Materiały źródłowe

• #1 Preventing Hip Dysplasia – International Hip Dysplasia Institute

  https://hipdysplasia.org/infant-child/preventing-hip-dysplasia/

  Unfortunately hip dysplasia cannot be prevented 100%. While the causes of hip dysplasia continue to be studied, there are some things you can do now to help prevent and reduce the risk of your child developing hip dysplasia: […] Some swaddling techniques may contribute to developing hip dysplasia. Learn how to keep your babys hips safe when swaddling. Improper swaddling may lead to or exacerbate hip dysplasia. […] Where does your baby spend significant amounts of time during the day? Learn what to look for in baby seats, carriers, slings, and other products to help prevent hip dysplasia.

• #2 Hip Dysplasia: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17903-hip-dysplasia

  You cant prevent your child from being born with hip dysplasia. You also cant prevent it in yourself. It happens on its own when your hips are shaped differently than usual. […] Talk to your healthcare provider about protecting your childs hips while theyre developing. They can give you tips to prevent putting too much stress on your babys joints.

• #3 Developmental Dysplasia of the Hip | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1015/p1310.html

  Developmental dysplasia of the hip refers to a continuum of abnormalities in the immature hip that can range from subtle dysplasia to dislocation. […] The identification of risk factors, including breech presentation and family history, should heighten a physicians suspicion of developmental dysplasia of the hip. […] Careful physical examination is recommended as a screening tool; early diagnosis helps improve treatment results and decrease the risk of complications. […] Risk factors for DDH should be identified in all children. […] A careful physical examination is the basis for screening for DDH. […] Ultrasonography should be ordered for infants six weeks to six months of age to clarify a clinical finding suggestive of DDH, assess a high-risk infant, and monitor DDH as it is observed or treated.

• #4 Developmental Hip Dysplasia DDH

  https://www.jplrc.com/developmental-dysplasia-of-the-hip.html

  1. Females – girls simply have a higher risk of being born with and/or developing DDH. […] 2. 1st-born children – your oldest child is more likely to have DDH than subsequent children. […] 3. Breech Birth – children presenting at birth in this position are more likely to suffer from DDH due to intra-uterine positioning while the young hip joint was still developing. […] 4. (+) Family History – if you or someone in your family was born with DDH, then you are more likely to have children born with DDH. […] 5. Oligohydramnios – Mothers diagnosed with this condition during pregnancy are more likely to have children with DDH, likely because the developing child has less room to move and the developing hip joint gets compressed. […] We also know that DDH is more commonly seen in association with several other conditions that your baby may be diagnosed with. If your child has any of these conditions, particular attention should be given to making sure that your baby does not have anything wrong with their hips too, by having a proper examination and testing.

• #5 Developmental Dysplasia Of The Hip – OrthoPaedia

  https://www.orthopaedia.com/developmental-dysplasia-of-the-hip/

  The exact causes of DDH are unknown, but it is likely a combination of several environmental and genetic factors. Known risk factors include: […] Inadequate intra-uterine space (e.g. firstborn child, oligohydramnios, etc.) […] Female sex, […] Family history, […] Breech presentation.

• #6 Developmental Dysplasia of the Hip | Riley Children’s Health

  https://www.rileychildrens.org/health-info/developmental-dysplasia-of-the-hip

  Developmental dysplasia of the hip (DDH) can develop during a child’s first year of life in addition to being present at birth. […] Certain factors may increase a child’s risk of developmental dysplasia of the hip, including being female, being a first-born child, being born in the breech position, having a family history of DDH and having low levels of amniotic fluid in the womb. […] Your child’s doctor may use a Pavlik harness to treat the condition. A Pavlik harness is a special brace that keeps the ball in the socket and helps with hip socket formation.

