![]() ![]() Intrauterine packaging deformities (eg plagiocephaly, foot deformities or torticollis).Developmental dysplasia of the hip: Referral guidelines 6 This, combined with an understanding of the risk factors, will help in the early diagnosis and management of children with DDH (Table 1). Establishing the diagnosisĪs previously stated by Williams, ‘repeated, carefully performed clinical examinations of the paediatric hip from newborn to walking age remain the best method for early detection of DDH’. The emphasis of this article is on the management of DDH in infancy and the early years management of DDH during adolescence and adulthood is not included. 4ĭDH and its sequelae continue to have a major impact on healthcare, with the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) reporting that nearly 7% of total hip replacements in Australia are directly attributable to DDH. ![]() 3 Management of this wide continuum of pathology requires careful consideration, because management varies greatly as the age of the child increases. Presentations can vary from an infant born with a fixed, irreducible dislocated hip through to mild acetabular dysplasia only diagnosed in adulthood. The wide spectrum of pathology affecting this process is named developmental dysplasia of the hip (DDH). Postnatally, the sphericity of the femoral head and deepening of the acetabulum are expected to increase progressively through childhood. Teleologically, it is possible that a temporarily increased hip range of motion in the third trimester is required to accommodate the lower limb within the limited intrauterine space. This trend reverses after birth, with the acetabulum deepening, femoral head coverage increasing and hip morphology improving. The embryonic acetabulum begins as a deeply set cavity that almost entirely encloses the femoral head but gradually becomes shallower as birth approaches. The human acetabulum is shallower at birth than at any other time during development.
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