Classification of congenital (congenital) hip dysplasia by sonography (ultrasound) according to R. Graf. Type Description Alpha angle Beta angle Measures and therapy Type I – Normally developed and mature hip. Ia Any age: normally developed hip. With pointed cartilaginous notch. > 60° < 55° No therapy. Ib Any age: normally developed hip. With blunt cartilaginous … Deformities of the Hip: Classification
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; furthermore: Inspection (viewing). Skin and mucous membranes Gait [limping] Body or joint posture Malpositions [deformity, shortening, rotational malposition]. Wrinkle asymmetries on the posterior thighs? Muscle atrophies Palpation (palpation) of prominent bone points, … Deformities of the Hip: Examination
2nd order laboratory parameters – depending on the results of the history, physical examination and obligatory laboratory parameters – for differential diagnostic clarification. Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate).
Therapeutic target Reduction of pain Therapy recommendations Analgesia (analgesics/pain relievers) for acute (sub)dislocation (incomplete dislocation of a joint/dislocation) and during diagnosis until definitive therapy. See also under “Further therapy“.
Obligatory medical device diagnostics. Postpartum hip ultrasonography/ultrasound method according to Graf (ultrasound hip screening: screening U3 (4th-6th week of life); newborns with risk factors early screening between the 3rd and 10th day of life (U2)) – Specificity (probability that actually healthy persons who do not suffer from the disease in question are also detected as … Deformities of the Hip: Diagnostic Tests
1st order Reduction (bringing back to a (near) normal position or normal position). In hip dysplasia: Open reduction – at 4-5 months of age using the anterior (front) approach; as with conservative therapy, retention is in a Fettweis cast (plaster cast for treatment of hip dysplasia or Subluxation of infant hips in dysplasia)Note: Early open … Deformities of the Hip: Surgical Therapy
To prevent deformities of the hip, attention must be paid to reducing individual risk factors. Behavioral causes “swaddling” (pucking) of infants (swaddling technique: swaddling the infant with blankets, sleeping bags, and other wraps) – 3.5-fold increase in late-diagnosed hip dysplasia cases after the third month of life (despite early clinical screening)
The following symptoms and complaints may indicate congenital (congenital) deformities of the hip: Leading symptoms of congenital (sub)dislocation. Severe pain in the hip joint Malalignment Luxatio iliaca (posterior dislocation) – leg shortening, internal rotation, adduction (lateral approach or the application of a body part to the center of the body). Luxation iliopubica (anterior dislocation) – … Deformities of the Hip: Symptoms, Complaints, Signs
Pathogenesis (development of disease) The pathogenesis of hip joint (sub)luxation is hip joint dysplasia (maldevelopment of the acetabulum) with predominant flatness of the acetabulum. Thus, the hip joint is abnormally wide. Hip dysplasia occurs due to skeletal malformations or positional abnormalities during pregnancy. Etiology (causes) Biographic causes Genetic burden from parents, grandparents. Behavioral causes “swaddling” … Deformities of the Hip: Causes
Medical aids Depending on the extent of the change or age, the following measures are used: Spreading treatment in infants (= abduction treatment), e.g., by means of Spreader pants Flexor-spreader splint (e.g., Tübingen hip flexor splint); this results in centering of the hip and allows time for post-maturation. Treatment principle: Setting a so-called sit-hock position. … Deformities of the Hip: Therapy
The medical history (history of the patient) represents an important component in the diagnosis of congenital (congenital) hip deformities. Family history Are there any bone/joint disorders in your family that are common? Social history Current medical history/systemic history (somatic and psychological complaints). Are you experiencing pain? If yes, when does the pain occur? At rest … Deformities of the Hip: Medical History
Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99). Chondrodysplasia (cartilage malformations), unspecified. Gaucher disease – genetic disease with autosomal recessive inheritance; lipid storage disease due to the defect of the enzyme beta-glucocerebrosidase, leading to storage of cerebrosides mainly in the spleen and medullary bones. Musculoskeletal system and connective tissue (M00-M99). Bursitis pectinea – bursitis of the … Deformities of the Hip: Or something else? Differential Diagnosis
