Congenital hip dysplasia

Definition: 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. Known as congenital hip dislocation Is a disorder in children that is either present at birth or shortly thereafter. is an abnormal formation of the hip joint in which the ball on top of the thighbone (femur) is not held firmly in the socket

Causes and symptoms Hormonal changes within the mother during pregnancy result in increased ligament looseness or laxity and are thought to possibly cross over the placenta and cause the baby to have lax ligaments while still in the womb. Other symptoms of complete dislocation include a shortening of the leg and limited ability to abduct the leg, or move it outward.

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.

Diagnostics

Physical Assessment - moving the hip to determine if the head of the femur is moving in and out of the hip joint. Ortolani test- examiner's hands around the infant's knees, with the second and third fingers pointing down the child's thigh. abducted (moved apart), hip click- the examiner may be able to hear a distinct clicking sound, Barlow method-the infant's hip brought together with knees in full bent position. The examiner's middle finger is placed over the outside of the hipbone while the thumb is placed on the inner side of the knee. The hip is abducted to where it can be felt if the hip is sliding out and then back in the joint. In older babies, if there is a lack of range of motion in one hip or even both hips, it is possible that the movement is blocked because the hip has dislocated and the muscles have contracted in that position.. 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 treatment.

Medical management - pavlik harness used in infants up to the age of six months to spread the legs apart and force the head of the femur into the acetabulum. - closed reduction - Reduction of a fractured bone by manipulation without incision into the skin. - open reduction - a surgical procedure for reducing a fracture or dislocation by exposing the skeletal parts involved.

Nursing management

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 For patients who have splints, remind parents to maintain good diaper area care: change diapers frequently and wash area and apply an ointment. For older patients encourage a balanced diet, foods that promote healings uch as protein rich foods and as well as vit c rich foods 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

Pathophysiology Breech Presentation ` Family History Firstborn

Hormonal change

Ligament relaxing hormone increased ligament looseness or laxity

Cross over the placenta

Joint laxity

Congenital hip dislocation

MEDICATION

Analgesics Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who have sustained trauma or who have sustained injuries.

Assessment Diagnosis Subjective: Objective: Pmobilization QR- back S- 8\10 T- 2 mins. * Muscle guarding

S. Explanation Planning

Intervention

Rationale -

evaluation

Acute pain r/t Bone dislocation SHORT TERM: * Monitor VS especially PR and bone Inflammatory After 8 hours f temp. dislocation process nursing *assess site of pain seondary to Release of intervention the Conduct comfort congenita hip chemical patient will be measures such as dysplasia as mediators such as able to: turning, cold and warm evidenced y substance P, a.) relieve pain compress pain scale of bradykinin etc. temporarily Encourage DBE and 8\10 Increase tissue b.) verbalize 2 diversional activities permeability understanding COLLABORATIVE Swelling/edema regarding the Administer analgesics case. as prescribed DISCHARGE OUTCOME: Upon discharge the patient will be able to: a.) Report absence of pain.

it is affected SHORT TERM: when felt After 8 hours f Determine nursing which side is intervention the affected patient was able to facilitate no to: pharmacological a.) relieved pain Intervention temporarily to divert anxiety b.) verbalized 2 to provide understanding immediate pain regarding the relief case. DISCHARGE OUTCOME: Upon discharge the patient will be able to: a.) Report absence of pain.

Assessment Subjective :

Diagnosis

s. Explanation

Planning SHORT TERM: After 8 hours of nursing intervention the patient will be able to:

Intervention Assess the capacity of the patient to move Encourage ROM increase calcium intake

Rationale -to determine intervention - For strengthening muscles - To promote bone growth. - To rehabilitate movement

evaluation SHORT TERM: After 8 hours of nursing intervention the patient will be able to: a.) verbalized 2 understanding regarding the case b.) demonstrate d minimal activities that promotes mobilization DISCHARGE OUTCOME: Upon discharge

Impaired physical Objectives: mobility r/t - (+) ortolani dislocation of test the acetebullum - (+) secondary to barlows congenital hip test dysplasia - Limited movements - uneven legs motor strength of 3/5

a.) verbalize 2 understanding COLLABORATIVE: regarding the case * Refer to a physical b.) demonstrate therapist minimal activities that promotes mobilization DISCHARGE OUTCOME: Upon discharge

the patient will be able to: a.) return to ADL.

the patient will be able to: a.) returned to ADL.