Submitted by Ms.

Meena
(M.Sc. Nursing 2nd Year)
Jamia Hamdard
Congenital dislocation of hip (CDH) is a spontaneous
dislocation of the hip which occurs before, during or
shortly after birth.
 Joint laxity: Generalized joint laxity (looseness of a limb or muscle)
may predispose dislocation of the hip.
 Hormonal joint laxity: CDH is more common in girls. In females, the
fetal uterus secretes a ligament relaxing hormone (called relaxin)
in response to the maternal estrogen and progesterone. The
ligament laxity at the hip may cause dislocation.
 Breech malposition: The dislocation of hip is more common after
breech delivery. Ligamentous laxity again, during breech delivery,
may cause dislocation of the hip.
 Asymmetrical skin folds on the inner aspect of thigh
 Limited abduction of the affected hip.
 Apparent shortening of the femur
 Later signs include protruding abdomen, shortened extremity,
duck-waddle gait, and a positive Trendelenburg sign.
 Barlow’s test: The clinician grasps the upper part of both
thighs with his or her thumb on the hip anteriorly and the
fingers on the buttocks. The hip joints are now adducted
while pressure is exerted on the thumb trying to push the
head of the femur out of the acetabulum. The hip may
dislocate with an audible “clunk”.
Ortolani’s test: The child is held in a similar manner as
described in the Barlow’s test. The hips are steadily abducted
and the middle finger of the examiner applies forward
pressure behind the greater trochanter. A “click” is heard as
the dislocated femoral head slips into the acetabulum.
 Ultrasonography is necessary for girls with a positive
family history or breech presentation in both sexes.(
This should be obtained after 6 weeks of age to avoid
confusion with physiologic laxity. Because the femoral
head begins to ossify at 4 to 6 months of age, plain
radiographs can be misleading until patients are older.)
 A radiograph will confirm the diagnosis. Arthrography
helps to show the outline of the cartilaginous parts of the
joint. An MRI may be equally useful.
Clubfoot or CTEV(Congenital Talipes Equinovarus) is a
deformity in which the entire foot is inverted, the heel is
drawn up, and the forefoot is adducted.
 Primary—idiopathic.
 Secondary—the clubfoot is a part of the systemic disease such as
arthrogryposis multiplex congenita (AMC), muscular dystrophy or
meningocele, etc.
Talipes equinovarus is detected easily in a newborn but must be
differentiated from a persisting “position of comfort” assumed in
utero.
The positional deformity may be corrected easily by the use of
passive exercise, but the true clubfoot deformity is fixed. The
positional deformity should be explained to the parents at once to
prevent anxiety.
 Radiographs of the foot may be done to measure the
talocalcaneal angle which quantifies the deformity,
 Physical examination
 Manipulation and bandaging or by application of a cast.
 Petaling of cast can be performed.
 Lengthening the Achilles tendon
Tenotomy is necessary because the Achilles tendon, unlike the
ligaments of the foot, is made up of thick, non-stretchable fibres.
After the tenotomy the foot is placed in a final cast in an over-
corrected position of maximal abduction and dorsiflexion. The
tendon re-grows in this lengthened position, allowing the range of
motion needed at the ankle joint.
Scoliosis is defined as lateral curvature of the spine Growth of only
one-half of a vertebra (called as hemivertebra) can result into
congenital scoliosis.
 Thebones (vertebrae) in the spine may not form
normally
 One or more bones in the spine may be absent
 Bones may partially form
 Bones may not be separated as they should be
 Localized lordosis
 Axial rotation.
 Lateral curvature of the spine
 Asymmetry of shoulders
 Shortened trunk
 Patches of hair in sacral area
 Unequal leg lengths
 Asymmetric scapulae
 Malalignment of trunk and pelvis
 Asymmetry of flanks
 Asymmetry of breasts
 Forward bending test, or Adam’s position—to assess
inequality of flank and ribs (screening test)
 Cobb diagnostic method—to assess angle of curvature
