Po1062 Don’T “Dislocate” Your Attention

Ana Sousa1, Patrícia Cunha2 e Adriana Relvas3
1USF Arco do Prado; 2USF Fiães; 3USF Familias
Objective: Developmental Dysplasia of the Hip (DDH) is an anomaly of the size, shape, orientation and organization of the head femur, acetabulum, or both, with dynamic and progressive character. About 30% of newborns are born with immature hips, the majority resolves spontaneously up to 3 months and only 2 to 3% need treatment. This work aims to: identify the risk factors of DDH; establish a screening algorithm, criteria for referral and treatment.
Methods: Research of published articles in the databases of evidence based medicine using MeSH terms: “Hip Dislocation”, “Congenital” and “Therapeutics”, published between 2006 and 2013. Out of the found articles, 11 were selected, based on clinical interest and proposed objectives.
Results: The risk factors for DDH are: primigravidas, twin pregnancy, oligohydramnios, female gender, family history of DDH and breech presentation. As per the Portuguese Society of Orthopaedics and Traumatology objective examination of the hip should be done from birth until the age of gait, searching for signs of instability (Barlow sign, Ortolani, limitation of abduction of the hip, Galeazzi sign or asymmetry of skinfold). When this examination is negative and there are no risk factors, there is no indication for screening. If there is a positive physical examination or risk factors, an ultrasound at 6 weeks should be performed. If the infant is older than 4 months of age, radiography of the pelvis is the first-line exam. The ultrasound should not be done before 6 weeks due to the large percentage of hip unstable. The treatment of DDH varies depending on age. Up to 6 months, the Pavlik harness is the first line treatment and should be used continuously for 6-12 weeks. Between 6 and 18 months of age, the first-line treatment is the skin traction followed by reduction under general anaesthesia and cast immobilization. Between 18 months and 6 years of age the main treatment is surgery. These treatments are not harmless, because risk of aseptic necrosis femoral head (up to 23% cases) exists, as well as the possibility of recurrence.
Conclusion: Family physicians play a key role in screening of DDH, as this might manifest later. It is very important a thorough objective examination for a early diagnosis, avoiding more invasive interventions. A child treated in the first months of life is more likely to have a normal hip in adulthood and not suffer the consequences of a late diagnosis (osteoarthritis and necessity of total hip replacement).
hip dislocation; congenital; therapeutics