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The lengh of the time in where    the proper hip position must be mmaintained .  The biggest femoral head migration  usually occurs in the Upper- Lateran part of acetabulum , therefore, femoral flexion must be bigger than 90 degrees(knees above the buttocks line)  and abduction should be minimum 45 degrees ( both spread thighs lying on the basis in symmetrical position)., but only till the border of contracture, if it exists.
It does not matter, what  we use for proper femoral and hip alignment to an end of socket restoration. On the other hand, theduration of proper hip alignment is crucial, and it is sufficient for good hip development in 97% of infants. The more delicate, earlier, and less traumatic treatment, the better results of treatment we achieve. 
Only a specialized medical doctor with appropriate knowledge and experience can properly diagnose of CDH and applied adequate treatment

In order to guarantee successful treatment, the Congenital Dyslocation of The Hip    (CDH )must be detected in the newborn Unit right after the Birth and rebuilding of Hip instability must be completed,by 5th week of age(when the  regeneration process is the fastest
The only secret to improve the results of treatment of congenital dislocation and subluxation
Of the hip is early recognition and atraumatic treatment during the first six months of life before weight bearing.
Failure to detect CDH in time or inappropriate treatment will result in complication many year later,when for prevention is too late.

We should always begin treatment with the attempt of prevention, which is applied by parents(. Pict 1,2)  after verify the clinical diagnosis of DDH by usg examination    If there is no improvement(down to50%) at the next examination (after from 3 days with type D to 14 days with small dysplasia ), we use orthoses, for stable hips in older infants , for example Pavlik harnesses.(  Pict.3)

Attention!
If a baby keeps crying after applying orthosis for the first  3 days, you should remove the orthosis  and put it on after a while, but with a smaller abduction. If after several attempts of using an orthosis the  child still cries, the orthosis should be taken off and parents should contact  the doctor for checking the treatment option . 
Inadequate traumatic treatment  causes a blood vessel disturbance in the Hip Joint and baby cry (that cannot te cry be stopped) due to  a pain  of  the dying cartilage cells in the thigh head .The cry stops after a few  hours, when all  cells with lack of blood  are sustained  the avascular necrosis.

During every control examination in the course of CDH treatment the doctor has to observe improvement in hip restoration in comparison with the last examination, which certificates the proper course of hip restoration and treatment means. It there is no improvement the cause should be found, or theconsultation in the other specialized medical center should be considered. Continuation ineffective treatment increases the risk of surgery, because the older the child, the slower restoration.

 

Treatment according to Graf’s method consists of the following three stages: reposition, immobilisation, and reconstruction. Reposition is performed on instable types of hip: II c instable, D, IIIa/b, IV. If this cannot be done manually, we use an overhead traction appliance. 
In newborns within the first week of life, we have no difficulty inserting the head into the acetabulum. After reposition, we need to keep the hip in this position to keep the head deep in the acetabulum until the loose capsule shrinks and hip stability is restored. According to Graf’s method, hip instability is treated with the use of a plaster cast, where the legs are bent >90° and up to 50° in abduction. The plaster reaches to the knees only, which allows for rotational movements to furrow the bottom of the acetabulum. Depending on the size of the baby, we change the plaster every 2-4 weeks. When treating hip instability with the use of different kinds of orthopaedic braces, we examine the hip every week until the hip achieves clinical stability and stability in an ultrasonography test. Afterwards, we examine the hip less frequently, i.e. every 4 weeks. The progress of treatment is examined clinically and through ultrasonography. If we have any doubt, an X-ray test is used. This kind of treatment is effective and practical and does not result in femur head necrosis. This allows us to proceed to the next stage of treatment. The roof of the acetabulum is reconstructed with the use of orthopaedic braces. This method of treatment is used in the case of stable type of hip joint: IIa-, Ilb and Ilc in newborns. The legs are positioned very much like when a plaster cast is used. The bone acetabulum is reconstructed only without pressure on the head. Therefore, bending in excess of 90° is necessary and an abduction of minimum 45° to the shrinkage angle prevents damage to the femur head. The treatment is considered complete when we achieve the type I correct hip. 
The results of the treatment are checked with the use of ultrasonography, clinically and using X-ray testing (If there is no improvement, the use of a plaster cast is treatment of choice). Afterwards, we examine the joints every 2-3 months until the baby reaches the age of one. Then another X-ray is taken. Subsequent follow-ups take place every three years until the patient reaches the age of 18, when the construction of the joint is complete. This is done to ensure there is not even the slightest irregularity in the structure of the hip joint.

 
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