This document discusses congenital hip dysplasia, a condition where the hip joint is unstable or dislocated. It is often caused by ligament laxity and can be detected in infants by physical exam findings like leg length discrepancy. Treatment depends on age and severity, ranging from use of a Pavlik harness or traction in infants to surgery to relocate the hip in older children or adults. Nursing care involves education on proper cast care, positioning, and exercise to aid treatment and prevent complications.
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This document discusses congenital hip dysplasia, a condition where the hip joint is unstable or dislocated. It is often caused by ligament laxity and can be detected in infants by physical exam findings like leg length discrepancy. Treatment depends on age and severity, ranging from use of a Pavlik harness or traction in infants to surgery to relocate the hip in older children or adults. Nursing care involves education on proper cast care, positioning, and exercise to aid treatment and prevent complications.
This document discusses congenital hip dysplasia, a condition where the hip joint is unstable or dislocated. It is often caused by ligament laxity and can be detected in infants by physical exam findings like leg length discrepancy. Treatment depends on age and severity, ranging from use of a Pavlik harness or traction in infants to surgery to relocate the hip in older children or adults. Nursing care involves education on proper cast care, positioning, and exercise to aid treatment and prevent complications.
Copyright:
Attribution Non-Commercial (BY-NC)
Available Formats
Download as PPTX, PDF, TXT or read online from Scribd
This document discusses congenital hip dysplasia, a condition where the hip joint is unstable or dislocated. It is often caused by ligament laxity and can be detected in infants by physical exam findings like leg length discrepancy. Treatment depends on age and severity, ranging from use of a Pavlik harness or traction in infants to surgery to relocate the hip in older children or adults. Nursing care involves education on proper cast care, positioning, and exercise to aid treatment and prevent complications.
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CONGENITAL HIP
DYSPLASIA (developmental hip dislocation / congenital hip dislocation) -A condition of abnormal development of the hip, resulting in hip joint instability and potential dislocation of the thigh bone from the socket in the pelvis. Cause: unknown
Predisposing Factors:
• Ligamentous laxity-bec. 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 bec. 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 SIGNS OF CONGENITAL HIP DYSPLASIA Different (asymmetric) leg positions Reduced movement on the side of the body with the dislocation Figure 3.3. The technique of performing the Barlow maneuver. clicking sound when the baby's legs are moved apart
• Figure 3.2. The technique of eliciting Ortolani’s sign
Shorter leg on the side with the dislocation Uneven folds of thigh fat/asymmetry of skin folds • Common adult symptoms include: • Pain in the groin region that radiates to the outer buttock or thigh • Weakness in the leg • Difficulty walking, possibly limping • Loss or limitation in the joint's range of motion • Feeling a grinding sensation in the joint • Hearing a click or clunk sound • Sensation of giving way, catching or locking Diagnostic Procedure 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 treatments of casting Ultrasound
Where the physical examination is positive,
ultrasound assessment should be undertaken to assess the anatomical position of the cartilaginous femoral head relative to the acetabulum. Treatment 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. Traction and Cast •Traction is the application of a force to stretch certain parts of the body in a specific direction. •purpose :to stretch the soft tissues around the hip and to allow the femoral head to move back into the hip socket. •used only when the Pavlik harness has been unsuccessful or when hip dysplasia has been diagnosed later than 6 months of age. Surgery and Casting • If the other methods are
not successful
• if DDH is diagnosed after
the age of 2 years, surgery
may be required to put
the hip back into place
manually, also known as a
"closed reduction". Nursing management • placing rolled cotton diapers or a pillow between the thighs, thereby keeping the knees in a frog like position • Pavlik harness, which has straps that allow the baby to move about freely while holding the hip in place and preventing movements that would make the condition worse. • ROM exercise to unaffected Tissue • Meticulous skin care around the immobilized tissues • Immobilization of hips in less than 60-degrees abduction per hip Cast care instructions:
• Keep the cast clean and dry.
• Check for cracks or breaks in the cast.
• Rough edges can be padded to protect the skin from scratches.
• Do not scratch the skin under the cast by inserting objects inside the cast.
• Use a hairdryer placed on a cool setting to blow air under the cast and cool
down the hot, itchy skin. Never blow warm or hot air into the cast.
• Do not put powders or lotion inside the cast.
• Cover the cast during feedings to prevent spills from entering the cast.
• Prevent small toys or objects from being put inside the cast.
• Elevate the cast above the level of the heart to decrease swelling.
• Do not use the abduction bar on the cast to lift or carry the baby. Medical Management • Anti-inflammatory diet • anti-inflammatory medications • Ice • Physical therapy, massage and bodywork Surgical Management • redirects or salvages bone in order to preserve the natural joint for as long as possible • total hip replacement (THR), replaces the entire joint and is used in cases of severe pain, considerably compromised mobility and cartilage that is so worn that replacement is necessary
• Children • Osteotomies • open reduction • Hip Replacement
• considered when pain from
osteoarthritis, caused by the normal aging process, drastically affects quality of life. Hip dysplasia can speed up this wear on the cartilage, making a total hip replacement (THR) Nursing Diagnosis:
• Deficient parental knowledge related to
splint, halter,or cast correction for hip dysplasia as evidenced by inaccurate follow- through of instruction.
