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Presenting Author ndash
Dr Sanjay M Khaladkar
Co-Authors ndash
Dr Dhaval K Thakkar
Institution ndash
Dr D Y Patil Medical College
Pimpri Pune
Drawing of the neonatal hip is provided to illustrate anatomical landmarks
Drawings of the neonatal hip are shown above demonstrating graphical overlays of the HIP
ANGLE measurement methods
Normal infant hip ultrasound
bull type I alpha angle gt 60 degrees (normal)bull type Ia beta angle lt 55 degreesbull type Ib beta angle gt 55 degrees
bull type IIbull type IIa alpha angle 50 - 59 degreesbull type IIb alpha angle 50 - 59 degreesbull type IIc
bull alpha angle 43 - 49 degreesbull beta angle lt 77 degrees
bull type D (about to decenter)bull alpha angle 43 - 49 degreesbull beta angle gt 77 degrees
bull type III alpha angle lt 43 degreesbull type IIIa and IIIb distinguished on the
grounds of structural alteration of the cartilaginous roof
bull type IVbull alpha angle lt 43 degreesbull dislocated with labrum interposed
between femoral head and acetabulum
Case 1 Clinical Profile
This was a 10 day old infant not moving the left lower limb with tenderness on left hip movement passively Clinical suspicion
was developmental dysplasia of hip and was referred for a scan
US revealed Alpha angle = 45560 and Beta angle = 52400
Developmental Dysplasia Of Hip (DDH)
Case 2 Clinical Profile
21 yearsfemale came with complaints of left hip pain since childhood which is slowly
increasing in intensity and aggravates during winters Patient is not able to squat for a long
time No ho traumafall No ho feverTB
Hilgenreiners lineHilgenreiners line is drawn horizontally through the superior aspect of both triradiate cartilages It should be horizontal but is mainly used as a reference for Perkins line and measurement of the acetabular angle
Perkins linePerkins line is drawn perpendicular to Hilgenreiners line intersecting the lateral most aspect of the acetabular roof The upper femoral epiphysis should be seen in the inferomedial quadrant (ie below Hilgenreiners line and medial to Perkins line)
Case 2 Clinical Profile
21 yearsfemale came with complaints of left hip pain since childhood which is slowly
increasing in intensity and aggravates during winters Patient is not able to squat for a long
time No ho traumafall No ho feverTB
Acetabular angleThe acetabular angle is formed by the intersection between a line drawn tangential to the acetabular roof and Hilgenreiners line forming an acute angle It should be approximately 30degrees at birth and progressively reduce with maturation of the joint
Case 2 Clinical Profile
21 yearsfemale came with complaints of left hip pain since childhood which is slowly
increasing in intensity and aggravates during winters Patient is not able to squat for a long
time No ho traumafall No ho feverTB
Lateral Center Edge Angle Of Wiberg ndashAngle formed by a line drawn from the centerof the femoral head to the outer edge of theacetabular roof and a verticle line drawnthrough the center of the femoral head
- angle greater than 25 deg are considerednormal
- less than 20 deg indicates severe dysplasia
Developmental Dysplasia Of Hip (DDH)
Coronal and Axial CT Scan Images reveals ndashSubarticular sclerosis subarticular geords shallow acetlabulum malformed femoral head
Definition ndash
Developmental dysplasia of the hip (DDH) results from an abnormal
relationship of the femoral head to the acetabulum It usually occurs from
ligamentous laxity and or abnormal position in utero
Incidence = 15 and 20 per 1000 births
with the majority (60-80) of abnormal hips resolving spontaneously within
2-8 weeks (so called immature hip)
Developmental Dysplasia Of Hip (DDH)
Definition ndash
Developmental dysplasia of the hip (DDH) results from an abnormal
relationship of the femoral head to the acetabulum It usually occurs from
ligamentous laxity and or abnormal position in utero
Incidence = 15 and 20 per 1000 births
with the majority (60-80) of abnormal hips resolving spontaneously within
2-8 weeks (so called immature hip)
Developmental Dysplasia Of Hip (DDH)
Incidence
Secondary Hip Dysplasia
Treatment and prognosis
bull Pavlik harness - usually for younger
patients (lt 6 months of age)
bull closed reduction - usually for older
patients
bull open reduction - much older
patient or if closed reduction not
successful
Application
1 Graf R The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment Arch
Orthop Trauma Surg 198097 (2) 117-33
2 Graf R Scott S Lercher K Hip sonography diagnosis and management of infant hip dysplasia Springer
Verlag (2006) ISBN3540309578
3 US Preventive Services Task Force ldquoScreening for Developmental Dysplasia of the Hip
Recommendation Statementrdquo PEDIATRICS 117 no 3 (3 2006) 898-902
4 Roposch Andreas Nicole M Moreau Elizabeth Uleryk and Andrea S Doria ldquoDevelopmental Dysplasia
of the Hip Quality of Reporting of Diagnostic Accuracy for US1rdquo Radiology 241 no 3 (December 2006)
854-860
5 Taeusch H William Roberta A Ballard Christine A Gleason and Mary Ellen Avery Averys diseases of
the newborn Elsevier Health Sciences 2005
REFERENCES
Developmental Dysplasia Of Hip (DDH)
