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If you are trying to understand hip dysplasia, read this article before reading further.

Definitions

Risk Factors: Common risk factors include female child, firstborn child, breech birth, large baby, low amniotic fluid, family history. But sometimes every one of these factors is absent, and the baby is still affected.

Acetabulum: The area on the pelvis that is capable of becoming a hip socket. In newborns this area is cartilage, as the child matures this area will ossify or harden into bone. Sometimes also called the area of triradiate cartilage because three bones come together to form the acetabulum.

Reduction: Reduction is the term used to describe putting a bone back into its proper position. A closed reduction is accomplished without making an incision in the skin. An open reduction is when an incision is made and the socket is cleaned and any debris is removed.

Adductor tenotomy: The adductor muscle is used to bring the legs together. It is located across the groin. An adductor tenotomy is the term used to describe the snipping of the tendon that attaches to the muscle. This will allow the legs to fall further apart giving better movement of the child's leg so that the doctor can properly position the femur into the acetabulum.

Osteotomy: Osteo means bone, and otomy means the cutting of, therefore an osteotomy is the cutting of bone. There are two main classifications of osteotomies (pelvic and femoral) which are determined by the part of the body that is cut.

Pelvic osteotomy: Cutting and reshaping the pelvis in order to hold the femur in the acetabulum. See surgery for a complete description of a pelvic osteotomy.

Femoral osteotomy: Cutting and repositioning the femur in order to hold the femur in the acetabulum. See Surgery for a complete description of femoral osteotomy.

Acetabular Index: The angle formed by drawing a horizontal line at the bottom of the pelvis and an angled line from the bottom of the pelvis to the outer edge of the socket. See a picture. By 4 months of age, a normal child will have an index of 30 degrees or less with the index decreasing until it reaches 20 degrees or less. An index above 30 degrees should prompt the doctor to begin treatment, with the treatment being more aggressive the higher the index. See a graph of the index versus age. The source for this graph is not currently known.

Avascular Necrosis: "A" means without and vascular pertains to blood flow. Necrosis is a type tissue death. Therefore, this means that no blood is getting to the tissue and the tissue dies. In most cases, the tissue here refers to the top of the femur.

Questions to ask the Pediatric Orthopedic Surgeon

If your child is being fitted with a Pavlic Harness or a Von Rosen splint:
Why does my child need this treatment?
How long does the treatment normally last?
What is the worst case scenario that is possible?
How many cases of DDH have you treated?
Where did you study? What type of fellowship did you complete?
What is my child's acetabular index (the doctor should be willing to show you the x-ray and how the index is calculated)? How was the index determined, Ultrasound or x-ray?
Can I remove the harness at all?
Do I come back here for adjustment to the harness?
Does the harness go under or over clothes? What if I have a question or a problem with the fit of the harness, do I call your office?

If your child is going to have either a closed or open reduction:
Why does my child need this treatment?
How long does the treatment normally last?
What is the worst case scenario that is possible?
How many cases of DDH have you treated?
Where did you study? What type of fellowship did you complete?
What is my child's acetabular index? (The doctor should be willing to show you the x-ray and how the index is calculated) How was the index determined, Ultrasound or x-ray?
What operation will you be performing? How long is the standard operation?
How many times have you performed this operation? How many times this year?
What type of pain control will be given to my child after the surgery?
Will you be using a caudal block? An anti-nausea drug?
How long will my child be in the hospital afterward?
How long will my child be casted afterwards? How many cast changes will there be? What shape will my child be casted in? (Ask to be shown with a picture or a drawing) Frog-legged, V-shaped? How wide will the cast be?
Will my child fit into a regular carseat? If not, does the hospital loan spelcast carseats?
Is there any restriction for my child afterwards? Can my child stand in the cast?
If there are problems with my child's cast whom do I call? The hospital or your office? Can I relate my question to the office staff and will you call me back?
Will my child be in a brace after the cast comes off? What type of brace? Rhino cruiser, scottish-rite brace (also called an Atlanta brace), camp brace. For how long will my child wear the brace? Will it be 24 hours a day, or will my child be allowed out for some play time?

If you can talk to the anesthesiologist before the operation:
Did you complete a fellowship in pediatrics in addition to your anesthesiology residency?
How long have you practiced?
How will you put my child to sleep (gas vs. needle in arm w/medication)?
How is the drug metabolized? How long will it take for the drug to be out of my child's system? Will my child be cranky, out of sorts, recognize me?
Can my child take a favorite toy to the operating room for comfort?
What kind of side effects can we expect?
Will you be using a caudal block for this procedure?
Will you be present for the entire procedure or do they allow a nurse anesthetist take over once the initial anesthesia was given?

If your child is going to have an osteotomy:
Is this a pelvic osteotomy or a femoral osteotomy, or both?
What type of the particular osteotomy will you be doing (there are different ways of entering the hip capsule and they are given different names)?
What pins, screws, etc. will they be using to hold the donor bone that they use in place and how long will they be in place?
Will the pins be buried under the skin?
From where will you take the donor bone (if this is a pelvic osteotomy)?
Can I direct donate blood for my child's operation?
What are the risks of each type of osteotomy?
Will she limp afterwards? How long?
Will she need to be in a brace afterwards?
Is there anything that my child is NOT allowed to do while in the cast after the osteotomy?
How and when will the pins/plates/screws be removed?

If the doctor wants to do a catscan:
Where do you recommend a cat-scan be performed?
Is this procedure necessary?
Does this facility have experience doing cat-scans on children?
Does the facility that you recommend modify the radiation load for children's settings?


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