CONGINITAL HIPS DISLOCATION (DYSPLASIA)

A malformation of the hip joint that is present at birth. Genetic factors likely play a role in this
disorder. Features include hip dislocation, asymmetry of leg positions, asymmetric fat folds, and
diminished movement on the affected side. Some children will exhibit little or no features and
must be diagnosed by physical examination of the hip joints.

It is abnormality of the hip joint present from birth, is the most common disorder affecting hip
joint of children. Younger than 3 yrs. Old it can unilateral or bilateral.

Is an imperfect development of the hip that can affect the femoral head, acetabulum, or both.

Occur when the ball of the hip of the joint come out of its socket.

3 Types
1. Hip dyaplasia
2. Subluxation
3. Complete or true congenital dislocation



Cause
Breech presentation
Oligohydramios


Sign and symptom
Congenital dislocation
Waddle like duck
Shortening of the limb
Lordosis
Leg with hip problem may appear to turn out more
Reduced movement on the side of the body with the dislocation
Shorter leg on the side with the hip dislocation
Uneven skin folds of thigh or buttocks
Diagnostic test
X-ray
CT-Scan
MRI
Ultrasounds



Risk factor

First child in the family
Being female
Breech position
Family history of disorder

Complications
Premature arthritis of the hip as early as late teen
Joint malformation
Crippling osteoarthritis
Degenerative hip changes
Treatment
Pavlik Harness
2 maneuvers
> Ortolani test
> Barlow test

Nursing management
Assist in teaching parents the important of exercise
Double diapering
Care of patient with cast and braces
Provide adequate stimuli to promote growth and development
Feed the child carefully to avoid aspiration and choking

Medical management
New born to 6 months
Application of external device to maintain proximal femur centered in the acetabuulum
6-18 months
Traction followed by reduction and plaster cast immobilization
Order child
Surgical reduction

Intevention
Teach parents how to correctly splint or braces the hip as ordered.
Instruct parents to remove braces and splint while bathing the infant but to replace them
immediately after word.
When transferring a child immediately after casting, use palm to avoid marking.
Turn the child every 2 hours.
Provide adequate nutrition and maintain adequate fluid intake.

Nonsurgical Hip Dysplasia

Many nonsurgical treatments for adults with hip dysplasia focus on reducing inflammation or
supporting joint health. Glucosamine and chondroitin sulfate, often sold as a single dietary
supplement, can be taken for joint health. Oral glucosamine comes from shellfish (although
vegetarian options exist) and may help rebuild cartilage. Chondroitin sulfate is also a major
component of cartilage. While both may reduce joint pain, there are conflicting reports about their
effectiveness in treating osteoarthritis.

A doctor can also give steroid shots to reduce inflammation. The decrease in inflammation
reduces the level of pain. The most common side effect is a condition called cortisone flare -- the
injected cortisone crystallizes and becomes painful for a day or two. Some studies have shown that
repeated use of cortisone can weaken tendons and soften cartilage, so a doctor may limit the
number of injections.
2
nd
. TREATMENT
When the problem is found during the first 6 months of life, a device or harness is used
to keep the legs apart and turned outward (frog-leg position). This device will usually
hold the hip joint in place while the child grows.
This harness works for most infants when it is started before age 6 months, but it is less
likely to work for older children.

PATHOPHYSIOLOGY

Newborn ( Girl) _____________Malformation of the hips


Breech presentation


Oligohydramios


Lordosis


Subluxation


Dislocation

Prevention

Prevention includes proper prenatal care to determine the position of the baby in the womb.
This may be helpful in preparing for possible breech births associated with hip problems.
Avoiding excessive and prolonged infant hip adduction may help prevent
strain on the hip joints.
Early diagnosis remains an important part of prevention of congenital
Congenital hip dysplasia.

Anatomy of Femur









PHYSIOLOGY


The Head (caput femoris).The head which is globular and forms rather more than a
hemisphere, is directed upward, medialward, and a little forward, the greater part of its
convexity being above and in front.

The Neck (collum femoris).The neck is a flattened pyramidal process of bone,
connecting the head with the body, and forming with the latter a wide angle opening
medialward.

The Trochanters.The trochanters are prominent processes which afford leverage to
the muscles that rotate the thigh on its axis.

The Greater Trochanter (trochanter major; great trochanter) is a large, irregular,
quadrilateral eminence, situated at the junction of the neck with the upper part of the
body

The medial surface, of much less extent than the lateral, presents at its base a deep
depression, thetrochanteric fossa

The Lesser Trochanter (trochanter minor; small trochanter) is a conical eminence,
which varies in size in different subjects; it projects from the lower and back part of the
base of the neck

The Body or Shaft (corpus femoris).The body, almost cylindrical in form, is a little
broader above than in the center, broadest and somewhat flattened from before
backward below

The articular surface of the lower end of the femur occupies the anterior, inferior, and
posterior surfaces of the condyles. Its front part is named the patellar surface and
articulates with the patella;

The Architecture of the Femur.Koch
62
by mathematical analysis has shown that in
every part of the femur there is a remarkable adaptation of the inner structure of the
bone to the machanical requirements due to the load on the femur-head.

The Inner Architecture of the Upper Femur.The spongy bone of the upper femur
(to the lower limit of the lesser trochanter) is composed of two distinct systems of
trabecul arranged in curved paths: one, which has its origin in the medial (inner) side
of the shaft and curving upward in a fan-like radiation to the opposite side of the bone

References
Professional guide to disease by: Wolter kluwer
Medical and surgical book by: Wolter kluwer


MARK JOSEPH ORDANZA