Hip Dislocation

3.  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 ofthe 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
INTRODUCTION

4.  Most common congenital
malformation.
 It occur about 1 in 750 live birth.
 Caused by various degree of
displacement of the femoral head
from the acetabulum.

5. A hip dislocation occurs when the
femoral head--the ball portion of
the hip joint--leaves the pelvic
socket.

6. Dislocation of hip refers to a hip
with no contact between the
articulating surfacesof the hip.
Developmental dysplasia of hip is
a spectrum of disorders related to
abnormal development of hip
that may develop at any time
during fetal life
,infancy orchildhood

7. 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.

8. 1. Acetabulum dysplacia
2. Subluxation
3. Dislocation

9. ACETABULAR DYSPLASIA (OR PRELUXATION) –
 this is the mildest form ofDDH,
 in which there is neithersubluxation nordislocation.
 Due to delay in acetabular development result it is
obliqueand shallow, and allowing the ball of the hip
too much mobility
 The femoral head remains in theacetabulum.

10. Subluxation –
 The femoral head remains in contact with the
acetabulum, butastretched capsuleand ligamentum
teres cause the head of the femur to be partially
displaced. Pressure on the cartilaginous roof inhibits
ossification and producesa flattening of the socket.

11. Dislocation –
 Hip dislocation refers to the state of the
hip when the femoral head is completely
laterally displaced from under the
acetabulum (MP=100%).

12. ETIOLOGY/ RISK FACTOR:-
Exact cause is unknown, butcertain
factors may be rsponsiblesuch as
Family history. If there is a parent,
brotherorsisterwith DDH, then this
makes it five times more likely than
normal for achild to have DDH.

13.  Gender- female baby > malebaby
 Left hip > right hip-
 Oligohydramnios -not able tomove
within the uterus asmuch.
 First born baby-uterus is tighterand
less elastic than futurepregnancies

14.  Breech position-thiscan put the legs in a position
which increases the risk of DDH.

15. INCIDENCE:-
Hip instability-10/1000 live birth
In breech presentation- 30-60 %
Left hip – 60 %
Girls – 60%

16. Hereditary factor
Fetal position
Extra uterine compression
Breech presentation
Neurological disorder

17. PATHOPHYSIOLOGY
Gradual dislocation
Dysplasia
Hip instability
Initial instability thoughtto becaused by maternal and fetal laxity,
genetic laxity, and intrauterine and postnatalmal-positioning

18. CLINICAL MANIFESTATIONS:-
Neonates: positive Ortolani or Barlowsign.

19. Infant:
shortening of the
thigh (The
Galeazzi sign)
Asymmetry of the
gluteal or thigh folds
and positioning of
the hip,

20. Limitation of abduction
in affected hip joint
Klisic test positive.

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

22. Positive
Galeazzi sign
Excessive
Lordosis

23. 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

25. 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.

27. Children 6 months to 2
yearsof 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 12weeks
 abduction orthoticdevice
for 2 months

28. baby wearing a Bock harness
Diagram of Pavlik harness
Diagram of Frejka pillow
Traction

29. ]

33. CHILDREN OLDER THAN 2 YEARS OF
AGE:
Open reduction
shortening osseotomy
to avoid excessive
pressure on theproximal
femur with reduction
acetabular procedure to
adequately cover the
femoralhead.

34. NURSING MANAGEMENT:
1. Acute pain ordiscomfort related toorthopaedicdeviceor
castas evidence bychild iscrying continuous
2. Risk for impaired skin integrityrelated to pressure of thecast
on the skin as evidence by child having rashes and redness
on theskin
3. Altered Physical mobility related to lengthy treatment or
orthopaedicdeviceas evidence bychild is not able to move
4. Diversnal activitydeficient related to hospitalization or
immobility as evidence bychild look boredom
5. impaired bowel pattern related to immobility as evidenceby
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 homecare

35.  Maintain body temperature.
 Maintain skin integrity.
 Promotion of muscle activity.
 Provision of comfort measures
 Prevention of urinary stasis and
constipation.
 Health education.
 Follow up health education.

36. COMPLICATIONS:-
 Avascular necrosis
 Reduced hip function
 Degenerative hipchanges
 Joint malformation
 Inability to reducedislocation
 Results in growth arrest and eventual joint
destruction
 Postoperative complications-wound
infection.

37. BIBLIOGRAPHY
Dutta Parul, “pediatric nursing’’,2nd edition,
New Delhi: jaypee publication,(2009) ,Pp-455
Ghai O.P, “Essential pediatrics’’,6th edition,
New Delhi: CBS Publication,(2004), Pp-601
Kyle Terri, “Essential of pediatric nursing’’,1st
edition , New Delhi : wolter kluwer
publication,(2009) Pp-855 & 856
Siddhartha and Brunner, “medical surgical
nursing”,12th edition , New Delhi: wolter kluwer
publication,(2009) ,Pp- 921 to 925
www.google.com
www.hemophilia slideshare.com

38. Thank
you