• #7 Developmental Dysplasia of the Hip (DDH) – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/developmental-dislocation-dysplasia-of-the-hip-ddh/

  Although DDH is most often present at birth, it may also develop during a child’s first year of life. Recent research shows that babies whose legs are swaddled tightly with the hips and knees straight are at a notably higher risk for developing DDH after birth. […] Given the popularity of swaddling, it is important for parents to learn how to swaddle their infants safely, and to understand that when done improperly, swaddling may lead to problems like DDH. […] Parents play an essential role in ensuring the harness is effective. Your doctor and healthcare team will teach you how to safely perform daily care tasks, such as diapering, bathing, feeding, and dressing. It is very important to attend all of your baby’s scheduled clinic visits so the doctor can check the hip and the fit of the Pavlik harness. […] To assist doctors in the management of pediatric developmental dysplasia of the hip, the American Academy of Orthopaedic Surgeons has conducted research to provide some useful guidelines. These are recommendations only and may not apply to every case.

• #8 Developmental Dysplasia of the Hip (DDH) | Boston Medical Center

  https://www.bmc.org/orthopedic-surgery/pediatrics/developmental-dysplasia-hip-ddh

  Recent research shows that babies whose legs are swaddled tightly with the hips and knees straight are at a notably higher risk for developing DDH after birth. […] It is important for parents to learn how to swaddle their infants safely, and to understand that when done improperly, swaddling may lead to problems like DDH. […] The Pavlik harness helps tighten the ligaments around the hip joint and promotes normal hip socket formation. […] Parents play an essential role in ensuring the harness is effective.

• #9 Preventing Developmental Hip Dysplasia | NYU Langone Health

  https://nyulangone.org/conditions/developmental-hip-dysplasia/prevention

  Most children with developmental hip dysplasia are born with this condition, in which the top of the thigh bone does not fit snugly into the socket of the hip joint. However, damage to the cartilage and bones can occur if a newborns legs are in a straightened position for long periods of timefor example, by improper swaddling, which is a method of calming newborns that involves tightly wrapping the legs and body in a blanket or cloth. […] If you swaddle your infant, make sure his or her hips can move freely. Avoid swaddling so snugly that the babys legs are pulled tightly together. His or her legs should be slightly bent and spread apart, similar to the position in the womb. […] Instead of swaddling, some parents use a sleep sack, which is a wearable blanket or sleeping bag for infants. Be sure to select one that has a loose pouch for the babys legs and feet and allows the hips to move freely.

• #10 Developmental Dysplasia of the Hip (DDH)

  https://patient.info/doctor/developmental-dysplasia-of-the-hip-pro

  Primary prevention of DDH through education about safe swaddling has been shown to be effective in communities who would otherwise use traditional swaddling techniques. […] The International Hip Dysplasia Institute and the Pediatric Orthopedic Society of North America advise that: […] Infant hips should be positioned in slight flexion and abduction during swaddling. […] The knees should also be maintained in slight flexion. […] Additional free movement in the direction of hip flexion and abduction may have some benefit. […] Avoidance of forced or sustained passive hip extension and adduction in the first few months of life is essential for proper hip development.

• #11 Developmental dysplasia of the hip – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/developmental-dysplasia-of-the-hip/

  Improper swaddling can lead to DDH. If swaddling is used, ensure the following to encourage proper hip development: Hips and knees should be in slight flexion and abduction and able to move freely. Avoid forced or sustained hip extension and adduction. Do not tightly swaddle the lower body; prolonged extension and adduction of the hips and knees can result in DDH.

• #12 Developmental Dysplasia of the Hip | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/1015/p1310.html

  The goal of treatment in DDH is to achieve and maintain reduction of the femoral head in the true acetabulum by closed or open means. […] The earlier treatment is initiated, the greater the success and the lower the incidence of residual dysplasia and long-term complications. […] In general, the goal of the family physician in examining for DDH should be early diagnosis and referral. This is because treatment earlier in life, especially within the first six months, is safer and more successful than treatment after the child is walking.

