Dysplasia of the hip
Dysplasia of the hip is the abnormal placement of the head of the femur in the hip socket.
It can occur in utero or in childhood.
What are the signs of dysplasia of the hip in an infant?
- shortening of the limb on the affected side
- unequal gluteal folds
- positive Ortolani's test
What is Ortolani's test (maneuver)?
Ortolani's test (maneuver) checks for hip dysplasia by rotating the thighs.
If a "click" sound is heard, it indicates a dislocated femoral head.
How is hip dysplasia treated in an infant?
Child wears a Pavlik harness continuously for 3 - 6 months to stabilize the hip.
What is the last resort treatment for hip dysplasia?
Hip surgery to realign the femoral head (closed or open reduction).
Child will have a spica cast and then an abduction brace for up to 6 months.
Congenital clubfoot is a deformity of the ankle and foot.
Congenital clubfoot is treated by manipulating the foot and putting a cast on it for about 8 - 12 weeks. Then a splint is applied.
What is the last resort treatment for congenital clubfoot?
Surgery to realign the bones and tendons if improvement is not seen by 6 - 12 weeks of age.
What are the general interventions for a child in a cast or brace?
Neurovascular checks - The 5 P's:
If the child is having these symptoms with a musculoskeletal injury or procedure, intervene right away.
Scoliosis is a spinal deformity that is usually diagnosed during the preadolescent growth spurt.
- If deformity is minor client will wear a brace
- if deformity is severe, client will get a spinal fusion surgery
What are the psychological concerns with scoliosis?
Scoliosis occurs during the preadolescent years, which puts the child at risk of social isolation and feelings of fear and anger.
Use therapeutic communication to help child cope.
Juvenile arthritis is an autoimmune disorder where the joints become inflamed.
It's more common in girls and there is no cure.
There is no cure for juvenile arthritis so interventions focus on preserving joint function and controlling inflammation:
- PT and OT
- DMARDs: disease-modifying antirheumatic drugs to decrease inflammation
What is the priority concern if an infant has a fracture?
Infants rarely get fractures, so it is a priority to rule out abuse.
What are the steps if a child gets a fracture?