SLOB

What we KNOW: 1. High muscle tone (especially 'dystonic') WILL deform these baby hips, and older ones as well. It is that fierce. 2. Cross leg posture focuses this abnormal pressure on the weakest part of the socket, the soft edge rather than the firm center. 3. This dysplasia is not a static anatomicdeformation – it is a process. However bad it looks now, it will look even worse next week. PDH x-rays are like a photo of windshield wipers, only capturing the moment. 4. Remove the high muscle generated pressure AND [must be “and”] abnormal crossed posture --- and the hips will be fine if damage has not yet created an inherently unstable joint as [a marble put into an empty shoe box]. 5. The palsy related muscle tendon contractures are often of greater strength than the socket walls. Muscle “STRETCHING” is only an assumption when doing stretching exercises. They should be called: Hopefully stretching muscle while not instead driving the bone out of the socket.” With the leg not aBducted, passive knee extension pistons the femur and presss the socket wall out. The femur is a huge lever and the hip socket walls are soft. At what age should we intervene to not lose the hips? Well, with CDH/DDH a few days old was certainly not too soon. It is the same with PDH in order to PREVENT dysplasia !!!! 'Early detection' [x-ray] is NOT early. You need to have substantial cartilage damage before anything – even trace change in BONE - can be seen on an x-ray. There is no ultrasound available for PDH. In PDH the cause isn't going away, it is increasing. You do not need x-ray to see the cause . We can see what damages these hips [using eyeballs] and feel the tension [hands] – we don't need a test that documents only our clinical ignorance. If you see someone choking a child, do we order an x-ray to see if the windpipe is truly collapsed – and if so - then ask if the perp will stop? We know that our CP perpetrator will NOT. But the CDH/DDH treatments for late damage involve chisels & metal plates and breaking and shortening bones and so on. To PREVENT (given visual & palpable evidence of the PROCESS that causes damage) small targeted nerve injection (ethanol) and a very tiny division of the abnormal reflex trigger parts of the self amplifying [similar to microphone feedback] is simple & outpatient. PREVENTION. In children less than 1 yo, it often lasts several years. We have no cases of later hip reconstruction in those treated early before damage, or those with minimal evidence as seen by ultrasound (different kind than the CDH/DDH variety).