• #13 Common Questions About Developmental Dysplasia of the Hip | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/1215/p843.html

  Developmental dysplasia of the hip is a common musculoskeletal condition in newborns. […] Evidence to support universal screening by physical examination or ultrasonography is limited and often conflicting. The U.S. Preventive Services Task Force found insufficient evidence that screening for developmental dysplasia of the hip prevents adverse outcomes. Physical examination screening is recommended by the American Academy of Pediatrics and the Pediatric Orthopaedic Society of North America. […] All infants should be screened for DDH with the Ortolani and Barlow maneuvers from birth up to three months of age. […] Ultrasonography should not be used for universal screening for DDH. […] The U.S. Preventive Services Task Force (USPSTF) and the American Academy of Family Physicians found insufficient evidence to recommend routine screening for DDH as a means to prevent adverse outcomes.

• #14 Common Questions About Developmental Dysplasia of the Hip | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/1215/p843.html

  Other U.S. expert groups, including the American Academy of Pediatrics (AAP) and the Pediatric Orthopaedic Society of North America, recommend screening all newborns for DDH with physical examination maneuvers, and targeted screening ultrasonography for infants with multiple risk factors, regardless of physical examination findings. […] The AAP also recommends performing a focused physical examination of the hips at routine health care visits until the child is older than 12 months. […] There are differing recommendations internationally; in particular, in some countries including Austria and Germany, universal DDH screening is performed with ultrasonography. […] Despite inconclusive evidence, the current standard of care is based on a recommendation from the AAP to perform physical examination screening.

• #15 Developmental dysplasia of the hip in neonates | Safer Care Victoria

  https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/neonatal/developmental-dysplasia-of-the-hip-in-neonates

  All newborn infants should have the hips tested for instability or dislocation. […] Early detection of hip dysplasia is vital. […] If DDH is left untreated the hip joint develops abnormally and surgical reduction is required. By contrast, early conservative management with splinting (for example, Denis-Browne splint) or Pavlik harness allows the hip joint to develop normally and avoids the need for surgery in most cases. […] All newborn infants should have the Ortolani and Barlow tests performed by a trained examiner as part of the routine newborn examination. […] Infants in whom either test is positive should be assessed by an experienced clinician prior to discharge and fitted with a splint/harness. In the absence of an experienced clinician at your health service, referral to an orthopaedic specialist is desirable. […] Since DDH can develop over time, all infants (both high and low risk) with normal newborn examinations should have their hips regularly re-examined during the first year of life.

• #16 Developmental Dysplasia of the Hip: How Many Risk Factors Are Needed?

  https://www.mdpi.com/2227-9067/10/6/968

  Developmental dysplasia of the hip (DDH) is a progressive condition that lacks clear diagnostic and management protocols, due to insufficient data. […] We recommend that children who present two or more risk factors for DDH be mandatorily evaluated sonographically, as well as children with clinical signs. DDH screening is recommended for each newborn for the long-term benefits of early detection and treatment. […] The goal of early treatment is to assure normal development of the hip joint and prevention of late complications. Therefore, there is a need for high suspicion and routine surveillance of DDH in infants. […] In North America ultrasound screening is carried out selectively in infants with risk factors such as breech presentation, family history, and clinical hip instability.

• #17 Developmental Dysplasia of the Hip: How Many Risk Factors Are Needed?

  https://www.mdpi.com/2227-9067/10/6/968

  It is mandatory for children with two or more risk factors to be evaluated clinically and sonographically. […] Children with clinical signs of DDH should be mandatorily evaluated sonographically. […] DDH screening is recommended for each newborn for the long-term benefits of early DDH diagnosis, regardless of the risk factors.