Drawing of the neonatal hip is provided to illustrate anatomical landmarks
Drawings of the neonatal hip are shown above demonstrating graphical overlays of the HIP
ANGLE measurement methods
Normal infant hip ultrasound
bull type I alpha angle gt 60 degrees (normal)bull type Ia beta angle lt 55 degreesbull type Ib beta angle gt 55 degrees
bull type IIbull type IIa alpha angle 50 - 59 degreesbull type IIb alpha angle 50 - 59 degreesbull type IIc
bull alpha angle 43 - 49 degreesbull beta angle lt 77 degrees
bull type D (about to decenter)bull alpha angle 43 - 49 degreesbull beta angle gt 77 degrees
bull type III alpha angle lt 43 degreesbull type IIIa and IIIb distinguished on the
grounds of structural alteration of the cartilaginous roof
bull type IVbull alpha angle lt 43 degreesbull dislocated with labrum interposed
between femoral head and acetabulum
Case 1 Clinical Profile
This was a 10 day old infant not moving the left lower limb with tenderness on left hip movement passively Clinical suspicion
was developmental dysplasia of hip and was referred for a scan
US revealed Alpha angle = 45560 and Beta angle = 52400
Developmental Dysplasia Of Hip (DDH)
Case 2 Clinical Profile
21 yearsfemale came with complaints of left hip pain since childhood which is slowly
increasing in intensity and aggravates during winters Patient is not able to squat for a long
time No ho traumafall No ho feverTB
Hilgenreiners lineHilgenreiners line is drawn horizontally through the superior aspect of both triradiate cartilages It should be horizontal but is mainly used as a reference for Perkins line and measurement of the acetabular angle
Perkins linePerkins line is drawn perpendicular to Hilgenreiners line intersecting the lateral most aspect of the acetabular roof The upper femoral epiphysis should be seen in the inferomedial quadrant (ie below Hilgenreiners line and medial to Perkins line)
Case 2 Clinical Profile
21 yearsfemale came with complaints of left hip pain since childhood which is slowly
increasing in intensity and aggravates during winters Patient is not able to squat for a long
time No ho traumafall No ho feverTB
Acetabular angleThe acetabular angle is formed by the intersection between a line drawn tangential to the acetabular roof and Hilgenreiners line forming an acute angle It should be approximately 30degrees at birth and progressively reduce with maturation of the joint
Case 2 Clinical Profile
21 yearsfemale came with complaints of left hip pain since childhood which is slowly
increasing in intensity and aggravates during winters Patient is not able to squat for a long
time No ho traumafall No ho feverTB
Lateral Center Edge Angle Of Wiberg ndashAngle formed by a line drawn from the centerof the femoral head to the outer edge of theacetabular roof and a verticle line drawnthrough the center of the femoral head
- angle greater than 25 deg are considerednormal
- less than 20 deg indicates severe dysplasia
Developmental Dysplasia Of Hip (DDH)
Coronal and Axial CT Scan Images reveals ndashSubarticular sclerosis subarticular geords shallow acetlabulum malformed femoral head
Definition ndash
Developmental dysplasia of the hip (DDH) results from an abnormal
relationship of the femoral head to the acetabulum It usually occurs from
ligamentous laxity and or abnormal position in utero
Incidence = 15 and 20 per 1000 births
with the majority (60-80) of abnormal hips resolving spontaneously within
2-8 weeks (so called immature hip)
Developmental Dysplasia Of Hip (DDH)
Definition ndash
Developmental dysplasia of the hip (DDH) results from an abnormal
relationship of the femoral head to the acetabulum It usually occurs from
ligamentous laxity and or abnormal position in utero
Incidence = 15 and 20 per 1000 births
with the majority (60-80) of abnormal hips resolving spontaneously within
2-8 weeks (so called immature hip)
Developmental Dysplasia Of Hip (DDH)
Incidence
Secondary Hip Dysplasia
Treatment and prognosis
bull Pavlik harness - usually for younger
patients (lt 6 months of age)
bull closed reduction - usually for older
patients
bull open reduction - much older
patient or if closed reduction not
successful
Application
1 Graf R The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment Arch
Orthop Trauma Surg 198097 (2) 117-33
2 Graf R Scott S Lercher K Hip sonography diagnosis and management of infant hip dysplasia Springer
Verlag (2006) ISBN3540309578
3 US Preventive Services Task Force ldquoScreening for Developmental Dysplasia of the Hip
Recommendation Statementrdquo PEDIATRICS 117 no 3 (3 2006) 898-902
4 Roposch Andreas Nicole M Moreau Elizabeth Uleryk and Andrea S Doria ldquoDevelopmental Dysplasia
of the Hip Quality of Reporting of Diagnostic Accuracy for US1rdquo Radiology 241 no 3 (December 2006)
854-860
5 Taeusch H William Roberta A Ballard Christine A Gleason and Mary Ellen Avery Averys diseases of
the newborn Elsevier Health Sciences 2005
REFERENCES
Developmental Dysplasia Of Hip (DDH)
Normal infant hip ultrasound
bull type I alpha angle gt 60 degrees (normal)bull type Ia beta angle lt 55 degreesbull type Ib beta angle gt 55 degrees
bull type IIbull type IIa alpha angle 50 - 59 degreesbull type IIb alpha angle 50 - 59 degreesbull type IIc
