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.

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

• Sex (females are more affected than males)

• statistics show that the Native American population has a high incidence of hipdislocation.

• infants born by caesarian and breech position births.

• 1st born infants• Hormonal changes within the mother

duringpregnancy

• Other musculoskeletal disorders of intrauterine malpositioning or crowding, such as

metatarsus adductus andtorticol lis• Oligohydramnios • Hip dysplasia can be associated with

underlying neuromuscular disorders, such as

cerebral palsy, myelomeningocele, arthrogryposis, and Larsen syndrome, although these are not usually considered DDH

• 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

Laboratory StudiesNo laboratory studies are routinely ordered in the workup of DDH.

Imaging StudiesUltrasonograms have been of significant benefit in the assessment and treatment of children with hip dysplasia

• o perform this maneuver correctly, the patient must be relaxed.

• Only one hip isexamined at a time.

• The examiner's thumb is placed over the patient's inner thigh, and theindex finger is gently placed over the greater trochanter.

• The hip is abducted, and gentlepressure is placed over the greater trochanter.

• In the presence of DDH, a clunk, similar toturning a light switch on or off, is felt when the hip is reduced.

• The Ortolani maneuver should be performed gently, such that the fingertips do not blanch

Standard radiographic views include a standing anteroposterior view of the pelvis,

A computed tomography (CT) scan Three-dimensional (3-D) images. Magnetic resonance images (MRIs) can

be beneficial in identifying the underlying bony and soft-tissue anatomy.

Diagnostic ProceduresArthrograms are dynamic studies, performed by injecting dye into the hip joint and then examining the patient with aid of fluoroscopy, usually with the patient under anesthesia.

Abnormal fetal positionExcessive laxity of the joint capsule

A tight uterus that prevent fetal movementBreech delivery

 

During the 7th week of gestation start of the development of the femoral head and acetabulum

 During the 11th week’s gestation the hip joint is fully formed which

in this time posteromedial surface of the femoral head flattens hip capsule thickens

Pulvinar(fibro fatty tissue) fills space bet. Acetabulum and femoral head contraction of the bup absuctions.

 The tight feet between acetabulum and femoral head are lost which causes easily displaced usually oocur in posterosuperior

direction. 

Asymmetry of skin folds limb shortening restricted abductions

The cone of stability-—a cone that involves hip flexion, abduction, and internal and/or external rotation—has also been defined. If this cone measures greater than 30º, it is considered satisfactory.

An adjustable chest halter that abducts the legs

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.

• 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

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

ACUTE PAIN r/t lack of continuity of the bone to joint; edema and muscle spasms as evidenced by facial grimace and crying

Impaired physical mobility r/t musculoskeletal impairment secondary to hip dysplasia as manifested by less mobility and flexibility on one side of the leg

Risk for injury r/t altered mobility

Assessment

Nursing diagnosis

Scientific explanation

Planning Intervention Rationale evaluation

Subjective:n/a

Objective:>Limited rom>limited to perform gross fine/ motor skills >slowed movement>jerky movements>decreased reaction time>movement- induced shortness of breath

Impaired physical mobility

r/t musculoskeletal

impairment

secondary to hip

dysplasia as

manifested by less mobility

and flexibility on one side of the leg

Discharge outcome:Upon discharge and continuous nursing interventions : A) the parents of the client will be able to perform all identified interventions to increase physical mobility and maintain safety of the client B) the client will be able to maintain strength and function of affected and/or compensatory body part

Short term outcome: after 8 hours of nursing interventions the parents of the client will be able to:a.Verbalize at least 5 importance of b.Identify 5 treatment regimen and safety measuresc.Perform 3/5 identified treatment regimen and safety measures.

Individual:a)Note decreased motor agility r/t Ageb)Support affected body parts/joints using pillows and rollsc)Instruct parents to provide safe environment to the Client (use of padded rails and devices, fall prevention)d) Provide regular skin care to include pressure area Managemente) Instruct parentsto increase the fluids/ nutritious foods given to the clientf) Instruct use of ROM exercise in unaffected areas

Collaborative:a)Consult with physical/ occupational therpist as inidcated

a)To identify causative/ contributing factorb)To maintain position of function and reduce risk of pressure ulcersc)To maintain safety of the client, reduce the risk for further injuryd)To maintain skin integrity both to affected and unaffected areas/ decreases irritationE)To maximize energy productionF)Promote circulation

a)To identify mobility program and adjunctive devices

Discharge outcome:Upon discharge and continuous nursing interventions : a)the parents of the client will be able to perform all identified interventions to increase physical mobility and maintain safety of the client B) the client will be able to maintainstrength and function ofaffected and/or compensatory body part

Short term outcome: after 8 hours of nursing interventions the parents of the client will be able to:a)Verbalize at least 5importance of b)Identify 5 treatment regimen and safety measuresc)Perform 3/5 identified treatment regimen and safety measures.