DDH  Dislocating clicks  not less than 25

 Dislocatable degrees
- According to severity:
o Ortolani  In Acetabular
o Acetabular Dysplasia (most mild)
 there’s relocation click Dysplasia = less
o Acetabular Dysplasia + Subluxation
 Completely dislocated hip than 25 degrees
o Dislocation of hip (most severe)
 Lateral displacement of
o 2 – 3 mos.: femoral head
- Acetabular Dysplasia 
 Limited hip ABD on one side Hilgenreiner’s(?) line
o Acetabulum is shallow (congenital)
 Presence of asymmetry of - Horizontal line connecting
o Femoral head still w/in acetabulum gluteal folds triradiate lig.
o Risk of dislocation  Proximal location of greater  Perkin’s line
o Hip is dislocatable trochanter  Vertical line passing
o Barlow’s  Location of thru outer edge of
dislocation is post. acetabulum
- Acetabular Dysplasia + Subluxation and proximal  Perkin’s + Hilgenreiner’s(?)
o Partial dislocation  Affected has true line meet = Quadrants
o femoral head developed outside of leg length  Upper lateral Q.
acetabulum discrepancy  Lower medial Q.
o certain maneuvers to reduce  Pistoning of hip: Pulling  Disrupted Shenton’s line
o Ortolani causes reduction of hip  traced following
 Shortening of thigh on shadow of femoral
- Risk Factors: affected side (Galeazzi’s neck up to upper
o Positive family history sign) border of obturator
o more common with females (80%)  Klisic Test foramen
o Breech presentation  Finds that Greater  Also: Obturator
- upon delivery, una paa trochanter is in Coxo-Femoral line
o Any condition that leads to a tighter level with ASIS  In dislocated hip,
intrauterine space (Abnormal) line is broken in
 Melaton’s line radiographic
- Clinical Presentation  Line connecting findings.
o 0 – 2 mos. available test: ischial tuberosity  NOTE:
Barlow & Ortolani test and (?) If bracing/immobilization
o Barlow not successful, last resort is
 exertion of pressure will o Radiographic Findings surgery
feel dislocation click as  Decreased CE (Center Edge)
head of femur rides on angle / Angle of Wiberg
acetabulum
 o Treatment Stages: - antalgic gait w/ associated limp
 Bracing or immobilization - restriction of IR, ABD and Flexion
- Condensation
- Von Rossen (Splint made
- Fragmentation
of POP)
- Reossification
- Ilfeld (Splint) ABNORMAL FEMORAL NECK ANGLES
- Residual
- Pavlik Harness - 125 degrees (N)
 In Frog leg position: Reossification - Less than 125 degrees: Coxa Vara
- Femoral head is congruent - Beginning of healing stage - More than: Coxa Valga: functional
inside acetabulum - Shape of femoral head becomes better weakness d/t gluteus medius moment arm
defined decreases
- Bone density begins to return
LEG-CALVE-PERTHES DSE (LCPD)
Residual
- Also: Coxa Plana, Idiopathic Avascular FEMORAL ANTEVERSION, INCREASED
- flattening of the articular surface
Necrosis of the femoral head
- widening of head and neck of femur - m/c of in-toeing in early childhood
- Impairment of the epiphyseal growth and
- Child sits in W position = knees IR and ADD
femoral head deformity
- runs in eggbeater fashion
- Secondary to blood supply occlusion TX:
- limited ER of hip
- Non-operative
EPIDEMIOLOGY - Operative
- More common in boys than girls (4/5:1)
- Peak incidence: 4 – 8 years old TRAUMATIC DSILOCATION OF HIP
- Usual manifestation: limping SLIPPED CAPITAL FEMORAL EPIPHYSIS - Dash Board Injury
- Post. hip dislocation (m/c direction)
- affects adolescents 12 – 15 years
Clinical presentation - results from high-energy impact
- displacement of the CFE (capital femoral
- shortening, flexion, ADD, and IR
- Limping m/c presentation epiphysis) from metaphysis
- Sciatic nerve injury occurs in 10-20% of
- Pain, if present, usually activity related - Obesity is most commonly associated factor
post. dislocations
- Hip motion, IR and ABD limited in development of SCFE
- Small, thin, extremely active child who is - Klein’s line:
always running and jumping - outline of sup. aspect of femoral neck
HETERPTOPIC OSSIFICATION
- Self-limiting: kusa gumagaling thru - should pass a small portion of the femoral
immobilization of the hip head - occurs around soft tissues around jt.
- Immobilized in ABIR using: calcifies
- Trilateral splint - prolonged immobilization after trauma
Clinical presentation
- Toronto splint - M/C in LE: Hip
- Scottish rite splint - Pain in affected hip - M/C in UE: Elbow
- Change in hip ROM
MYOSITIS OSSIFICANS

- M/C affected in LE: Quadriceps

LIGAMENTATOUS OSSIFICATION

- Ligaments affected