bull alpha angle 43 - 49 degreesbull beta angle lt 77 degrees
bull type D (about to decenter)bull alpha angle 43 - 49 degreesbull beta angle gt 77 degrees
bull type III alpha angle lt 43 degreesbull type IIIa and IIIb distinguished on the
grounds of structural alteration of the cartilaginous roof
bull type IVbull alpha angle lt 43 degreesbull dislocated with labrum interposed
between femoral head and acetabulum
Case 1 Clinical Profile
This was a 10 day old infant not moving the left lower limb with tenderness on left hip movement passively Clinical suspicion
was developmental dysplasia of hip and was referred for a scan
US revealed Alpha angle = 45560 and Beta angle = 52400
Developmental Dysplasia Of Hip (DDH)
Case 2 Clinical Profile
21 yearsfemale came with complaints of left hip pain since childhood which is slowly
increasing in intensity and aggravates during winters Patient is not able to squat for a long
time No ho traumafall No ho feverTB
Hilgenreiners lineHilgenreiners line is drawn horizontally through the superior aspect of both triradiate cartilages It should be horizontal but is mainly used as a reference for Perkins line and measurement of the acetabular angle
Perkins linePerkins line is drawn perpendicular to Hilgenreiners line intersecting the lateral most aspect of the acetabular roof The upper femoral epiphysis should be seen in the inferomedial quadrant (ie below Hilgenreiners line and medial to Perkins line)
Case 2 Clinical Profile
21 yearsfemale came with complaints of left hip pain since childhood which is slowly
increasing in intensity and aggravates during winters Patient is not able to squat for a long
time No ho traumafall No ho feverTB
Acetabular angleThe acetabular angle is formed by the intersection between a line drawn tangential to the acetabular roof and Hilgenreiners line forming an acute angle It should be approximately 30degrees at birth and progressively reduce with maturation of the joint
Case 2 Clinical Profile
21 yearsfemale came with complaints of left hip pain since childhood which is slowly
increasing in intensity and aggravates during winters Patient is not able to squat for a long
time No ho traumafall No ho feverTB
Lateral Center Edge Angle Of Wiberg ndashAngle formed by a line drawn from the centerof the femoral head to the outer edge of theacetabular roof and a verticle line drawnthrough the center of the femoral head
- angle greater than 25 deg are considerednormal
- less than 20 deg indicates severe dysplasia
Developmental Dysplasia Of Hip (DDH)
Coronal and Axial CT Scan Images reveals ndashSubarticular sclerosis subarticular geords shallow acetlabulum malformed femoral head
Definition ndash
Developmental dysplasia of the hip (DDH) results from an abnormal
relationship of the femoral head to the acetabulum It usually occurs from
ligamentous laxity and or abnormal position in utero
Incidence = 15 and 20 per 1000 births
with the majority (60-80) of abnormal hips resolving spontaneously within
2-8 weeks (so called immature hip)
Developmental Dysplasia Of Hip (DDH)
Definition ndash
Developmental dysplasia of the hip (DDH) results from an abnormal
relationship of the femoral head to the acetabulum It usually occurs from
ligamentous laxity and or abnormal position in utero
Incidence = 15 and 20 per 1000 births
with the majority (60-80) of abnormal hips resolving spontaneously within
2-8 weeks (so called immature hip)
Developmental Dysplasia Of Hip (DDH)
Incidence
Secondary Hip Dysplasia
Treatment and prognosis
bull Pavlik harness - usually for younger
patients (lt 6 months of age)
bull closed reduction - usually for older
patients
bull open reduction - much older
patient or if closed reduction not
successful
Application
1 Graf R The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment Arch
Orthop Trauma Surg 198097 (2) 117-33
2 Graf R Scott S Lercher K Hip sonography diagnosis and management of infant hip dysplasia Springer
Verlag (2006) ISBN3540309578
3 US Preventive Services Task Force ldquoScreening for Developmental Dysplasia of the Hip
Recommendation Statementrdquo PEDIATRICS 117 no 3 (3 2006) 898-902
4 Roposch Andreas Nicole M Moreau Elizabeth Uleryk and Andrea S Doria ldquoDevelopmental Dysplasia
of the Hip Quality of Reporting of Diagnostic Accuracy for US1rdquo Radiology 241 no 3 (December 2006)
854-860
5 Taeusch H William Roberta A Ballard Christine A Gleason and Mary Ellen Avery Averys diseases of
the newborn Elsevier Health Sciences 2005
REFERENCES
Developmental Dysplasia Of Hip (DDH)
Case 1 Clinical Profile
This was a 10 day old infant not moving the left lower limb with tenderness on left hip movement passively Clinical suspicion
was developmental dysplasia of hip and was referred for a scan
US revealed Alpha angle = 45560 and Beta angle = 52400
Developmental Dysplasia Of Hip (DDH)
Case 2 Clinical Profile
21 yearsfemale came with complaints of left hip pain since childhood which is slowly
increasing in intensity and aggravates during winters Patient is not able to squat for a long
time No ho traumafall No ho feverTB
Hilgenreiners lineHilgenreiners line is drawn horizontally through the superior aspect of both triradiate cartilages It should be horizontal but is mainly used as a reference for Perkins line and measurement of the acetabular angle
