HIP DISLOCATION, CONGENITAL
DESCRIPTIONCongenital hip dislocation is a disorder in which the head of the thigh bone doesn't fit properly into, or is outside of, the hip socket. One or both hip joints may be involved. Congenital hip dislocations are present at birth. About 1 in every 60 newborns has a possible hip dislocation. About 85% are girls.
Appropriate health care includes:
Home care after diagnosis.
Physician's monitoring of general condition and medications.
SIGNS & SYMPTOMSThe 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.
A child old enough to walk may limp or favor one side.
Unknown. Congenital hip dislocations seem more common after breech deliveries than after 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.
PREVENTING COMPLICATIONS OR RECURRENCECannot be prevented at present.
MEDICAL TESTSYour own observation of symptoms; medical history and physical exam by a doctor; X-rays of the hip.
POSSIBLE COMPLICATIONSLate detection and treatment can lead to permanent crippling.
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.
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. See Care of Casts, Appendix 41.
While an infant or young child is immobilized, the child 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 your 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.
Medicine usually is not necessary for this disorder.
ACTIVITYIf traction is required, your child must stay in bed until the dislocation is corrected. The child may read or watch TV.
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 & FLUIDS
No special diet.
OK TO GO TO SCHOOL?Yes. Try to keep activity as normal as possible.
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 child's 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.