Congenital Dislocation of the Hip

  1. General information
    1. Displacement of the head of the femur from the acetabulum; present at birth, although not always diagnosed immediately
    2. One of the most common congenital malformations; incidence is 1 in 500-1000 live births
    3. Familial disorder, more common in girls; may be associated with spina bifida
    4. Cause unknown; may be fetal position in utero (breech delivery), genetic predisposition, or laxity of ligaments
    5. The acetabulum is shallow and the head of the femur cartilaginous at birth, contributing to the dislodgment.
  2. Medical management
    1. Goal is to enlarge and deepen socket by pressure.
    2. The earlier treatment is initiated, the shorter and less traumatic it will be.
    3. Early treatment consists of positioning the hip in abduction with the head of the femur in the acetabulum and maintaining it in position for several months.
    4. If these measures are unsuccessful, traction and casting (hip spica) or surgery may be successful.
  3. Assessment findings
    1. May be unilateral or bilateral, partial or complete
    2. Limitation of abduction (cannot spread legs to change diaper)
    3. Ortolani's click (should only be performed by an experienced practitioner)
      1. With infant in supine position (on the back), bend knees and place thumbs on bent knees, fingers at hip joint.
      2. Bring femurs 90° to hip, then abduct.
      3. With dislocation there is a palpable click where the head of the femur snaps over edge of acetabulum.
    4. Barlow's test
      1. With infant on back, bend knees.
      2. Affected knee will be lower because the head of the femur dislocates towards bed by gravity (referred to as telescoping of limb).
    5. Additional skin folds with knees bent, from telescoping
    6. When lying on abdomen, buttocks of affected side will be flatter because head of femur falls toward bed from gravity
    7. Trendelenburg test (used if child is old enough to walk)
      1. Have child stand on affected leg only.
      2. Pelvis will dip on normal side as child attempts to stay erect.
  4. Nursing interventions
    1. Maintain proper positioning: keep legs abducted.
      1. Use triple diapering.
      2. Use Frejka pillow splint (jumperlike suit to keep legs abducted).
      3. Place infant on abdomen with legs in "frog" position.
      4. Use immobilization devices (splints, casts, braces).
    2. Provide adequate nutrition; adapt feeding position as needed for immobilization device.
    3. Provide sensory stimulation; adapt to immobilization device and positioning.
    4. Provide client teaching and discharge planning concerning
      1. Application and care of immobilization devices
      2. Modification of child care using immobilization devices.