Hip dislocation

HIP DISLOCATION

PRESNTED BYMAHAVEER SWARNKARM.Sc. Pediatric Nursing

In a normal hip,the head of the femur and the acetabulum are in close contact,

When abnormality either in the shape of the head of the femur, the shape of the acetabulum, or the supporting structures around them. As a result, the acetabulum and femur are not in close contact result hip dis location

INTRODUCTION

DEFINITION: Dislocation of hip refers to a hip with no

contact between the articulating surfaces of the hip.

Developmental dysplasia of hip is a spectrum of disorders related to abnormal development of hip that may develop at any time during fetal life ,infancy or childhood

CLASSIFICATION OF DDHTypical DDH: - occurs in otherwise normal

individuals or those without define syndromes or genetic conditions. Its risk factor such as oligohydramnios, breech presentation

Teratologic hip dislocation: usually have identifiable causes and occur before birth. It involves a neuromuscular defect such as arthrogryposis or myelodysplasia. The teratologic forms usually occur in utero and are much less common.

THREE DEGREE OF DDH

•Acetabular dysplasia (or preluxation) – •Subluxation•dislocation

ACETABULAR DYSPLASIA (OR PRELUXATION) –

this is the mildest form of DDH, in which there is neither subluxation nor

dislocation. Due to delay in acetabular development result it

is oblique and shallow, and allowing the ball of the hip too much mobility

The femoral head remains in the acetabulum.

Subluxation –The femoral head remains in contact with the

acetabulum, but a stretched capsule and ligamentum teres cause the head of the femur to be partially displaced. Pressure on the cartilaginous roof inhibits ossification and produces a flattening of the socket.

Dislocation – Hip dislocation refers to the state of the hip

when the femoral head is completely laterally displaced from under the acetabulum (MP=100%).

ETIOLOGY/ RISK FACTOR:- Exact cause is unknown, but certain

factors may be rsponsible such as Family history. If there is a parent,

brother or sister with DDH, then this makes it five times more likely than normal for a child to have DDH.

Gender- female baby > male

baby

Left hip > right hip -Oligohydramnios -not able to

move within the uterus as much.First born baby-uterus is

tighter and less elastic than future pregnancies

Breech position-this can put the legs in a position which increases the risk of DDH.

CONGENITAL MALFORMATIONS

Congenital torticollis

Metatarsus adductus

Chromosomal abnormalities

Neuromuscular disorders

POSTNATAL POSITIONINGhips in extension and adduction (e.g. papoose.

parent carrying baby on their hip) increases risk

X

INCIDENCE:-Hip instability-10/1000 live

birthIn breech presentation- 30-

60 %Left hip – 60 %Girls – 60%

PATHOPHYSIOLOGY

CLINICAL MANIFESTATIONS:-Neonates: positive Ortolani or Barlow sign.

Infant:

shortening of the thigh(The Galeazzi sign)

Asymmetry of the gluteal or thigh folds and positioning of the hip,

Limitation of abduction in affected hip joint

Klisic test positive.

The walking child: Limp, a waddling gait, or leg

length differance.affected side appears shorter

than normal extremitytoe-walk on the affected side.Trendlenberg sign is positive

Positive Galeazzi sign

Excessive Lordosis

DIAGNOSTIC EVALUATION: A. HistoryB. Physical examination -

Barlow testOrtolani testPositive Galeazzi sign

(allis sign)Klisic testTrendelenburg's sign

C. UltrasonographyD. Radiography

MANAGEMENT0-6 MONTHS: Pavlik harness for 6 weeks By maintain Ortoloni positive hip, It prevents hip extension

and adduction and permits flexion and abduction.

Children 6 months to 2 years of age:

goals in the treatment of the late-diagnosed patient are to obtain and maintain reduction of the hip without damaging the femoral head.

Closed or open reduction(some time before C.R. use skin traction)

The reduction is maintained in plaster cast for 12 weeks

abduction orthotic device for 2 months

CHILDREN OLDER THAN 2 YEARS OF AGE: Open reduction shortening osseotomy to

avoid excessive pressure on the proximal femur with reduction

acetabular procedure to adequately cover the femoral head.

COMPLICATIONS:-Avascular necrosisReduced hip functionDegenerative hip changesJoint malformationInability to reduce dislocationResults in growth arrest and eventual joint

destructionPostoperative complications-wound infection.

NURSING MANAGEMENT:1. Acute pain or discomfort related to orthopaedic device or

cast as evidence by child is crying continuous2. Risk for impaired skin integrity related to pressure of the

cast on the skin as evidence by child having rashes and redness on the skin

3. Altered Physical mobility related to lengthy treatment or orthopaedic device as evidence by child is not able to move

4. Diversnal activity deficient related to hospitalization or immobility as evidence by child look boredom

5. impaired bowel pattern related to immobility as evidence by decrease frequency of passing stool and hypoactive bowel sound

6. Knowledge Deficit of family caregiver related to home care of child in the orthopaedic device or cast as evidence by parents asking many questions regarding home care