Musculoskeletal congenital Disorders 2
Terms in this set (18)
What is developmental dysplasia of the hip (DDH)??
a broad term that is used to describe a variety of disorders resulting in abnormal development of the hip structures.
When is DDH identified??
DDH may be identified during prenatal or postnatal periods or early in childhood.
What are the risk factors of DDH??
may be affected by family history, gender, birth order, intrauterine position, and/ or laxity of a joint.
Predisposing factors include intrauterine placement, mechanical situations (size of infant, multiple births, breech presentation), and genetic factors.
What are the s/s of DDH??
Asymmetrical gluteal and thigh folds
Limited abduction of hips
One knee that appears shorter when the infant is supine with thighs flexed at 90° towards the abdomen (Allis sign)
For infants from birth to 3 months of age, the provider performs the Barlow and Ortolani tests. The hips are taken through adduction (the thighs are brought
towards the midline) and abduction, and an audible click or clunk is heard as the head of the femur on the affected hip can be moved from the socket (Barlow test) and then reduced back into the socket (Ortolani test) by manipulation of the joint.
For children able to walk, observe postural gait.
Abnormal downward tilting of pelvis on the unaffected side when bearing weight on the affected side (Trendelenburg sign)
Waddling gait or abnormal lordosis of spine if bilateral dislocation
What is allis sign??
One knee that appears shorter when the infant is supine with thighs flexed at 90° towards the abdomen
What is the trendelenburg sign??
Abnormal downward tilting of pelvis on the unaffected side when bearing weight on the affected side
What are the diagnostic procedures of DDH??
Ultrasound - An ultrasound should be performed at 2 weeks of age to determine the cartilaginous head of the femur.
X-ray - An x-ray can diagnose DDH in infants older than 4 months of age.
What is a pavlik harness??
It is a noninvasive device for keeping hips in a continually abducted position, which allows for the femoral head to remain in contact with the acetabulum.
What age does the child have to be to use a pavlik harness??
can be used from birth up to 5 or 6 months of age.
How long does the child where the harness for??
The infant will wear the harness continuously for 3 to 5 months, until the hip is determined, by radiograph, to be stable. Frequent follow-up will be needed for strap adjustment.
What are the nursing actions for the pavlik harness??
Perform frequent assessment of skin integrity.
Ensure proper positioning at all times.
Assess the familyfs ability to adjust the harness.
What are the client education for the harness??
Instruct the family to keep the harness on continuously, except during bathing, if prescribed.
Instruct the family to return for follow-up visits weekly at the start of therapy and then as needed.
Teach and reinforce skin care. Encourage application of a cotton shirt and cotton socks under the harness to prevent irritation and the avoidance of powders and lotions.
What is a hip spica cast??
Is a cast made out of fiberglass for pt with DDH.
What age can the hip spica cast be used for??
can be used for infants older than 6 months of age. It can also be used in children whose hips were not stabilized by use of the Pavlik harness.
What is sometimes used prior to the application of a hip spica cast??
A short course of traction.
What are the nursing actions for the hip spica cast??
Assess and maintain the hip spica cast.
Perform frequent neurovascular checks.
Perform range of motion with the unaffected extremities.
Perform frequent assessment of skin integrity, especially in the diaper area.
Assess for pain control using an age-appropriate pain tool. Intervene as
Evaluate hydration status frequently.
Assess elimination status daily.
What are the client education for the hip spica cast??
Reinforce teaching regarding positioning, turning, neurovascular assessments, and care of the cast.
-Position casts on pillows.
-Keep the casts elevated until dry.
-Encourage frequent position changes to allow for drying.
-Handle the casts with the palm of the hand until dry.
Note color and temperature of toes on casted extremity.
Give sponge baths to avoid wetting the cast.
Use a waterproof barrier around the genital opening of spica cast to prevent soiling with urine or feces.
Educate regarding care after discharge with emphasis on using appropriate equipment (stroller, wagon, car seat) for maintaining mobility.
What are the complications of ddh??
Postoperative complications (atelectasis, ileus, wound infection)
Effects of immobilization (decreased muscle strength, bone demineralization, decreased metabolic rate, altered bowel motility).
Effects of casting or bracing (skin breakdown, neurovascular alterations).