on radiographic studies
 Anteroposterior and lateral radiographic studies of
spine—to evaluate curvature of spine
 Three-dimensional computed tomography—to assess
for axial rotation of the spine
 Magnetic resonance imaging—to assess for intraspinal
pathology
Polydactyly and syndactyly are congenital malformations of the
fingers and/or toes. Polydactyly is the presence of extra fingers or
toes, and syndactyly is the fusing together or webbing of two or
more fingers or toes.
 Genetic factors
 Both polydactyly and syndactyly can be caused by the presence
of an autosomal dominant trait. An autosomal dominant trait is a
gene that is not related to the chromosome that determines
gender
The primary symptom of polydactyly is the presence of extra
digits on the hands or feet. Polydactyly rarely causes any
difficulties for the child. The extra fingers and/or toes are usually
removed for cosmetic reasons.
 In children with syndactyly of the hand, finger function may be
impaired and, in cases where fingers of different lengths are
connected by tissue, finger growth may be limited unless surgery
to separate the fingers is performed.
For children with minor cases of polydactyly, the extra finger or toe
may be tied at its base to restrict blood flow into it. Eventually the
extra digit will fall off.
In more significant cases, a pediatric orthopedic surgeon will
remove the extra finger or toe and reconstruct the part of the hand
or foot that was affected. The surgeon will save the digit that best fits
with the others. This surgery usually occurs when the child is
between one and two years old
  NURSING DIAGNOSIS
 Knowledge Deficient
 Anxiety
 Risk for injury
 Impaired physical Mobility,
 Risk for Fluid volume, deficient
 Risk for Peripheral neurovascular dysfuntion,
 Ineffective Therapeutic regimen management,
 Body image, Disturbed
1. Prepare child or adolescent and family before preoperative and
operative procedures for sequence of events and sensations that will
be experienced.
2. Prepare child or adolescent for surgery
3. Orient child or adolescent to intensive care unit and treatment
procedures used postoperatively (e.g., blow gloves and spirometer).
1. Monitor for signs and symptoms of potential complications.
a. Monitor arterial lines.
b. Monitor temperature, respirations, blood pressure, and pulse
every 1 to 2 hours until stable, and then every 4 hours.
c. Auscultate breath sounds; report changes in respiratory status
(increased respirations, increased congestion, color change, chest
pain, dyspnea). ; fluid overload—increased apical pulse,
d. Monitor for spinal nerve trauma—observe lower extremities for
warmth, sensation, movement, pulses, and pain.
e. Monitor for paralytic ileus—auscultate bowel sounds.
f. Monitor dressing for intactness and signs of complications.
i. Note bleeding along incision.
ii. Monitor for signs of infection.

2. Promote proper body alignment.

a. Turn child or adolescent every 2 hours (log roll only).
b. Monitor for reddened areas and pressure.
c. Institute passive range of motion exercises on second
postoperative day
3. Promote pulmonary ventilation.
a. Monitor vital signs as often as every 2 hours.
b. Have child or adolescent cough, turn, and deep breathe as often
as every 2 hours.
c. Use incentive spirometer every 2 hours.
d. Monitor respiratory status every 2 hours until stable, and then
every 4 hours.
4. Monitor fluid and electrolyte balance.
a. Monitor and record intake and output—intravenous fluids, urine,
nasogastric drainage.
b. Monitor bowel sounds.
c. Advance diet as tolerated (clear liquid to regular diet).
d. Monitor for signs and symptoms of dehydration and fluid
overload: dehydration—decreased urinary output, increased
specific gravity, doughy skin, dry mucous membranes increased
respiratory rate, pulmonary congestion, dyspnea, edema initially of
extremities.
 5. Provide pain relief measures as necessary
a. Medicate routinely every 2 to 4 hours for first 72 hours.
b. Medicate before procedures.
c. Provide diversional activities and relaxation techniques
THANK YOU