I am interested in information regarding hip deformation in new born. There is a tiny chance that our picture perfect first grandchild, a boy, only 2 days old and born through C-section, may have a condition I only know as Frog-hips. The delivery team said they heard a clicking noise in his hip/knee area and suspect some problem. While invitro the babies position revealed his tiny feet up by the head. His 33 year old father, when a child, remembers having a brace and a metal bar between his lower limbs. The whole situation reminds me of Berlin during the mid 50's, a time which exposed me to numerous toddlers in waist to foot plaster casts and metal bars between their lower limbs, these casts were supposed to be worn by the tots for up to 2 years. Does anyone know the medical term for this condition?
hip problems in the newborn
- Thread starter Annemarie
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United KingdomI can fully answer your question here, Annemarie. The condition is CDH - congenital dislocation of the hip - and does indeed run in families and is more prevalent in males than in females. I am not sure that the invitro position contributes to it as it is a question of the development of the femoral head. acetabulum that causes it.
The crux of the issue is that the upper end of the femur just grows out of alignment with the acetabulum which has some serious conseuqences. The development of each structure is dependent upon the presence of the other to grow properly. This means that the acetabulum will not develop its nice cup-shaped depression without the femoral head for it to grow around and similarly, the femoral head will not grow its nice ball shape without the acetabulum to help shape it. Therefore it is vital that the condition is picked up immediately upon birth. This is done very simply by the midwife who performs a simple test called the Ortolani test
Ortolani's sign
Ortolani's test is used to detect the presence of a dislocated hip in CDH. A positive Ortolani's sign indicates a hip that is dislocated but reducible.
The procedure is as follows:
* relax the child, for example examine just after a feed
* hips and knees flexed to 90 degrees
* thumbs on the inner side of the baby's knee
* index finger over the greater trochanter
* the hips are abducted through 90ΓΈ smoothly and gently
* note that there is no element of attempting to force the joint into dislocation
Ortolani's sign is the palpable sensation of the femoral head slipping into the acetabulum. Ortolani described the accompanying sound as a click; it is more often thought of as a clunk nowadays, although audibility is by no means an essential requirement. Restriction of abduction may indicate an irreducible dislocation.
This was brought in as a routine labour room examination around 1980 since when the early identification of CDH has meant that the condition was easily remedied by such simple things as use of double terry nappies for a few months. The "frog plasters" you and your son-in-law remember were as a result of the late diagnosis of the condition, often not picked up until the child began trying to walk. We had all sorts of bizarre equipment to try and correct the condition
As an aside, the bar between the legs was put there not only to strengthen to cast but to help mother care for her babe whilst changing nappies, etc!!
Nowadays, when frog plaster are used, the fibre glass casting material is much much stronger and also immersible so baby can be bathed!
The procedure of treatment would be as follows, each being employed as and when one was tried and failed to effect a resolution
1. double terry nappies
2. frog cast
3. open reduction
4. refashioning of the joint.
The vast majority are sorted by No 1. The next treatment resolves a great percentage of the rest.
The very, very few that are not resolved by 1 and 2 go on to No 3 which when the joint is opened. It is often then found that the reason the joint is not realigning is because the cartilage rim of the acetabulum, the labrum, has turned inwards and needs to be removed in order to effect realignment. The child is then put in a frog cast.
Refashioning the joint is very rare but is needed in occasions - more commonly where diagnosis has been delayed - where the acetabulum and/or the femoral head have become misshapen due to not being together during the crucial developmental phase. In this situation, the pelvis is restructured to provide an artificial 'roof' to the acetabulum so the hip joint can function more or less normally.
In the early treatment stages, the patient can expect to have a normal. trouble free adulthood. In no 2, there may be some early arthritis, in No 4 it is almost inevitable. But I think that around 90% of cases are dealt with by the No 1 and 2 options so do not worry about that.
Hope this has been a help.
End of lecture on Hip Dysplasia!!!
The crux of the issue is that the upper end of the femur just grows out of alignment with the acetabulum which has some serious conseuqences. The development of each structure is dependent upon the presence of the other to grow properly. This means that the acetabulum will not develop its nice cup-shaped depression without the femoral head for it to grow around and similarly, the femoral head will not grow its nice ball shape without the acetabulum to help shape it. Therefore it is vital that the condition is picked up immediately upon birth. This is done very simply by the midwife who performs a simple test called the Ortolani test
Ortolani's sign
Ortolani's test is used to detect the presence of a dislocated hip in CDH. A positive Ortolani's sign indicates a hip that is dislocated but reducible.
The procedure is as follows:
* relax the child, for example examine just after a feed
* hips and knees flexed to 90 degrees
* thumbs on the inner side of the baby's knee
* index finger over the greater trochanter
* the hips are abducted through 90ΓΈ smoothly and gently
* note that there is no element of attempting to force the joint into dislocation
Ortolani's sign is the palpable sensation of the femoral head slipping into the acetabulum. Ortolani described the accompanying sound as a click; it is more often thought of as a clunk nowadays, although audibility is by no means an essential requirement. Restriction of abduction may indicate an irreducible dislocation.
This was brought in as a routine labour room examination around 1980 since when the early identification of CDH has meant that the condition was easily remedied by such simple things as use of double terry nappies for a few months. The "frog plasters" you and your son-in-law remember were as a result of the late diagnosis of the condition, often not picked up until the child began trying to walk. We had all sorts of bizarre equipment to try and correct the condition
As an aside, the bar between the legs was put there not only to strengthen to cast but to help mother care for her babe whilst changing nappies, etc!!
Nowadays, when frog plaster are used, the fibre glass casting material is much much stronger and also immersible so baby can be bathed!
The procedure of treatment would be as follows, each being employed as and when one was tried and failed to effect a resolution
1. double terry nappies
2. frog cast
3. open reduction
4. refashioning of the joint.
The vast majority are sorted by No 1. The next treatment resolves a great percentage of the rest.
The very, very few that are not resolved by 1 and 2 go on to No 3 which when the joint is opened. It is often then found that the reason the joint is not realigning is because the cartilage rim of the acetabulum, the labrum, has turned inwards and needs to be removed in order to effect realignment. The child is then put in a frog cast.
Refashioning the joint is very rare but is needed in occasions - more commonly where diagnosis has been delayed - where the acetabulum and/or the femoral head have become misshapen due to not being together during the crucial developmental phase. In this situation, the pelvis is restructured to provide an artificial 'roof' to the acetabulum so the hip joint can function more or less normally.
In the early treatment stages, the patient can expect to have a normal. trouble free adulthood. In no 2, there may be some early arthritis, in No 4 it is almost inevitable. But I think that around 90% of cases are dealt with by the No 1 and 2 options so do not worry about that.
Hope this has been a help.
End of lecture on Hip Dysplasia!!!
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