CONGENITAL

HIP DISLOCATION

CACHUELA, CHEYEANNE U.
SAGADRACA, CATHERINE N.
CONGENITAL HIP DISLOCATION
Often referred to
as "congenital
hip dysplasia"

Is an improper formation and function of the hip socket. It may be evident as subluxation or
dislocation of the head of the femur
Congenital defect caused by shallow acetabulum, resulting in partial or complete
displacement of head of femur; often bilateral
Present at birth but NOT always diagnosed immediately
Most common congenital malformation
ANATOMY...
PATHOPHYSIOLOGY
 CHD...
Etiology: UNKNOWN
Incidence: more common in
girls and associated with spina
bifida
SIGNS AND SYMPTOMS
Earliest sign: "CLICKING" sound
Legs of different lengths
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
 DIAGNOSTIC TEST
BARLOW'S TEST
- hip is flexed, then thigh adducted while pushing
posteriorly in line of shaft of femur; positive sign if the
femoral head dislocate posteriorly from the acetabulum

ORTOLANI'S CLICK TEST

- with infant supine, flex hips and knees to 90
degree (examiner’s palms at knees while fingers at hip
joint) then gently abduct (bringing the femoral head from
its dislocated posterior position into the acetabulum, thus
reducing the femoral head); a positive sign is when there is
a palpable or audible clunk or pop as hip reduces
TRENDELENBURG TEST
- use if child is old enough to walk; ask child to stand unassisted on each leg in turn;
positive sign is when standing on one leg, the pelvis drops on the opposite side
SURGICAL MANAGEMENT
Hip replacement (hip arthroplasty)
the damaged bone and cartilage is
removed and replaced with prosthetic
components

The spica cast is hard and made of

fiberglass, covering the child's body from
the chest to the legs. Babies with
developmental hip dysplasia typically wear
a spica cast for three months.
M A N A G E M E N T (aimed to keep the bone in the socket and
stimulate normal hip development):

Double or triple diapering can be sufficient to maintain

abduction in the newborn
Soft positioning devices, like Pavlik harness will keep
the bone in the socket
Hip spica cast applied to maintain
abduction in older infant; brace
or splint may also be used
If unsuccessful, surgery maybe
advised
A. Frejka splint is made of plastic and
buckles onto the child like a huge confining
diaper

B. Pavlik Harness is an adjustable chest

halter that abducts the legs

C. Spica Cast If a hip is fully dislocated or the

subluxation is severe, the infant may be placed
immediately in a frog- leg cast or a spica cast to
maintain an externally rotated hip position.
 NURSING MANAGEMENT
1. Placing rolled cotton diapers or a pillow between the thighs,
thereby keeping the knees in a frog like position
2. ROM exercise to unaffected tissue
3. Immobilization of hips in less than 60-degrees abduction per
hip
4. Meticulous skin care around the immobilized tissues
5. For patients who have splints, remind parents to maintain
good diaper area care
6. 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
 NURSING MANAGEMENT
7. Maintain proper positioning and alignment to limit further
injury

8. Accompanying soft tissue injuries are treated by RICE

therapy:
P-protect
R-rest
I-ice
C-compression bandage
E-elevation with or without immobilization

9. Stimulation of affected area by isometric and isotonic

exercises also helps promote healing
 CONGENITAL
HIP DISLOCATION

THANK YOU
CACHUELA, CHEYEANNE U.
SAGADRACA, CATHERINE N.