip.](https://reader036.fdocuments.in/reader036/viewer/2022062407/56649dc55503460f94ab9048/html5/thumbnails/37.jpg)
Quality Education for a Healthier Scotland
MultidisciplinarySummary
Aim – to reduce incidence of hip arthritis
The Five points of the examination History of risk factors Leg length difference Groin/buttock creases Range of abduction Tests of stability