Perkins linePerkins line is drawn perpendicular to Hilgenreiners line intersecting the lateral most aspect of the acetabular roof The upper femoral epiphysis should be seen in the inferomedial quadrant (ie below Hilgenreiners line and medial to Perkins line)
Case 2 Clinical Profile
21 yearsfemale came with complaints of left hip pain since childhood which is slowly
increasing in intensity and aggravates during winters Patient is not able to squat for a long
time No ho traumafall No ho feverTB
Acetabular angleThe acetabular angle is formed by the intersection between a line drawn tangential to the acetabular roof and Hilgenreiners line forming an acute angle It should be approximately 30degrees at birth and progressively reduce with maturation of the joint
Case 2 Clinical Profile
21 yearsfemale came with complaints of left hip pain since childhood which is slowly
increasing in intensity and aggravates during winters Patient is not able to squat for a long
time No ho traumafall No ho feverTB
Lateral Center Edge Angle Of Wiberg ndashAngle formed by a line drawn from the centerof the femoral head to the outer edge of theacetabular roof and a verticle line drawnthrough the center of the femoral head
- angle greater than 25 deg are considerednormal
- less than 20 deg indicates severe dysplasia
Developmental Dysplasia Of Hip (DDH)
Coronal and Axial CT Scan Images reveals ndashSubarticular sclerosis subarticular geords shallow acetlabulum malformed femoral head
Definition ndash
Developmental dysplasia of the hip (DDH) results from an abnormal
relationship of the femoral head to the acetabulum It usually occurs from
ligamentous laxity and or abnormal position in utero
Incidence = 15 and 20 per 1000 births
with the majority (60-80) of abnormal hips resolving spontaneously within
2-8 weeks (so called immature hip)
Developmental Dysplasia Of Hip (DDH)
Definition ndash
Developmental dysplasia of the hip (DDH) results from an abnormal
relationship of the femoral head to the acetabulum It usually occurs from
ligamentous laxity and or abnormal position in utero
Incidence = 15 and 20 per 1000 births
with the majority (60-80) of abnormal hips resolving spontaneously within
2-8 weeks (so called immature hip)
Developmental Dysplasia Of Hip (DDH)
Incidence
Secondary Hip Dysplasia
Treatment and prognosis
bull Pavlik harness - usually for younger
patients (lt 6 months of age)
bull closed reduction - usually for older
patients
bull open reduction - much older
patient or if closed reduction not
successful
Application
1 Graf R The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment Arch
Orthop Trauma Surg 198097 (2) 117-33
2 Graf R Scott S Lercher K Hip sonography diagnosis and management of infant hip dysplasia Springer
Verlag (2006) ISBN3540309578
3 US Preventive Services Task Force ldquoScreening for Developmental Dysplasia of the Hip
Recommendation Statementrdquo PEDIATRICS 117 no 3 (3 2006) 898-902
4 Roposch Andreas Nicole M Moreau Elizabeth Uleryk and Andrea S Doria ldquoDevelopmental Dysplasia
of the Hip Quality of Reporting of Diagnostic Accuracy for US1rdquo Radiology 241 no 3 (December 2006)
854-860
5 Taeusch H William Roberta A Ballard Christine A Gleason and Mary Ellen Avery Averys diseases of
the newborn Elsevier Health Sciences 2005
REFERENCES
Developmental Dysplasia Of Hip (DDH)
Developmental Dysplasia Of Hip (DDH)
Case 2 Clinical Profile
21 yearsfemale came with complaints of left hip pain since childhood which is slowly
increasing in intensity and aggravates during winters Patient is not able to squat for a long
time No ho traumafall No ho feverTB
Hilgenreiners lineHilgenreiners line is drawn horizontally through the superior aspect of both triradiate cartilages It should be horizontal but is mainly used as a reference for Perkins line and measurement of the acetabular angle
Perkins linePerkins line is drawn perpendicular to Hilgenreiners line intersecting the lateral most aspect of the acetabular roof The upper femoral epiphysis should be seen in the inferomedial quadrant (ie below Hilgenreiners line and medial to Perkins line)
Case 2 Clinical Profile
21 yearsfemale came with complaints of left hip pain since childhood which is slowly
increasing in intensity and aggravates during winters Patient is not able to squat for a long
time No ho traumafall No ho feverTB
Acetabular angleThe acetabular angle is formed by the intersection between a line drawn tangential to the acetabular roof and Hilgenreiners line forming an acute angle It should be approximately 30degrees at birth and progressively reduce with maturation of the joint
Case 2 Clinical Profile
21 yearsfemale came with complaints of left hip pain since childhood which is slowly
increasing in intensity and aggravates during winters Patient is not able to squat for a long
time No ho traumafall No ho feverTB
Lateral Center Edge Angle Of Wiberg ndashAngle formed by a line drawn from the centerof the femoral head to the outer edge of theacetabular roof and a verticle line drawnthrough the center of the femoral head
- angle greater than 25 deg are considerednormal