• #18 Improving early detection of developmental dysplasia of the hip through general practitioner assessment and surveillance

  https://www1.racgp.org.au/ajgp/2018/september/improving-early-detection-of-developmental-dysplas

  The GP can order medical imaging when indicated and refer promptly for treatment, minimising communication breakdowns and treatment delays that occur with screening programs generally.9 Young children visit the GP for a range of reasons, including immunisations and common childhood illnesses, providing opportunities for repeated DDH assessment. […] Early DDH detection and treatment harnesses the maximal growth potential of the infant hip, with increased likelihood of treatment success, fewer invasive procedures and fewer complications.3,4,17 Late diagnosis may occur as a result of screening failures,3 inappropriate swaddling22,23 or progression of pathology; efforts to minimise late cases may be hampered by lack of consensus in screening guidelines.31

• #19 Developmental Hip Dysplasia DDH

  https://www.jplrc.com/developmental-dysplasia-of-the-hip.html

  The GOOD NEWS is that Pediatricians are usually very good at detecting when your child has DDH. In some cases, it may not be detectable immediately after birth, but this is OK. This is why Orthopedists changed the name from Congenital Dysplasia of the Hip, to Developmental Dysplasia of the Hip, because the process can continue to develop after the child is born. […] Despite all the technology and expensive tests that we have today, the GOLD Standard for detecting DDH is still a thorough Physical Examination performed by a trained medical professional. […] We prefer to begin treating DDH as soon as it is diagnosed because many times with proper early treatment, your child’s acetabulum can remodel on its own without the need for any surgery. […] A Pavlik Harness is a set of straps that brace the legs into the best position that can allow the hips to stay in place while the acetabulum properly remodels.

• #20 Improving early detection of developmental dysplasia of the hip through general practitioner assessment and surveillance

  https://www1.racgp.org.au/ajgp/2018/september/improving-early-detection-of-developmental-dysplas

  As well as maximising the chance of successful treatment with an abduction splint or Pavlik harness, early DDH detection lowers the age at diagnosis for children who develop progressive signs outside the newborn period. […] A holistic approach to DDH assessment acknowledges that a combination of risk factor assessment, clinical examination and imaging studies may permit early detection of DDH.25,30 […] The GP may consider medical imaging in patients with an equivocal examination, for selective screening for infants with risk factors or to provide further anatomical information regarding the diagnosis.17 […] Increased selective ultrasonography screening for babies with DDH risk factors has been associated with an increase in late-diagnosed DDH in South Australian children without traditional risk factors.4 Selective ultrasonography screening may lead overall to a false sense of security9 and less vigilance with DDH clinical examination and surveillance in all children.

• #21 Modern approach to developmental dysplasia of the hip – Mayo Clinic

  https://www.mayoclinic.org/medical-professionals/pediatrics/news/modern-approach-to-developmental-dysplasia-of-the-hip/mac-20538657

  „To prevent the 'missed’ hip dislocation, asking families about their history of DDH along with the presence of breech position during pregnancy can identify which patients can benefit from a careful examination and hip ultrasound.” […] „A low threshold for ultrasound is prudent to ensure early diagnosis and treatment.” […] „Hip ultrasounds are great screening tools for patients who have the risk factors noted above.” […] „Patients with unstable hip examinations should be immediately referred without an ultrasound.” […] „DDH is a common condition with reliable nonoperative treatment options if detected early.”

• #22 Developmental Hip Dysplasia DDH

  https://www.jplrc.com/developmental-dysplasia-of-the-hip.html

  It is absolutely imperative that parents follow the instructions for Pavlik Harnesses, and keep their babies in them 23 hours a day, removing only very briefly for the sake of cleaning. […] Up to 90% of babies with mild to moderate DDH can be safely treated with a Pavlik Harness, with good results. […] If your child is older than 6 months of age, or if the hip cannot be safely reduced with only a Pavlik Harness, we then need to consider a different treatment. […] In cases where we are unable to relocate the hip joint with a Closed Reduction, or if there are conditions that prevent the hip from safely staying in place despite the cast and soft tissue release(s), we then need to perform what is called an Open Reduction. […] In more moderate to severe DDH, we will sometimes need to not only look into the hip joint, but we may also need to cut the femur bone and either intentionally shorten it or move it so that the hip is reduced.

