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CONGENITAL HIP DYSPLASIA

I. DEFINITION

Also known as Hip dysplasia, developmental dysplasia of the hip (DDH) or congenital
dysplasia of the hip (CDH) is a congenital or acquired deformation or misalignment of the hip joint.

Is a disorder in children that is either present at birth or shortly thereafter.


Congenital dislocation of hip is a condition present since birth in which the head of the femur is detached from the acetabulum or can be moved in and out of the acetabulum easily.

II. CAUSES
unknown

Predisposing Factors:
Ligamentous Laxity - Because of Hormonal changes within the mother during pregnancy and is thought to possibly cross over to the placenta and cause the baby to have lax ligaments while still in the womb Intrauterine position - Higher in infants born by caesarian and breech position births Genetic factor/ family history of the disorder More females affected than males - Possibly because the hip are normally more flaring in females and possibly because Maternal hormone relaxin causes the pelvic ligaments to be more relaxed. Greater chance of this hip abnormality in the first born compared to the second or third child. Oligohydramnios/Low levels of amniotic fluid during pregnancy.

Degree of Dislocation: 1. Subluxation/predislocation incomplete dislocation Most common; more difficult to detect If untreated , it may result in complete dislocation 2. Congenital dislocation refers to case in which there is an actual complete dislocation Occurs during interuterine life or result from untreated subluxation sometimes after birth

III. SIGNS AND SYMPTOMS


Legs of different lengths. Hip click Uneven thigh skin folds. Less mobility or flexibility on one side. In children who have begun to walk, limping, toe walking and a waddling "duck-like" gait are also signs. Ankle fractures Buttocks folds also may not be symmetrical with more creases on the dislocated side Hip pain commonly manifests as knee or anterior thigh pain

IV. DIAGNOSTIC PROCEDURE


Physical Assessment - moving the hip to determine if the head of the femur is moving in and out of the hip joint. Ortolani test- examiner's hands around the infant's knees, with the second and third fingers pointing down the child's thigh. Abducted (moved apart). Hip click- the examiner may be able to hear a distinct clicking sound. Barlow method-the infant's hip brought together with knees in full bent position. The examiner's middle finger is placed over the outside of the hipbone while the thumb is placed on the inner side of the knee. The hip is abducted to where it can be felt if the hip is sliding out and then back in the joint. In older babies, if there is a lack of range of motion in one hip or even both hips, it is possible that the movement is blocked because the hip has dislocated and the muscles have contracted in that position. X-ray films- can be helpful in detecting abnormal findings of the hip joint. X rays may also be helpful in finding the proper positioning of the hip joint for treatment.

V. TREATMENT
A. Medical management Pavlik Harness used on babies up to 6 months of age The harness places the femur in the socket at the correct angle and keeps the legs apart. A doctor will put the harness on in order to get the proper fit and will likely recommend that the baby wear it 24 hours a day for 6 to 12 weeks. success rate is 85 to 95 percent for infants under 6 months old.

Spica Cast A spica cast is applied after surgery to hold the hips in the most appropriate position for bone growth. The purpose of the cast is to stabilize the hip after a reduction. A spica consists of a plaster or fiberglass cast that encases the child from stomach to feet.

B. Surgical Management Open reduction is the treatment of choice for children older than 2 years at the time of the initial diagnosis or for children in whom attempts at closed reduction have failed. Most often, especially in older children, the standard anterolateral or Smith-Petersen approach is used. In a child older than 3 years, femoral shortening is typically performed instead of traction Pelvic osteotomy may be needed for residual hip dysplasia

C. Nursing management Placing rolled cotton diapers or a pillow between the thighs, thereby keeping the knees in a frog like position. ROM exercise to unaffected Tissue Immobilization of hips in less than 60-degrees abduction per hip Meticulous skin care around the immobilized tissues

Maintain proper positioning and alignment to limit further injury Accompanying soft tissue injuries are treated by RICE therapy: R-rest I-ice C-compression bandage E-elevation with or without immobilization Stimulation of affected area by isometric and isotonic exercises also helps promote healing.
for patients who have splints, remind parents to maintain good diaper area care: change diapers frequentky and wash area and apply an ointment such as A and D ointkment, vaseline or Desitin at each diaper change since this can lead to severe diaper rash. teach parents to swaddle the baby tightly because this action is comforting. for older patients encourage a balanced diet, foods that promote healing such as protein rich foods and as well as vit c rich foods.

CONGENITAL HIP DYSPLASIA

Famela F. Lauzon BSN IV-2 (Group 2)

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