- less than 20 deg indicates severe dysplasia
Developmental Dysplasia Of Hip (DDH)
Coronal and Axial CT Scan Images reveals ndashSubarticular sclerosis subarticular geords shallow acetlabulum malformed femoral head
Definition ndash
Developmental dysplasia of the hip (DDH) results from an abnormal
relationship of the femoral head to the acetabulum It usually occurs from
ligamentous laxity and or abnormal position in utero
Incidence = 15 and 20 per 1000 births
with the majority (60-80) of abnormal hips resolving spontaneously within
2-8 weeks (so called immature hip)
Developmental Dysplasia Of Hip (DDH)
Definition ndash
Developmental dysplasia of the hip (DDH) results from an abnormal
relationship of the femoral head to the acetabulum It usually occurs from
ligamentous laxity and or abnormal position in utero
Incidence = 15 and 20 per 1000 births
with the majority (60-80) of abnormal hips resolving spontaneously within
2-8 weeks (so called immature hip)
Developmental Dysplasia Of Hip (DDH)
Incidence
Secondary Hip Dysplasia
Treatment and prognosis
bull Pavlik harness - usually for younger
patients (lt 6 months of age)
bull closed reduction - usually for older
patients
bull open reduction - much older
patient or if closed reduction not
successful
Application
1 Graf R The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment Arch
Orthop Trauma Surg 198097 (2) 117-33
2 Graf R Scott S Lercher K Hip sonography diagnosis and management of infant hip dysplasia Springer
Verlag (2006) ISBN3540309578
3 US Preventive Services Task Force ldquoScreening for Developmental Dysplasia of the Hip
Recommendation Statementrdquo PEDIATRICS 117 no 3 (3 2006) 898-902
4 Roposch Andreas Nicole M Moreau Elizabeth Uleryk and Andrea S Doria ldquoDevelopmental Dysplasia
of the Hip Quality of Reporting of Diagnostic Accuracy for US1rdquo Radiology 241 no 3 (December 2006)
854-860
5 Taeusch H William Roberta A Ballard Christine A Gleason and Mary Ellen Avery Averys diseases of
the newborn Elsevier Health Sciences 2005
REFERENCES
Developmental Dysplasia Of Hip (DDH)
Case 2 Clinical Profile
21 yearsfemale came with complaints of left hip pain since childhood which is slowly
increasing in intensity and aggravates during winters Patient is not able to squat for a long
time No ho traumafall No ho feverTB
Hilgenreiners lineHilgenreiners line is drawn horizontally through the superior aspect of both triradiate cartilages It should be horizontal but is mainly used as a reference for Perkins line and measurement of the acetabular angle
Perkins linePerkins line is drawn perpendicular to Hilgenreiners line intersecting the lateral most aspect of the acetabular roof The upper femoral epiphysis should be seen in the inferomedial quadrant (ie below Hilgenreiners line and medial to Perkins line)
Case 2 Clinical Profile
21 yearsfemale came with complaints of left hip pain since childhood which is slowly
increasing in intensity and aggravates during winters Patient is not able to squat for a long
time No ho traumafall No ho feverTB
Acetabular angleThe acetabular angle is formed by the intersection between a line drawn tangential to the acetabular roof and Hilgenreiners line forming an acute angle It should be approximately 30degrees at birth and progressively reduce with maturation of the joint
Case 2 Clinical Profile
21 yearsfemale came with complaints of left hip pain since childhood which is slowly
increasing in intensity and aggravates during winters Patient is not able to squat for a long
time No ho traumafall No ho feverTB
Lateral Center Edge Angle Of Wiberg ndashAngle formed by a line drawn from the centerof the femoral head to the outer edge of theacetabular roof and a verticle line drawnthrough the center of the femoral head
- angle greater than 25 deg are considerednormal
- less than 20 deg indicates severe dysplasia
Developmental Dysplasia Of Hip (DDH)
Coronal and Axial CT Scan Images reveals ndashSubarticular sclerosis subarticular geords shallow acetlabulum malformed femoral head
Definition ndash
Developmental dysplasia of the hip (DDH) results from an abnormal
relationship of the femoral head to the acetabulum It usually occurs from
ligamentous laxity and or abnormal position in utero
Incidence = 15 and 20 per 1000 births
with the majority (60-80) of abnormal hips resolving spontaneously within
2-8 weeks (so called immature hip)
Developmental Dysplasia Of Hip (DDH)
Definition ndash
Developmental dysplasia of the hip (DDH) results from an abnormal
relationship of the femoral head to the acetabulum It usually occurs from
ligamentous laxity and or abnormal position in utero
Incidence = 15 and 20 per 1000 births
with the majority (60-80) of abnormal hips resolving spontaneously within
2-8 weeks (so called immature hip)
Developmental Dysplasia Of Hip (DDH)
Incidence
Secondary Hip Dysplasia
Treatment and prognosis
bull Pavlik harness - usually for younger
patients (lt 6 months of age)
bull closed reduction - usually for older
patients
bull open reduction - much older
patient or if closed reduction not
successful
Application
1 Graf R The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment Arch
Orthop Trauma Surg 198097 (2) 117-33