• #23 A comprehensive nonoperative treatment protocol for developmental dysplasia of the hip in infants | Bone & Joint

  https://boneandjoint.org.uk/Article/10.1302/0301-620X.105B8.BJJ-2023-0149.R1

  Our study addresses the gap in evidence-based treatment protocols for the brace treatment of infant developmental dysplasia of the hip (DDH). […] Our comprehensive nonoperative protocol for infant DDH conforms to published consensus principles, and shows high rates of success and extremely low rates of residual dysplasia at a mean age of five years. […] This reproducible evidence-based treatment protocol can be used to help standardize care, improve outcomes, and reduce unnecessary surgery, and can be used as a baseline for future treatment comparisons. […] Early diagnosis of DDH and nonoperative management with a brace is the most effective overall strategy. […] Optimizing the nonoperative treatment strategy of infant DDH is important to improve outcomes, minimize complications, and reduce the need for surgical intervention.

• #24 A comprehensive nonoperative treatment protocol for developmental dysplasia of the hip in infants | Bone & Joint

  https://boneandjoint.org.uk/Article/10.1302/0301-620X.105B8.BJJ-2023-0149.R1

  Several international orthopaedic societies and a recent Cochrane Review have urgently called for the development of reproducible evidence-based pathways for nonoperative management of DDH in infants aged under six months. […] Development of these protocols will reliably guide and predict the success of brace treatment, detail the risk of late radiological dysplasia, and characterize those hips which need closer follow-up. […] We therefore developed a comprehensive nonoperative treatment protocol for infant DDH conforming to published consensus principles, with well-defined a priori criteria for inclusion and classification of dysplasia, and criteria for success and failure of brace treatment with detailed long-term radiological follow-up. […] Our comprehensive protocol for nonoperative treatment of infant DDH has shown high rates of success and extremely low rates of residual dysplasia at a mean age of five years.

• #25 OrthoKids – Developmental Dysplasia of the Hip (DDH)

  https://orthokids.org/conditions/developmental-dysplasia-of-the-hip-(ddh)/

  In the United States, there are 1 or 2 babies born with DDH for every 1,000 babies born. All babies are checked for DDH when they are born during their first examination. Your pediatrician will check for DDH at every check-up during the first year of life. […] Babies who are in the breech position (where the baby’s bottom, instead of the head, is positioned to be delivered first) also have a risk of DDH. Low amniotic fluid during pregnancy is also associated with DDH. […] If you swaddle your baby, make sure that the legs are not wrapped tightly together. The hips and knees should be able to flex and bend in the swaddle. There is a risk of developing DDH if the legs are tightly swaddled with the hips and knees straight. In swaddling, make sure there is enough room at the bottom of the blanket for your baby to bend his/her legs up and out from his/her body. […] Double and triple diapering may put the hips in a bent position that is better for growth of the hip joint. However, double and triple diapering has not been shown to improve results compared to no treatment.

• #26 Hip Dysplasia (DDH) – STEPS Charity

  https://www.stepsworldwide.org/conditions/hip-dysplasia-ddh/

  Developmental dysplasia of the hip (DDH) is when the ball-shaped part of the end of the thighbone and the socket do not fit correctly together. […] Things that could hinder normal hip development are; tight swaddling or spending long periods of time in car seats. Anything that pulls the hips straight or restricts their natural movement should be avoided. […] Early diagnosis gives the best chance for effective treatment. The condition becomes more difficult to treat as child gets older and there is a risk of developing arthritis of the hip at a young age.

• #27 Update on the management of infant and toddler developmental dysplasia of the hip

  https://www1.racgp.org.au/ajgp/2021/april/infant-and-toddler-developmental-dysplasia-of-the

  Recent advances in surveillance, diagnosis and management of the DDH spectrum have improved outcomes for many patients, but much remains to be discovered. […] In the meantime, the universal tenet in DDH care remains that prompt diagnosis and management are the most important factors related to outcome; it is important to be cognisant about developmental hip pathology in asymptomatic patients through infancy and childhood. […] Increased awareness of safe swaddling techniques […] Evolution of baby carrier slings to improve infant hip abduction.

