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Shallow/underdeveloped acetabulum
Dysplasia
Dislocation in utero, unable to reduce upon birth
Teratologic hip
Displacement with some joint contact
Subluxation
Total displacement, able to reduce
Dislocation
Occurs in adolescence/late childhood
Late type of DDH
You were checking for dislocation and dislocated the babies hip... you now need to put it back in by abducting the hip and pushing anterior. Which test is this?
Ortolani
- Barlow
- Ortolani
- Galeazzi
- Reduced hip abduction
- LLD
- About 20% with torticollis
- About 10% with metatarsus adductors
Exam for DDH
What position of the hip is usually the most unstable?
Adduction
- 90% of neonatal mild hip dysplasia will spontaneously resolve (b/c of weightbearing)
- Residual dysplasia occurs in 20% of those treated with Pavlik harness
- Recurrent hip dislocation can lead to: increased femoral and/or acetabular anteversion (toe in); increased joint obliquity; reduced acetabular concavity; flattening of femoral head; premature osteoarthritis; changes in gait
Prognosis of DDH
T/F: Most (78%) of ACL injuries are non-contact
True
1. Abduction splinting (Pavlik)
2. Closed reduction with spica casting
3. Open reduction with spica casting
4. Open reduction with femoral osteotomy
5. Open reduction with pelvic osteotomy
Treatment of DDH
- Early identification of hip dysplasia
- Refer to appropriate provider for splinting or surgical interventions
- Address residual impairments
- Gait impairments
- Weakness
- Developmental milestone achievement
- Functional mobility
- Weight bearing is important to shape acetabulum
PT role in DDH
Name the graft type:
- 1.7-17.9% failure rate
- PROS: evidence of significantly higher max load until failure; maintenance of the integrity of the extensor mechanism; Better for patients with more lax ligaments and tendons
- CONS: highly correlated with graft diameter; later integration rate (8-12 weeks)
Hamstring graft
Which test do you have the child laying supine and abduct the hip to the size and bring the hip/knee back to 90 degrees adduction and then have a posterior force (looking for possibility of dislocation)
Barlow test
Name the graft type:
- 0.72-2.3% failure rate
- PROS: 20% more collagen fibril per cross sectional area than the PT; easy to attain graft length; increase of emerging research
- CONS: evidence of associated higher revision rates; second highest prevalence of anterior knee pain; 2nd most impaired extensor mechanism
Quad tendon graft
- Increased integration time due to gamma ray sterilization
- Improved immediate post op function
- Recommended to hold off on running until 6 months post-op
- 1.76% failure rate in first year
- 25% of failures require an additional surgery
- Usually not an active population
Allograft (cadaver graft)
Name the graft type:
- 1.16-6.6% failure rate
- PROS: evidence of significantly higher max load until failure compared to intact ACL; considered "best choice" for biomechanical properties and revisions; earlier integration rate (6 weeks)
- CONS: highest prevalence of anterior knee pain and difficulty kneeling; may take longer to meet RTS criteria, and quad index compared to HT and allograft; most impaired extensor mechanism
Bone patellar tendon bone graft
Which graft starts the latest to heal and takes the longest to heal completely?
Ligament graft
Valgus loading
- MCL gets taut and lateral compression occurs
The compressive loading causes a lateral femoral posterior displacement due to posterior slope of lateral plateau
- ACL ruptures through ATT and IR
ACL injury mechanism
Graft tissue healing phase:
Host response: tunnel closure
Graft response: matrix remodeling (different in mid substance and in tunnels)
Maturation phase
Which week is the graft at its weakest point and this is where we can start heavy resisted weight training and strengthening so need to educate on being careful
6 weeks
Host response: inflammation
Graft response: cell necrosis
Early healing phase
At this week, we can run, building maximal strength, but still have a slightly weak tendon
12 weeks
Graft tissue healing phase:
Host response: angiogenesis
Graft response: cell repopulation
Proliferation phase
Strength at this month is pre-injury strength, return back to sport
- Every month you go back early, 10% increase in failure
- Every month after 9 months, 10% increase in not getting back to prior function
9 month mark