2 Graf R Scott S Lercher K Hip sonography diagnosis and management of infant hip dysplasia Springer
Verlag (2006) ISBN3540309578
3 US Preventive Services Task Force ldquoScreening for Developmental Dysplasia of the Hip
Recommendation Statementrdquo PEDIATRICS 117 no 3 (3 2006) 898-902
4 Roposch Andreas Nicole M Moreau Elizabeth Uleryk and Andrea S Doria ldquoDevelopmental Dysplasia
of the Hip Quality of Reporting of Diagnostic Accuracy for US1rdquo Radiology 241 no 3 (December 2006)
854-860
5 Taeusch H William Roberta A Ballard Christine A Gleason and Mary Ellen Avery Averys diseases of
the newborn Elsevier Health Sciences 2005
REFERENCES
Developmental Dysplasia Of Hip (DDH)
Case 2 Clinical Profile
21 yearsfemale came with complaints of left hip pain since childhood which is slowly
increasing in intensity and aggravates during winters Patient is not able to squat for a long
time No ho traumafall No ho feverTB
Acetabular angleThe acetabular angle is formed by the intersection between a line drawn tangential to the acetabular roof and Hilgenreiners line forming an acute angle It should be approximately 30degrees at birth and progressively reduce with maturation of the joint
Case 2 Clinical Profile
21 yearsfemale came with complaints of left hip pain since childhood which is slowly
increasing in intensity and aggravates during winters Patient is not able to squat for a long
time No ho traumafall No ho feverTB
Lateral Center Edge Angle Of Wiberg ndashAngle formed by a line drawn from the centerof the femoral head to the outer edge of theacetabular roof and a verticle line drawnthrough the center of the femoral head
- angle greater than 25 deg are considerednormal
- less than 20 deg indicates severe dysplasia
Developmental Dysplasia Of Hip (DDH)
Coronal and Axial CT Scan Images reveals ndashSubarticular sclerosis subarticular geords shallow acetlabulum malformed femoral head
Definition ndash
Developmental dysplasia of the hip (DDH) results from an abnormal
relationship of the femoral head to the acetabulum It usually occurs from
ligamentous laxity and or abnormal position in utero
Incidence = 15 and 20 per 1000 births
with the majority (60-80) of abnormal hips resolving spontaneously within
2-8 weeks (so called immature hip)
Developmental Dysplasia Of Hip (DDH)
Definition ndash
Developmental dysplasia of the hip (DDH) results from an abnormal
relationship of the femoral head to the acetabulum It usually occurs from
ligamentous laxity and or abnormal position in utero
Incidence = 15 and 20 per 1000 births
with the majority (60-80) of abnormal hips resolving spontaneously within
2-8 weeks (so called immature hip)
Developmental Dysplasia Of Hip (DDH)
Incidence
Secondary Hip Dysplasia
Treatment and prognosis
bull Pavlik harness - usually for younger
patients (lt 6 months of age)
bull closed reduction - usually for older
patients
bull open reduction - much older
patient or if closed reduction not
successful
Application
1 Graf R The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment Arch
Orthop Trauma Surg 198097 (2) 117-33
2 Graf R Scott S Lercher K Hip sonography diagnosis and management of infant hip dysplasia Springer
Verlag (2006) ISBN3540309578
3 US Preventive Services Task Force ldquoScreening for Developmental Dysplasia of the Hip
Recommendation Statementrdquo PEDIATRICS 117 no 3 (3 2006) 898-902
4 Roposch Andreas Nicole M Moreau Elizabeth Uleryk and Andrea S Doria ldquoDevelopmental Dysplasia
of the Hip Quality of Reporting of Diagnostic Accuracy for US1rdquo Radiology 241 no 3 (December 2006)
854-860
5 Taeusch H William Roberta A Ballard Christine A Gleason and Mary Ellen Avery Averys diseases of
the newborn Elsevier Health Sciences 2005
REFERENCES
Developmental Dysplasia Of Hip (DDH)
Case 2 Clinical Profile
21 yearsfemale came with complaints of left hip pain since childhood which is slowly
increasing in intensity and aggravates during winters Patient is not able to squat for a long
time No ho traumafall No ho feverTB
Lateral Center Edge Angle Of Wiberg ndashAngle formed by a line drawn from the centerof the femoral head to the outer edge of theacetabular roof and a verticle line drawnthrough the center of the femoral head
- angle greater than 25 deg are considerednormal
- less than 20 deg indicates severe dysplasia
Developmental Dysplasia Of Hip (DDH)
Coronal and Axial CT Scan Images reveals ndashSubarticular sclerosis subarticular geords shallow acetlabulum malformed femoral head
Definition ndash
Developmental dysplasia of the hip (DDH) results from an abnormal
relationship of the femoral head to the acetabulum It usually occurs from
ligamentous laxity and or abnormal position in utero
Incidence = 15 and 20 per 1000 births
with the majority (60-80) of abnormal hips resolving spontaneously within
2-8 weeks (so called immature hip)
Developmental Dysplasia Of Hip (DDH)
Definition ndash
Developmental dysplasia of the hip (DDH) results from an abnormal
relationship of the femoral head to the acetabulum It usually occurs from
ligamentous laxity and or abnormal position in utero
Incidence = 15 and 20 per 1000 births
with the majority (60-80) of abnormal hips resolving spontaneously within
2-8 weeks (so called immature hip)
