HIP DISLOCATION, CONGENITAL

General Information

DEFINITION--A disorder in which the head of the thigh bone doesn't fit properly into, or is outside of, the hip socket.

BODY PARTS INVOLVED--One or both hip joints.

SEX OR AGE MOST AFFECTED--About 1 of every 60 newborns has a possible hip dislocation. About 85% are girls.

SIGNS & SYMPTOMS--The earliest symptom may be a clicking sound in a newborn when the legs are pulled apart. However, this symptom is not always present. After the newborn period, partial dislocation may become full dislocation. Then the thigh bone (femur) rides up behind or to the side of its hip socket. The limb will appear shorter than its mate. Skin folds of the buttocks will not be symmetrical; the side with the dislocated hip will have more creases than the other. When the child is old enough to walk, he or she may limp or favor one side.

CAUSES--Unknown. Congenital hip dislocations seem more common after breech deliveries than following head-first or Cesarean deliveries. Theories about the reasons include: hormonal changes in the mother during pregnancy; abnormal fetal position in the uterus; or birth injury.

RISK INCREASES WITH

• Family history of hip dislocation.
• Breech birth.
• Position of unborn child in the uterus (possibly).

HOW TO PREVENT--Cannot be prevented at present.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• Ultrasound (See Glossary) and/or x-rays of the hip.

APPROPRIATE HEALTH CARE

• Home care after diagnosis.
• Doctor's treatment.
• Surgery (rare).

POSSIBLE COMPLICATIONS--Late detection and treatment can lead to permanent crippling.

PROBABLE OUTCOME--If congenital hip dislocation is detected early, it can often be cured. Surgery is used only when conservative treatment fails or the disorder has not been discovered until late in childhood.

How To Treat

GENERAL MEASURES--

• To correct the dislocation, the head of the thigh bone must be returned to its socket in the pelvic bone and held firmly in place. For mild forms, use triple diapers to immobilize the child and arrange for frequent medical exams. For more severe forms, splints, casts or traction are used to immobilize the ball and socket until it heals. Plaster casts may be necessary for several months. They must be replaced every 1-1/2 to 2 months.
• While an infant or young child is immobilized, he or she will require more physical care than normal. Soiled diapers, especially, should not be left on the child for any length of time.
• During the first few days that the child is in a cast, splints, or traction, stay as close by as possible to give reassurance and love.
• Remove braces or splints for bathing but replace them immediately afterward.
• Turn the child in bed at least every 2 hours during the day and every 4 hours at night.

MEDICATION--Medicine usually is not necessary for this disorder.

ACTIVITY--

• If traction is required, the child must stay in bed until the dislocation is corrected.
• If a cast or splints are used and the child's condition allows it, put the child on the floor for short play periods--either alone or with other children. Car rides are acceptable.

DIET--No special diet.

Call Your Doctor If

• Your child has signs of a congenital hip dislocation.
• The following occurs during treatment: Rectal temperature rises to 101F (38.3C) or higher, which may indicate infection of the skin or urinary tract. The cast, bar or other immobilization device does not seem to hold the hip in position. A dent appears in the cast, which might cause a pressure sore. The child shows signs of severe pain. Color or mobility of the child's legs and feet change. The child loses appetite.