Hip dysplasia Beukes type
Overview
A very rare inherited disease characterized by premature degeneration of the hip joints.
Symptoms
* Hip pain * Progressive crippling * Flattened femoral capital epiphyses * Irregular femoral capital epiphyses
Causes
Experts are uncertain about the causes of DDH. Dislocation is 10 times more common after breech delivery (malpositioning in utero) than after cephalic delivery, and it’s also more common among large neonates and twins. Females are affected more often than males. Genetic factors may also play a role. Although DDH is found throughout the world, incidence is particularly high among Native Americans.
Diagnosis
A CBC, sedimentation rate, chemistry panel, arthritis panel, tuberculin test, and x-rays of the lumbosacral spine and hip will diagnose 90% of the cases. These are relatively expensive in comparison to MRI. A bone scan may be necessary to diagnose occult fractures. A serum protein electrophoresis will help diagnose multiple myeloma. A trigger point injection of the greater trochanter bursa or ischiogluteal bursa will assist in the diagnosis of these conditions. An orthopedic surgeon should be consulted before ordering MRI of the lumbar spine or hip. However, MRI is especially important if the diagnosis of avascular necrosis is suspected.
Treatment
* Septic arthritis, femoral neck fracture, and irreducible traumatic hip dislocation require immediate surgical intervention * Infectious disease consult for septic joint * Once surgical emergencies are ruled out, keeping the patient non-weight bearing on the affected extremity will allow continued investigation without further injury * SCFE: Prevent further slippage by percutaneous pinning or screw fixation * Legg-Calvé-Perthes: Treatment goals include restoring ROM, improving symptoms, and containing the femoral epiphysis during reossification phase; accomplished by limiting activity, traction, Petrie casting, and surgical procedures for containment * DDH: Pavlik harness, closed reduction and casting, open reduction for irreducible hip dislocation, or femoral and/or pelvic osteotomy depending on status and age of developing hip