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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Congenital Hip Dislocation

Congenital hip dislocation, also known as developmental dysplasia of the hip, is a condition involving the abnormal formation of the hip joint in newborns. This occurs when the ball joint at the top of the thighbone (femoral head) is not stable within the socket (acetabulum). The degree of looseness or instability varies. The ball of the hip may be loosely in the socket (subluxed) or completely dislocated at birth. The ligaments in the hip joint may also be loose and stretched. It is important that infants suspected of having congenital hip dislocation are regularly assessed, since this disorder of the hip is progressive, making early detection and treatment essential. The condition tends to affect the left hip, is more common in girls and babies born in the breech position (Health Grades Inc., 2011; MedicineNet.com).

Risk factors:

  • Familial tendency
  • Being born female
  • First born children
  • Babies born in a breech position
  • Being of Native American descent (MedicineNet.com).

Symptoms:

Children with congenital hip dysplasia may have the following features;

  • Hip dislocation
  • Asymmetry of leg positions, i.e. the legs are different lengths
  • Asymmetric fat folds under the buttocks on the affected side
  • Uneven thigh skin folds
  • Diminished movement in terms of mobility and/or flexibility on the affected side
  • Some young children exhibit little or no features and are only diagnosed on the basis of a physical examination of the hip joints
  • In older children, who have already begun walking; limping, toe walking and 'duck-like' waddling are also signs to look out for (Arthritis-Symptom.com).

Diagnosis:

All babies are screened after birth and are checked periodically during the first year of life. Congenital hip dislocation is generally spotted when a doctor manipulates a newborn's thighs and hips. He may feel a jolting or jerking sensation as the head of the femur moves into the socket of the hip. Another early sign of a dislocated hip is a clicking sound when the baby's legs are moved apart (abduction). One method used to test for increased abduction and therefore hip joint instability, is the Ortoloni test. This test is only valid a few weeks after birth. In older infants, if there is a limited range of motion in 1 or both hips, it is possible that the movement is blocked because the hip has dislocated and the muscles have contracted in that position. The Barlow method is particularly useful for making a diagnosis on this basis. Some hospitals use ultrasound screening to confirm the diagnosis. If the problem goes undetected until your child learns to walk, you may notice that she favours one side or limps and that there are more skin folds below the buttocks of the affected leg (Arthritis-Symptoms.com; Collins, 2003).

Treatment:

Treatment of dislocation depends on the age of the child, their overall health and medical history.

In newborns or very young children, a soft positioning device called a Pavlik harness, can be used to keep the hip bone in the socket and stimulate normal development. The same result is achieved by using a stiff shell cast, to spread the legs apart and force the head of the femur into the acetabulum.

If this does not work, a procedure called closed reduction, can be performed in children of 6 months to 2 years, under anesthetic. It involves pushing the hip bone back into place and is only an option up until the age of 2.

If closed reduction fails to remedy the problem, open surgery to reposition the hip may be required.

Following either of these techniques, your child will have to wear a cast and/or braces for several months. This ensures that the hip bone remains in the socket while it heals. The use of home traction programs are also common.

Other alternative non-surgical treatments include an exercise program with a physical therapist designed to strengthen, increase the range of motion, control pain and help your child perform functional activities. Chiropractic medicine and the use of closed manipulations may also be helpful (Arthritis-Symptom.com; Zimmer, Inc., 2011).

Cast care instructions:

Ensure that the cast remains dry, clean and intact, i.e. that there are no breaks or cracks in the cast.

Do not insert objects inside the cast to scratch the skin.

Use a hairdryer on a cool setting to blow cool air under the cast and cool down hot, itchy skin. Never blow warm or hot air under the cast.

Avoid putting lotions or powders under the cast.

To prevent spills during feeding, cover the cast during this time.

Ensure that no small toys or objects are placed inside the cast.

To minimize swelling, elevate the cast above the level of the heart.

Do not use the abduction bar on the cast to lift or carry the baby (Lucile Packard Children's Hospital, 2011).

Complications:

If your child is wearing a cast and develops any of the following symptoms, call your doctor immediately:

  • Fever
  • Increased pain
  • Swelling that is evident above or below the cast
  • Drainage or a foul odor coming from the cast
  • A change in colour or temperature of the toes (Lucile Packard Children's Hospital, 2011).
  • If left untreated, the condition can cause;
  • Legs of different lengths
  • A 'duck-like' walk
  • Decreased agility
  • Pain on walking
  • Early osteoarthrirtis (MedicineNet.com).
  • Bracing may cause skin irritation. In some cases, despite appropriate treatment, limb length discrepancies may persist (A.D.A.M., 2011).

Prognosis:

If diagnosed early, treatment for congenital hip dislocation is highly effective, with children going on to have normal hip and leg development. If a diagnosis is only made at a later stage, the prognosis is not as positive. These children may require extensive surgery after which, the chances of having normal development in their hips and legs is good. However, after the age of 8, surgery is merely performed as a means of pain reduction and the need for total hip surgery in later adulthood is inevitable (Advameg, Inc., 2011).