Developmental Dysplasia Of Hip (DDH)
Incidence
Secondary Hip Dysplasia
Treatment and prognosis
bull Pavlik harness - usually for younger
patients (lt 6 months of age)
bull closed reduction - usually for older
patients
bull open reduction - much older
patient or if closed reduction not
successful
Application
1 Graf R The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment Arch
Orthop Trauma Surg 198097 (2) 117-33
2 Graf R Scott S Lercher K Hip sonography diagnosis and management of infant hip dysplasia Springer
Verlag (2006) ISBN3540309578
3 US Preventive Services Task Force ldquoScreening for Developmental Dysplasia of the Hip
Recommendation Statementrdquo PEDIATRICS 117 no 3 (3 2006) 898-902
4 Roposch Andreas Nicole M Moreau Elizabeth Uleryk and Andrea S Doria ldquoDevelopmental Dysplasia
of the Hip Quality of Reporting of Diagnostic Accuracy for US1rdquo Radiology 241 no 3 (December 2006)
854-860
5 Taeusch H William Roberta A Ballard Christine A Gleason and Mary Ellen Avery Averys diseases of
the newborn Elsevier Health Sciences 2005
REFERENCES
Developmental Dysplasia Of Hip (DDH)
Developmental Dysplasia Of Hip (DDH)
Coronal and Axial CT Scan Images reveals ndashSubarticular sclerosis subarticular geords shallow acetlabulum malformed femoral head
Definition ndash
Developmental dysplasia of the hip (DDH) results from an abnormal
relationship of the femoral head to the acetabulum It usually occurs from
ligamentous laxity and or abnormal position in utero
Incidence = 15 and 20 per 1000 births
with the majority (60-80) of abnormal hips resolving spontaneously within
2-8 weeks (so called immature hip)
Developmental Dysplasia Of Hip (DDH)
Definition ndash
Developmental dysplasia of the hip (DDH) results from an abnormal
relationship of the femoral head to the acetabulum It usually occurs from
ligamentous laxity and or abnormal position in utero
Incidence = 15 and 20 per 1000 births
with the majority (60-80) of abnormal hips resolving spontaneously within
2-8 weeks (so called immature hip)
Developmental Dysplasia Of Hip (DDH)
Incidence
Secondary Hip Dysplasia
Treatment and prognosis
bull Pavlik harness - usually for younger
patients (lt 6 months of age)
bull closed reduction - usually for older
patients
bull open reduction - much older
patient or if closed reduction not
successful
Application
1 Graf R The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment Arch
Orthop Trauma Surg 198097 (2) 117-33
2 Graf R Scott S Lercher K Hip sonography diagnosis and management of infant hip dysplasia Springer
Verlag (2006) ISBN3540309578
3 US Preventive Services Task Force ldquoScreening for Developmental Dysplasia of the Hip
Recommendation Statementrdquo PEDIATRICS 117 no 3 (3 2006) 898-902
4 Roposch Andreas Nicole M Moreau Elizabeth Uleryk and Andrea S Doria ldquoDevelopmental Dysplasia
of the Hip Quality of Reporting of Diagnostic Accuracy for US1rdquo Radiology 241 no 3 (December 2006)
854-860
5 Taeusch H William Roberta A Ballard Christine A Gleason and Mary Ellen Avery Averys diseases of
the newborn Elsevier Health Sciences 2005
REFERENCES
Developmental Dysplasia Of Hip (DDH)
Definition ndash
Developmental dysplasia of the hip (DDH) results from an abnormal
relationship of the femoral head to the acetabulum It usually occurs from
ligamentous laxity and or abnormal position in utero
Incidence = 15 and 20 per 1000 births
with the majority (60-80) of abnormal hips resolving spontaneously within
2-8 weeks (so called immature hip)
Developmental Dysplasia Of Hip (DDH)
Definition ndash
Developmental dysplasia of the hip (DDH) results from an abnormal
relationship of the femoral head to the acetabulum It usually occurs from
ligamentous laxity and or abnormal position in utero
Incidence = 15 and 20 per 1000 births
with the majority (60-80) of abnormal hips resolving spontaneously within
2-8 weeks (so called immature hip)
Developmental Dysplasia Of Hip (DDH)
Incidence
Secondary Hip Dysplasia
Treatment and prognosis
bull Pavlik harness - usually for younger
patients (lt 6 months of age)
bull closed reduction - usually for older
patients
bull open reduction - much older
patient or if closed reduction not
successful
Application
1 Graf R The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment Arch
Orthop Trauma Surg 198097 (2) 117-33
2 Graf R Scott S Lercher K Hip sonography diagnosis and management of infant hip dysplasia Springer
Verlag (2006) ISBN3540309578
3 US Preventive Services Task Force ldquoScreening for Developmental Dysplasia of the Hip
Recommendation Statementrdquo PEDIATRICS 117 no 3 (3 2006) 898-902
4 Roposch Andreas Nicole M Moreau Elizabeth Uleryk and Andrea S Doria ldquoDevelopmental Dysplasia
of the Hip Quality of Reporting of Diagnostic Accuracy for US1rdquo Radiology 241 no 3 (December 2006)
854-860
5 Taeusch H William Roberta A Ballard Christine A Gleason and Mary Ellen Avery Averys diseases of
the newborn Elsevier Health Sciences 2005
REFERENCES
Developmental Dysplasia Of Hip (DDH)
Definition ndash
Developmental dysplasia of the hip (DDH) results from an abnormal
relationship of the femoral head to the acetabulum It usually occurs from
ligamentous laxity and or abnormal position in utero
