Introduction: abnormal position of femoral head outIntroduction: abnormal position of femoral head out

 

Introduction:

Hip joint is a ball-and-socket joint consists of acetabulum and the
head of femur. The head of femur stabilized in the acetabulum by strong and
thick ligaments. But, it might get out of the deep acetabulum causing
dislocation of the hip joint.

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Congenital dislocation of hip, also called developmental dysplasia
of the hip joint is a condition which results from abnormal position of femoral
head out of the acetabulum. This condition occurs before or during birth or
short time after birth. It is one of the commonest deformities of skeletal
system in western races.

This
article will include definition, symptoms, pathophysiology, risk factors, body
chart, subjective findings, behavior of symptoms, aggravating and easing
factors, physical examination findings, differential, diagnosis, treatment
objectives, therapy options and prognosis of congenital hip dislocation.

 

Causes:
In many cases, the cause of this disease is unknown. But there are some factors
that effect on having this condition.

Genetic joint laxity is one of the common causes of this condition. Parents may have
laxity of ligaments so the baby is more likely to have as well. Because of
ligaments laxity the stability of the hip joint will reduce, so dislocation
will occur to the joint.

Hormonal joint laxity, girls are more likely to have this disease than boys due to
ligament-relaxing hormone called “Relaxin” which secreted by fetal uterus as a
response to estrogen and progesterone hormones. This will also lead to
instability of the hip joint causing dislocation.

Breech malposition may also cause congenital hip dislocation due to the extending of
hip joint during delivery.

 

 

 

 

Symptoms:

Symptoms will
present differently from one baby to another, but most common symptoms are:

–      
Leg is shorter on
side of dislocated joint.

–      
Leg is turned
outward on side of dislocated joint.

–      
Uneven folds of
thigh and buttocks.

–      
Wide space between
the two legs.

 

 

Pathophysiology:

In this condition the acetabular
socket is unable to distribute the force equally. That extra force will push
the head of femur out of this socket laterally and upward, this is called
dislocation.

Structures that surround the
acetabulum such as joint capsule and the fibro-cartilaginous labrum will try to
resist the force so that they can avoid dislocation, but the force is strong
enough to cause tear to these structures and that will also cause pain.

 

 

Risk Factors that cause the congenital hip
dislocation:

There are many
factors that may lead to congenital hip dislocation. These factors include:

·   Female gander.

·   First pregnancy of the mother.

·   Twin babies or multiple.

·   Family history of congenital hip
dislocation.

 

 

Diagnosis:

This condition is
diagnosed in two ways, Physical examination and imaging.

Physical
examinations: The doctor or the physiotherapist will gently move the legs of
baby and listen for clicking or clunking sounds which indicate that there is
dislocation in the hip joint. They also use two tests to make sure if there is
dislocation or not.

Ortolani test, move
child’s hip away from the body (abduction) and applies upward force at the same
time.

Barlow test, move
child’s hip cross the body (adduction) and applies downward force at the same
time.

These two tests are
used only before the baby is 3 months ago, after 3 months the child will have
limping, limited abduction and there will be a difference in length of the two
legs.

Imaging tests: Ultra
sound is used to diagnose congenital hip dislocation for babies who are less
than 6 months old. And x-ray is used for older children.

 

 

Treatment:

Treatment of this
condition varies according to patient’s age, two groups will be discussed:

Neonatal cases (within six months of birth), in these cases we have to wait three weeks before we start the treatment.
In some cases the hip joint will stabilize by its own. But, we have to check it
again after five or six months to make sure that the joint is stable. If not,
splinting in abduction position is recommended for at least 6 weeks.

Six months and above, there are many
ways to treat this condition in this age group.

Medical treatment: three methods are
used to treat these patients medically. Pavlik Harness, is one of these methods
when the doctor gently position the hip of the baby in a correct position. This
will develop normal hip over time. Another method used is hip abduction braces,
which is when the doctor use a brace to hold the hip in a correct position,
it’s also called “fixed-abduction braces”. Traction is the other way used to
treat these babies. This method is common in Asia and Europe more than USA.

Physical therapy treatment: physiotherapist has a great roll in
treating babies with congenital hip dislocation by ball catching, target
throwing, kicking, running & jumping, gait and stairs and unleveled
terrain, and ball bouncing. Also they can use sensory activities like Swiss
ball, scooter board and vestibular swing tasks which are very helpful for those
patients.

Surgical treatment: is the last choice for treating babies
with congenital hip dislocation. Surgeries used only when other treatments are
not effective. There are several types of surgeries used for babies with
congenital hip dislocation such as: closed reduction, open reduction, pelvic
osteotomy and femoral osteotomy.

 

 

Complications of
congenital hip dislocation:

Several possible complications may occur before and after treating
this condition including re-dislocation, infection, stiffness of the joint, and
the most common one is Avascular necrosis of the head of femur due to loss of
blood supply to that region.

 

Conclusion:

Overall, congenital hip dislocation is a common
disease in girls who born in the first pregnancy of the mother. These girls
will have abnormal position of the femoral head out of the acetabulum but it is
an easy condition to be treated medically or by physiotherapy and surgeries.