Question

Create a 15 slide PowerPoint presentation of the pediatric condition you selected. Ensure that your presentation addresses: Developmental dysplasia of the hip

1. Description and etiology  of the condition
2. Epidemiology for the condition
3. Pathophysiology
4. Clinical Manifestation
5. Diagnostic evaluation
6. Therapeutic Management: Be sure to address medication as well as surgical and non-surgical management if applicable
7. Care Management to include nursing intervention

The presentation should have a title slide and a reference slide. They are not included in the slide count.

Answer 1

1) Ans) Developmental dysplasia of the hip (DDH) is a condition where the "ball and socket" joint of the hip does not properly form in babies and young children. It's sometimes called congenital hip dislocation or hip dysplasia. The hip joint attaches the thigh bone (femur) to the pelvis.

Description:

the term DDH is used in referring to patients who are born with dislocation or instability of the hip, which may then result in hip dysplasia. More broadly, DDH may be defined simply as abnormal growth of the hip. Abnormal development of the hip includes the osseous structures, such as the acetabulum and the proximal femur, as well as the labrum, capsule, and other soft tissues. This condition may occur at any time, from conception to skeletal maturity. The author prefers to use the term hip dysplasia, considering it both simpler and more accurate. Internationally, this disorder is still referred to as congenital dislocation of the hip.

cause of DDH:

The exact cause of DDH is unknown, but it’s considered to be a "multifactorial trait," meaning there are many factors involved. The risk of developmental hip dysplasia is higher for:

children with a positive family history of DDH in a first-degree relative

females, who have looser ligaments than males

first-born babies, whose fit in the uterus is tighter than in later babies

breech babies, whose constrained position tends to strain the joint’s ligaments

Pathophysiology of developmental dysplasia of the hip (DDH):

DDH involves abnormal growth of the hip. Ligamentous laxity is also believed to be associated with hip dysplasia, though this association is less clear. DDH is not part of the classic description of disorders that are associated with significant ligamentous laxity, such as Ehlers-Danlos syndrome or Marfan syndrome.

Children often have ligamentous laxity at birth, yet their hips are not usually unstable; in fact, it takes a great deal of effort to dislocate a child's hip. Therefore, more than just ligamentous laxity may be required to result in DDH. At birth, white children tend to have a shallow acetabulum. this may provide a susceptible period in which abnormal positioning or a brief period of ligamentous laxity may result in hip instability.

symptoms of developmental dysplasia of the hip (DDH):

Common symptoms of developmental dysplasia of the hip (DDH) may include:

The leg on the side of the dislocated hip may appear shorter.

The leg on the side of the dislocated hip may turn outward.

The folds in the skin of the thigh or buttocks may appear uneven.

The space between the legs may look wider than normal.

developmental dysplasia of the hip diagnostic test:

The first step to treating developmental dysplasia of the hip (DDH) is to form a complete and accurate diagnosis. The doctor will take your child’s history, including the position of the baby during pregnancy and the family history, including any hip problems.

The doctor will also do a physical assessment and can often feel the ball popping in and out of the socket. The assessment may include diagnostic tests to get detailed images of your child’s hip joint, including an ultrasound of the hip or an x-ray.

Typical assessment can include:

Ultrasound (sonogram): Ultrasound is the preferred way to diagnose hip dysplasia in babies up to 6 months of age. It uses high-frequency sound waves to create pictures of the femoral head (ball) and the acetabulum (socket).

X-ray: After a child is 6 months of age, x-rays are the more reliable test for the child, because additional bone forming into the head of the femur interferes with the accuracy of the ultrasound imaging. X-rays are also used to diagnose hip dysplasia in older children, adolescents and adults.

DDH non-surgical treatment

Hip dysplasia ranges from a mild abnormality of the hip socket formation to a complete dislocation of the femoral head (ball) from the acetabulum (socket). The goal of all treatments for DDH is to put the ball back into the hip socket, so the hip can develop normally.

Observation

If the socket of a child 6 months of age or younger is only slightly shallow and there is no instability, the doctor may follow the hip closely, since often, the joint will form normally on its own.

Pavlik harness

A Pavlik harness is used on babies up to four months of age to hold the hip in place, while allowing the legs to move a little. The baby usually wears it full time until the hip is stable and the ultrasound is normalized. Typically, the length of treatment is around eight to 12 weeks for unstable hips. It is possible that treatment will start full time (24 hours per day) and then change to part-time (12 hours per day), depending on the severity of hip dysplasia.

During this time the doctor frequently assess the hip, checks the harness for proper fit and obtains a hip ultrasound to check the hip position and success of Pavlik Harness treatment. After successful treatment, your child will need to continue with follow up and repeat imaging during the first few years of life to monitor the development and growth of the hip joint.

DDH surgical treatment

Closed reduction

If the hip continues to be partially or completely dislocated despite the use of the Pavlik harness, a cast may be required. Under anesthesia, the doctor will insert a very fine needle in the baby’s hip and inject contrast to clearly view the ball and the socket. This test is called an “arthrogram.” The process of setting the ball back into the socket after arthrogram is called closed reduction.

If the hip can be set into place, then a “spica cast” is applied. This cast extends from the nipple line to the legs to hold the hip in place. It is changed from time to time as the baby grows and remains on the hip for about three to six months.

Open reduction

If closed reduction does not work, then an open-reduction surgery is typically recommended. This surgery repairs the hip with an incision to reposition the hip so it can grow and function normally. The type of procedure needed depend on the child’s specific problem, such as reshaping the hip socket, redirecting the femoral head or repair of a dislocation.

Follow-up care

Success rates are high for hip dysplasia treatments at Boston Children’s. Even so, any child who’s been treated for hip dysplasia must still be followed periodically by an orthopedist until skeletal growth is complete. The doctor will monitor the repaired hip, since it needs to grow normally through the whole growth period in order to be durable for a lifetime and minimize risk for early arthritis