Incidence = 15 and 20 per 1000 births
with the majority (60-80) of abnormal hips resolving spontaneously within
2-8 weeks (so called immature hip)
Developmental Dysplasia Of Hip (DDH)
Incidence
Secondary Hip Dysplasia
Treatment and prognosis
bull Pavlik harness - usually for younger
patients (lt 6 months of age)
bull closed reduction - usually for older
patients
bull open reduction - much older
patient or if closed reduction not
successful
Application
1 Graf R The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment Arch
Orthop Trauma Surg 198097 (2) 117-33
2 Graf R Scott S Lercher K Hip sonography diagnosis and management of infant hip dysplasia Springer
Verlag (2006) ISBN3540309578
3 US Preventive Services Task Force ldquoScreening for Developmental Dysplasia of the Hip
Recommendation Statementrdquo PEDIATRICS 117 no 3 (3 2006) 898-902
4 Roposch Andreas Nicole M Moreau Elizabeth Uleryk and Andrea S Doria ldquoDevelopmental Dysplasia
of the Hip Quality of Reporting of Diagnostic Accuracy for US1rdquo Radiology 241 no 3 (December 2006)
854-860
5 Taeusch H William Roberta A Ballard Christine A Gleason and Mary Ellen Avery Averys diseases of
the newborn Elsevier Health Sciences 2005
REFERENCES
Developmental Dysplasia Of Hip (DDH)
Incidence
Secondary Hip Dysplasia
Treatment and prognosis
bull Pavlik harness - usually for younger
patients (lt 6 months of age)
bull closed reduction - usually for older
patients
bull open reduction - much older
patient or if closed reduction not
successful
Application
1 Graf R The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment Arch
Orthop Trauma Surg 198097 (2) 117-33
2 Graf R Scott S Lercher K Hip sonography diagnosis and management of infant hip dysplasia Springer
Verlag (2006) ISBN3540309578
3 US Preventive Services Task Force ldquoScreening for Developmental Dysplasia of the Hip
Recommendation Statementrdquo PEDIATRICS 117 no 3 (3 2006) 898-902
4 Roposch Andreas Nicole M Moreau Elizabeth Uleryk and Andrea S Doria ldquoDevelopmental Dysplasia
of the Hip Quality of Reporting of Diagnostic Accuracy for US1rdquo Radiology 241 no 3 (December 2006)
854-860
5 Taeusch H William Roberta A Ballard Christine A Gleason and Mary Ellen Avery Averys diseases of
the newborn Elsevier Health Sciences 2005
REFERENCES
Developmental Dysplasia Of Hip (DDH)
Secondary Hip Dysplasia
Treatment and prognosis
bull Pavlik harness - usually for younger
patients (lt 6 months of age)
bull closed reduction - usually for older
patients
bull open reduction - much older
patient or if closed reduction not
successful
Application
1 Graf R The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment Arch
Orthop Trauma Surg 198097 (2) 117-33
2 Graf R Scott S Lercher K Hip sonography diagnosis and management of infant hip dysplasia Springer
Verlag (2006) ISBN3540309578
3 US Preventive Services Task Force ldquoScreening for Developmental Dysplasia of the Hip
Recommendation Statementrdquo PEDIATRICS 117 no 3 (3 2006) 898-902
4 Roposch Andreas Nicole M Moreau Elizabeth Uleryk and Andrea S Doria ldquoDevelopmental Dysplasia
of the Hip Quality of Reporting of Diagnostic Accuracy for US1rdquo Radiology 241 no 3 (December 2006)
854-860
5 Taeusch H William Roberta A Ballard Christine A Gleason and Mary Ellen Avery Averys diseases of
the newborn Elsevier Health Sciences 2005
REFERENCES
Developmental Dysplasia Of Hip (DDH)
Treatment and prognosis
bull Pavlik harness - usually for younger
patients (lt 6 months of age)
bull closed reduction - usually for older
patients
bull open reduction - much older
patient or if closed reduction not
successful
Application
1 Graf R The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment Arch
Orthop Trauma Surg 198097 (2) 117-33
2 Graf R Scott S Lercher K Hip sonography diagnosis and management of infant hip dysplasia Springer
Verlag (2006) ISBN3540309578
3 US Preventive Services Task Force ldquoScreening for Developmental Dysplasia of the Hip
Recommendation Statementrdquo PEDIATRICS 117 no 3 (3 2006) 898-902
4 Roposch Andreas Nicole M Moreau Elizabeth Uleryk and Andrea S Doria ldquoDevelopmental Dysplasia
of the Hip Quality of Reporting of Diagnostic Accuracy for US1rdquo Radiology 241 no 3 (December 2006)
854-860
5 Taeusch H William Roberta A Ballard Christine A Gleason and Mary Ellen Avery Averys diseases of
the newborn Elsevier Health Sciences 2005
REFERENCES
Developmental Dysplasia Of Hip (DDH)
1 Graf R The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment Arch
Orthop Trauma Surg 198097 (2) 117-33
2 Graf R Scott S Lercher K Hip sonography diagnosis and management of infant hip dysplasia Springer
Verlag (2006) ISBN3540309578
3 US Preventive Services Task Force ldquoScreening for Developmental Dysplasia of the Hip
Recommendation Statementrdquo PEDIATRICS 117 no 3 (3 2006) 898-902
4 Roposch Andreas Nicole M Moreau Elizabeth Uleryk and Andrea S Doria ldquoDevelopmental Dysplasia
of the Hip Quality of Reporting of Diagnostic Accuracy for US1rdquo Radiology 241 no 3 (December 2006)
854-860
5 Taeusch H William Roberta A Ballard Christine A Gleason and Mary Ellen Avery Averys diseases of
the newborn Elsevier Health Sciences 2005
REFERENCES
Developmental Dysplasia Of Hip (DDH)
Recommended