Pediatric Nursing Demystified

Acetabular dysplasia (preluxation): The acetabulum is shallow and dish

shaped rather than the normal cup shape, indicating delayed acetabular

development. This is the mildest form of hip dysplasia.

Subluxation: Incomplete dislocation of the femoral head from the

acetabulum. This is the most common form of hip dysplasia.

 Dislocation: The femoral head loses contact with the acetabulum.

This is the most serious form of hip dysplasia.

Signs and Symptoms

Asymmetry of gluteal and thigh folds due to the dislocation

Shortened femur due to the dislocation

Unequal knee lengths when knees are flexed due to the dislocation

Test Results

Positive Ortolani test administered from birth to 4 weeks of age due to

the dislocation

Positive Barlow test due to the dislocation

Limited hip abduction due to the dislocation

Treatment

Newborn to 6 months of age:

• Place the patient in a Pavlik harnessfor 3 to 5 months. Legs are
  flexed and knees fall outward to place the hips in proper alignment.
  Six to 18 months of age:


• Place the patient in a hip spica cast for 2 to 4 months following sur-
  gical realignment of hips. The hip spica cast immobilizes the legs
  and knees and holds the hips in proper alignment.
  Older than 18 months of age:


• An osteotomy might be performed to align the femoral head with
  the hips.

Nursing Intervention

Assess the patient for restricted movement and wide perineum and

unequal gluteal and thigh folds.

Assess the patient for limp or unequal gait.

If the patient is in a Pavlik harness:

• Examine the skin under the harness three times a day for redness and
  skin integrity.


• Don’t apply lotions or powder to the skin.


• Place an undershirt between the skin and the harness.


• Place the diaper under the harness straps.


• Massage the skin once a day to stimulate circulation.

5

(^286) Pediatric Nursing Demystified