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Freih Odeh Abu Hassan F.R.C.S (Eng.), F.R.C.S(Tr.&Orth.)
Professor of Orthopedics and
Pediatrics Orthopedics Surgery
University of Jordan
Developmental dysplasia
But not developmental dislocation
And not
developmental disturbances
1- Jordan University
Dislocation at birth
1- Neuromuscular disorders
(AMC , Spina bifida…….)
2- Sacral agenesis
3- Syndromatic, Larsen….
Jordan University
Suspicion from hx. •Female
•Family hx 10 times
•First born
•First presenting part
(F.Breech) 5-10 times
•Feet deformity
•Fetal anomalies
•Facial asymmetry
•Faulty gait !!!!!!!!
•Family habits
•1st 3 months.
•Negative in A.D.
•Only +ve for dislocation.
•You should examine each
hip alone.
Jordan University
= Hurried doctor
= Little experienced
= Poor understanding of the tests
Treating Doctor problems Jordan University
*Business motivation !!!!!
*Not before 9 weeks.
*Iliac line must be vertical.
*Cost !!!!!!
5-
Jordan University
*Needs the (Orth.) expert !!!!
*Dynamic more conclusive
*If you depend on it you may
treat more normal hips !!!
Jordan University
High anteversion *Straight neck-shaft angle
*O.N Symmetrical
*Disturbance of Shenton’s lines
7-
False pregnancy
Full abduction doesn’t
mean no DDH.
Normal acetabulum
means no DDH
Jordan University
Problems
= Can’t reduce hips
= AVN
= Long R/
= Abd. Position only
= Frequent removal
Jordan University
*Simple, Safe, Easy.
*Needs only orientation.
*Acceptable by the parents.
*Very effective.
*Short duration of R/
*No need to be removed .
Jordan University
1-We don’t know the Diamonds !!!
2-We don’t know how to use
the Diamonds properly?
3-We have other cheap Jewelry!!!
4-We have sensitivity to Diamonds.
Jordan University
* Teratologic dislocation ( CDH)
* >6m, Obese child
*Failure of reduction after 4 weeks.
* Irreducible dislocation.
Jordan University
How long you will keep the spica ?
1- After closed reduction
6 W + 6 W
2- After open reduction
6 W
Jordan University
Spica Problems
1- Osteoporosis fracture
2- Can hide unreduced hip
3- Hip stiffness
4- Pressure sore
5- Hygiene problems
6- Heavy
7- May break
Jordan University
Surgeon did inform the parents ,
Probably I did break his bones !
I will do X-ray next week !!!!
Surgeon’s fracture
Don’t Force the reduction !!!
= False reduction
= AVN
= Fracture
= Redislocation
10 Jordan University
= DDH is very common.
= Needs a warness in Dx.
= Wrong R/.disability.
= Would you allow this to be
done for your child?
= Pavlik harness.