• #28 Developmental Hip Dysplasia DDH

  https://www.jplrc.com/developmental-dysplasia-of-the-hip.html

  For children with severe DDH, their hips are often not amenable to Pavlik Harness, Closed Reduction and sometimes even Open Reductions with only cutting the femur bone. […] Orthopedists continue to learn more and more about the long-term consequences of not adequately treating DDH. […] With proper early treatment, mild to moderate DDH can oftentimes be completely reversed. Even patients with severe DDH, if treated early on and properly, can grow up to be adults with healthy hip joints.

• #29 Common Questions About Developmental Dysplasia of the Hip | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/1215/p843.html

  Although controversial as a screening tool, ultrasonography has good negative predictive value (as high as 90%) for disproving a diagnosis of DDH. […] The most important adverse effect of DDH treatment is avascular necrosis of the femoral head. […] The major complication of avascular necrosis is early-onset osteoarthritis and the need for hip replacement surgery.

• #30 Improving early detection of developmental dysplasia of the hip through general practitioner assessment and surveillance

  https://www1.racgp.org.au/ajgp/2018/september/improving-early-detection-of-developmental-dysplas

  DDH results from a combination of environmental and genetic factors.17 Associated gene defects occur in the transforming growth factor beta superfamily, necessary for normal bone and joint development.18 […] Tight swaddling of lower limbs in extension and adduction is associated with DDH in epidemiological, anatomical and animal studies.1921 High rates of swaddling are seen in patients with DDH diagnosed after three months of age.22,23 Conversely, habitually carrying babies with hips flexed and abducted is associated with low DDH incidence.20 Optimal babywearing has been proposed as a public health initiative to minimise DDH.20 […] Early detection for any condition seeks to identify and treat individuals who have developed pathology but not yet sought medical attention.9 DDH treatment harnesses the ossification potential of the hip to achieve a reduced, stable and mature hip, while attempting to avoid treatment complications including growth disturbance and avascular necrosis.25,26

• #31 Prevention of hip dysplasia in children and adults – PubMed

  https://pubmed.ncbi.nlm.nih.gov/22819156/

  Klisic and Pajic summarized the history of early diagnosis and treatment of hip dysplasia when they wrote, Devising the preventive approach to developmental dysplasia of the hip (DDH) required much time…. Despite the 2400-year-old suggestion made by Hippocrates that children’s hip dislocations are curable if treatment is started very early, the preventive approach was proposed by Roser only in 1879 [who] described early diagnosis in newborns and performed reduction by abduction… He also advocated early treatment by fixing babies’ hips in abduction. However, surgeons did not readily accept these proposals, despite the good results shown by Froelich in 1906 and Le Damany in 1911. […] The turning point came in 1935 when pediatrician Ortolani introduced early detection of DDH by early clinical search shortly after a child’s birth, instructing obstetricians, pediatricians, and midwives to perform the search. Rediscovering the diagnostic segno della scatto, ie, reducible displacement, he popularized the prophylactic approach to DDH by early detection and treatment.

• #32 Prevention of hip dysplasia in children and adults – PubMed

  https://pubmed.ncbi.nlm.nih.gov/22819156/

  Since Klisic and Pajic wrote this in 1993, the use of ultrasound, albeit still controversial in some ways, has influenced the treatment and prevention of DDH. Klisic’s attempts to universally prevent the disease may still be able to be incorporated into further efforts at disease prevention through education and the systematic trials of hip abduction pillows or braces similar to his wide-diaper diapering technique. The goal of prevention is to eradicate a disease so that it does not present to the physician. For DDH, this goal may be tenable.

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