INTRODUCTION

In a normal hip,the head of

the femur and the
acetabulum are in close
contact,
When abnormality either in
the shape of the head of the
femur, the shape of the
acetabulum, or the
supporting structures
around them. As a result,
the acetabulum and femur
are not in close contact
result hip dis location
DEFINITION:
Dislocation of hip refers to a hip with no contact
between the articulating surfaces of the hip.

Developmental dysplasia of hip (DDH) is a

spectrum of disorders related to abnormal
development of hip that may develop at any
time during fetal life
,infancy or childhood
CLASSIFICATION OF DDH
Typical DDH: - occurs in otherwise normal
individuals or those without define syndromes or
genetic conditions. Its risk factor such as
oligohydramnios, breech presentation
Teratologic hip dislocation: usually have identifiable
causes and occur before birth. It involves a
neuromuscular defect such as arthrogryposis or
myelodysplasia. The teratologic forms usually occur in
utero and are much less common.
THREE DEGREE OF DDH
•Acetabular dysplasia (or preluxation) –
•Subluxation
•dislocation
ACETABULAR DYSPLASIA (OR PRELUXATION) –
this is the mildest form of DDH,
in which there is neither subluxation nor dislocation.
Due to delay in acetabular development result it is
oblique and shallow, and allowing the ball of the hip
too much mobility
The femoral head remains in the acetabulum.
Subluxation –
The femoral head remains in contact with the
acetabulum, but a stretched capsule and ligamentum
teres cause the head of the femur to be partially
displaced. Pressure on the cartilaginous roof inhibits
ossification and produces a flattening of the socket.
Dislocation –
Hip dislocation refers to the state of the hip when the
femoral head is completely laterally displaced from
under the acetabulum (MP=100%).
ETIOLOGY/ RISK FACTOR:-
Exact cause is unknown, but certain
factors may be rsponsible such as
Family history. If there is a parent,
brother or sister with DDH, then this
makes it five times more likely than
normal for a child to have DDH.
Gender- female baby > male baby
Left hip > right hip -
Oligohydramnios -not able to move
within the uterus as much.
First born baby-uterus is tighter and
less elastic than future pregnancies
Breech position-this can put the legs in a position
which increases the risk of DDH.
CONGENITAL MALFORMATIONS

 Congenital torticollis

 Metatarsus adductus

 Chromosomal abnormalities

 Neuromuscular disorders
POSTNATAL POSITIONING
hips in extension and adduction (e.g. papoose. parent
carrying baby on their hip) increases risk
INCIDENCE:-
Hip instability-10/1000 live birth
In breech presentation- 30-60 %
Left hip – 60 %
Girls – 60%
 PATHOPHYSIOLOGY
Initial instability thought to be caused by maternal and fetal laxity,
genetic laxity, and intrauterine and postnatal mal-positioning

Hip instability

Dysplasia

Gradual dislocation
CLINICAL MANIFESTATIONS:-
Neonates: positive Ortolani or Barlow sign.
Infant:

shortening of the thigh

(The Galeazzi sign)

Asymmetry of the gluteal or

thigh folds and positioning of
the hip,
Limitation of abduction
in affected hip joint

Klisic test positive.

The walking child:
Limp, a waddling gait, or leg length
differance.
affected side appears shorter than
normal extremity
toe-walk on the affected side.
Trendlenberg sign is positive
Positive Galeazzi
sign

Excessive Lordosis
DIAGNOSTIC EVALUATION:

A. History
B. Physical examination -
Barlow test
Ortolani test
Positive Galeazzi sign (allis
sign)
Klisic test
Trendelenburg's sign
C. Ultrasonography
D. Radiography
 MANAGEMENT
0-6 MONTHS:
Pavlik harness for 6 weeks
By maintain Ortoloni positive hip, It prevents hip extension and
adduction and permits flexion and abduction.
Children 6 months to 2 years of
age:
goals in the treatment of the late-
diagnosed patient are to obtain
and maintain reduction of the
hip without damaging the
femoral head.
Closed or open reduction(some
time before C.R. use skin
traction)
The reduction is maintained in
plaster cast for 12 weeks
abduction orthotic device for 2
months
CHILDREN OLDER THAN 2
YEARS OF AGE:
Open reduction
 shortening osseotomy to avoid
excessive pressure on the proximal
femur with reduction
 acetabular procedure to
adequately cover the femoral head.
COMPLICATIONS:-
Avascular necrosis
Reduced hip function
Degenerative hip changes
Joint malformation
Inability to reduce dislocation
Results in growth arrest and eventual joint destruction
Postoperative complications-wound infection.
 NURSING MANAGEMENT:
1. Acute pain or discomfort related to orthopaedic device or
cast as evidence by child is crying continuous
2. Risk for impaired skin integrity related to pressure of the cast
on the skin as evidence by child having rashes and redness
on the skin
3. Altered Physical mobility related to lengthy treatment or
orthopaedic device as evidence by child is not able to move
4. Diversnal activity deficient related to hospitalization or
immobility as evidence by child look boredom
5. impaired bowel pattern related to immobility as evidence by
decrease frequency of passing stool and hypoactive bowel
sound
6. Knowledge Deficit of family caregiver related to home care of
child in the orthopaedic device or cast as evidence by parents
asking many questions regarding home care