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DevelopmentalDysplasiaoftheHip (DDH) I

This document describes Developmental Dysplasia of the Hip (DDH), which reflects abnormalities in hip development including shallow sockets and hip dislocations or subluxations. It affects 10 in 1000 births, most commonly white females on the left hip. DDH ranges from mild acetabular dysplasia to complete dislocation of the femoral head. Prenatal risk factors include maternal hormones and fetal positioning. Early diagnosis before age 2 months is best, using tests like the Ortolani click or gait analysis. Treatment depends on age, starting with harness devices and progressing to casting or surgery if untreated past age 6. Nursing care focuses on skin care, cast care, education, and developmental activities.

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63 views2 pages

DevelopmentalDysplasiaoftheHip (DDH) I

This document describes Developmental Dysplasia of the Hip (DDH), which reflects abnormalities in hip development including shallow sockets and hip dislocations or subluxations. It affects 10 in 1000 births, most commonly white females on the left hip. DDH ranges from mild acetabular dysplasia to complete dislocation of the femoral head. Prenatal risk factors include maternal hormones and fetal positioning. Early diagnosis before age 2 months is best, using tests like the Ortolani click or gait analysis. Treatment depends on age, starting with harness devices and progressing to casting or surgery if untreated past age 6. Nursing care focuses on skin care, cast care, education, and developmental activities.

Uploaded by

api-3822433
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Developmental Dysplasia of the Hip (DDH)

I. General
Describes a group of disorders related to abnormal development of the hip.
Reflects a variety of hip abnormalities including shallow Acetabulum, subluxation, or dislocation
10 out of every 1000 births have hip problems
60% of the time the left hip, 20% of the time the right hip, 20% of the time both hips, and mostly white
females.

II. Degrees of DDH


Acetabular Dysplasia (Preluxation)- delay in development of acetabelum, roof not well developed
o Mildest form, no subluxation or dislocation
Subluxation
o Most common
o Implies an incomplete dislocation of the hip
o Femoral head remains in contact with acetabulum- puts pressure on ligaments
Complete dislocation
o Femoral head has lost all contact with acetabulum and is displaced posteriorly & superiorly over
the fibrocartilaginous rim
shortening of tendons so pulled away

III. Prenatal Factors


Maternal hormone secretion
o Estrogen produces laxity of maternal pelvis at end of pregnancy and also affects fetal joints
Mechanical factors of intrauterine posture
o Higher incidence with Breech presentations and C-sections
o Twins
o Large infants

IV. Diagnostics
The earlier diagnosis occurs – the better
Best to diagnosis and begin treatment prior to 2 months of age
As a newborn is appears as a lax hip joint
Hip should be examined regularly until child begins to walk and normal gat is observed
X-rays usually not done in infants less than 4 months old due to bone not being completely hard

V. Diagnosis
Asymmetry of Gluteal and thigh folds
Limited hip abduction, as seen in flexion
Apparent shortening of the femur, as indicated by the knees in flexion
Ortolani click – if infant is less than 4 weeks of age, only special trained nurses do this
Positive trendelenburg sign or gait if child is weight bearing
Waddling gait
Lordosis- trying to compensate; box on 1224

VI. Therapeutic Management


Newborn to 6 months
o Pavlik harness – worn 24 hours a day for 3-6 months; maintains abduction; parent teaching ( no
removal, no baths)
6-18 months
o Gradual reduction by traction followed by cast immobilization
may be put in spica cast- teach to change diaper, special carseat, if notice smell or hotspot go to dr
to check for skin breakdown
Older child
o Difficult to manage since secondary adaptive changes complicate the condition
o Open reduction required with casting and rehab
o IF NOT TREATED BY AGE 6 AY BE UNREVERSIBLE WITHOUT MAJOR SURGERY

VII. Nursing Care


Assessment observation
Teaching
o Skin care
o Cast care
o How to apply and maintain the device
o Toy selection- need to be developmental
o Age/Developmentally appropriate activities
o Transport of the child

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