Developmental Dysplasia of the Hip From Birth to Six Months

Guille, James T.; Pizzutillo, Peter D.; Gd, MacEwen

doi:10.5435/00124635-200007000-00004

Cited by 185 publications

(127 citation statements)

References 25 publications

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“…Careful screening and early detection can prevent the potential complications and more difficult treatment often required when DDH is diagnosed in the later stages of infancy [2,14,18,20,39]. According to the newly published guidelines on DDH from the American Academy of Orthopaedic Surgeons, breech fetal presentation, family history, and a history of clinical hip instability are significant risk factors for DDH [1].…”

Section: Discussionmentioning

confidence: 99%

“…In some children, hip dislocations may not be detected until a limp is evident when a child has reached walking age. Nonsurgical management of hip dislocation is more likely to fail in the older infant and therefore often requires more intrusive treatment like prolonged immobilization or surgery in comparison to treatment of those who have a confirmed DDH diagnosis at a younger age [2,14,18,20,39].…”

Section: Introductionmentioning

confidence: 99%

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What Risk Factors and Characteristics Are Associated With Late-presenting Dislocations of the Hip in Infants?

Mulpuri

Schaeffer

Andrade

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Most infants with developmental dysplasia of the hip (DDH) are diagnosed within the first 3 months of life. However, late-presenting DDH (defined as a diagnosis after 3 months of age) does occur and often results in more complex treatment and increased long-term complications. Specific risk factors involved in late-presenting DDH are poorly understood, and clearly defining an associated set of factors will aid in screening, detection, and prevention of this condition. Questions/purposes Using a multicenter database of patients with DDH, we sought to determine whether there were differences in (1) risk factors or (2) the nature of the dislocation (laterality and joint laxity) when comparing patients with early versus late presentation. Methods A retrospective review of prospectively collected data from a multicenter database of patients with dislocated hips was conducted from 2010 to 2014. Baseline demographics for fetal presentation (cephalic/breech), birth presentation (vaginal/cesarean), birth weight, maternal age, maternal parity, gestational age, family history, and swaddling history of patients were compared among nine different sites for patients who were enrolled at age younger than 3 months and those enrolled between 3 and 18 months of age. A total of 392 patients were enrolled at baseline between 0 and 18 months of age with at least one dislocated hip. Of that group, 259 patients were youngerThe contributing members of the IHDI study group are: Pablo Castañeda, Nicholas M. P. Clarke, Bruce K. Foster, José A. HerreraSoto, James R. Kasser, Simon P. Kelley, Young-Jo Kim, Colin F. Moseley, Unni G. Narayanan, Ernest L. Sink, Vidyadhar Upasani, and John H. Wedge. One author (KM) has received funding from the International Hip Dysplasia Institute for REDCap database coordination, maintenance, and support (http://hipdysplasia.org). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. Included patients were recruited from all listed sites as well as Centro Médico ABC Santa Fe, Mexico City, Mexico; Hospital for Sick Children, Toronto, Ontario, Canada; and Southampton General Hospital, Southampton, UK. Data analysis and review were carried out at BC Children's Hospital, Vancouver, British Columbia, Canada. Clinical Orthopaedics and Related Research ®A Publication of The Association of Bone and Joint Surgeons® than 3 months of age and 133 were 3 to 18 months of age. The proportion of patients with DDH who were enrolled and followed at the nine participating centers was 98%. Results A univariate/multivariate analysis was performed comparing key baseline demographics between early-and late-presenting patient...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

What Risk Factors and Characteristics Are Associated With Late-presenting Dislocations of the Hip in Infants?

Mulpuri

Schaeffer

Andrade

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…The cause of this association has been widely investigated before, and attributed to potentiation by endogenous estrogens produced by the female infant and the transiently increased ligamentous laxity in the perinatal period caused by high levels of circulating maternal hormones [20]. First-born babies carry a high risk of DDH, and form more than 50% [16,21,22]. We noted that the rate of first-born babies who had DDH is lower than that reported in the literature (34%), but it is still a high risk factor,and first-born are affected more frequently than subsequent siblings, which may be related to the confining effects of an unstretched primigravid uterus and abdominal wall, with subsequent effects on fetal limb position and hip joint development through the intrauterine crowding effect [5].…”

Section: Discussionmentioning

confidence: 99%

Associated risk factors in children who had late presentation of developmental dysplasia of the hip

Hassan

Shannak

2007

Journal of Children's Orthopaedics

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Purpose The purpose of this study was to assess the role of clinical examination, associated risk factors and plain radiograph of the pelvis in children who had late presentation of DDH. Methods We report on a 7-year prospective study, in children who had late presentation of developmental dysplasia of the hip (DDH). For this purpose, 740 hips in 370 referred children, age range 3-7 months (mean 3.44 months) were clinically and radiologically assessed, and the associated risk factors recorded. Results Female sex, first born, positive family history and breech presentation were confirmed as risk factors for DDH. Significant findings were an increased risk for vaginal delivery over caesarean section for breech presentation (P = 0.002). There was an increased risk for caesarean section in the absence of breech presentation. Multiple births and preterm births had a reduced risk. For breech presentation, the risk of DDH was estimated to be at least 1.6% for girls and 3.4% for boys; a combination of factors increased the risk. Limitation of abduction (43.2%) and asymmetry of the groin skin folds (72.7%) were found to be the two most common clinical findings associated with DDH. Bilateral acetabular dysplasia is more common than unilateral dysplasia. Foot deformities were rarely encountered in children with acetabular dysplasia. Conclusions The percentage of first-born babies who had DDH is lower than reported in the literature (34%), but still shows significant risk. We did find that bilateral acetabular dysplasia is more common than unilateral dysplasia. Torticollis and foot deformities are rarely found to be associated with DDH. All these findings needs further evaluation in children who had surgical treatment for DDH, to see if they are different from dysplastic groups. Limitation of abduction is an important clinical finding, but is not always associated with DDH. Asymmetry of the skin folds in the groin were found to be an important clinical finding associated with DDH for all age groups. As clinical examination depends on many factors, and most DDH cases are of the dysplastic type, it is mandatory to depend on further diagnostic tools for confirmation of DDH.

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“…The limbus forms as a result of a secondary adaptive change that occurs with prolonged subluxation or dislocation of the hip [4]. The limbus is able to invert and evert, and is a potential block to concentric reduction of the dysplastic hip (Fig.…”

Section: Introductionmentioning

confidence: 99%