Hesperian Health Guides

Chapter 18: Hip Problems

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HealthWiki > Disabled Village Children > Chapter 18: Hip Problems


Dislocated Hips

A hip is dislocated when the thigh bone is out of its socket at the hip. Some babies are born with one or both hips already dislocated. Sometimes these babies have no other problem. With early treatment, the problem can often be corrected easily, and the child will not be disabled or have a limp.

NORMAL HIP: The round head of the thigh bone is inside the hip socket.
DVC Ch18 Page 155-1.png
DISLOCATED HIP: The head of the thigh bone often lies above the socket.



For this reason it is important to examine all babies when they are 10 days old to see whether they have dislocated hips.

1. Compare the 2 legs. If one hip is dislocated, that side may show these signs:
DVC Ch18 Page 155-2.png
the upper leg partly covers this part of the body
there are fewer skin folds
the leg may seem shorter, or turn out at a strange angle
hands hold a child's bent knees together
2. Hold both legs with the knees bent, like this,
hands hold a child's bent knees wide open
If one leg stops early or makes a jump or click when you open it wide, the hip is dislocated.
and open them wide, like this.
3. To test a slightly older child, bend the knees and compare their height. DVC Ch18 Page 155-5.png If one knee is lower, the hip on that side is probably dislocated.
Treatment

Keep the baby with his knees high and wide apart. To do this,

  • Use many thicknesses of diapers (nappies) like this,
child with thick diapers
  • or pin his legs like this (when the baby sleeps)
  • or carry the baby like this.
woman carries child on her back with legs spread
child lies down with legs pinned high and wide apart


In places where babies are traditionally carried with their legs spread on the woman’s hips or back, usually no other treatment is necessary.

Children with the disabilities listed here often are born with dislocated hips.

  • Down syndrome
  • spina bifida
  • arthrogryposis
  • cerebral palsy
  • club feet

Therefore, it is essential to examine these children carefully a few days after birth, to make sure there are no dislocations.

Many (but not all) dislocated hips can be corrected in the ways we described on "Hip Problems". Keeping the legs wide apart during the first months of the child’s life helps to improve the shape of the socket.

Dislocated hips with other orthopedic problems
CAST
child in a hip cast urinates in a bottle
bottle to catch urine
BRACE
hip brace
The stick here helps to keep the legs apart.

If it is difficult to keep the legs apart, you may need to use casts or make special braces.

The casts should be used for 2 to 4 months or longer, depending on the child’s age (longer for older children) and the amount of the deformity. (Use a cloth or bottle to catch the baby’s pee, so it does not run inside the cast.)

Not all dislocations can be corrected in these ways. Some need surgery, and in some cases the hip is so deformed that the dislocation cannot be corrected, even with surgery.

With spina bifida, if one hip is dislocated, surgery may help. But if both hips are dislocated, hip surgery usually will not help the child to walk any better.

Dislocated hips can also occur after the child is born, either from an accident or as a complication of some other disability—especially polio (due to weakness in the muscles and cords that hold the hip joint together) or cerebral palsy (due to spasticity and contractures). DISLOCATED HIP
a dislocated hip
The spasticity and contracture of this muscle cause dislocation of the hip.

legs crossed like scissors
DVC Ch18 Page 156-4.png


THE TELESCOPE TEST

To find out if the hip is dislocated or can easily be pulled out of joint, place the child on his back.

a child doing the telescope test
Pull up on his knee, and then push it down, like this.
At the same time, feel his hip with your other hand, like this.
If the thigh bone moves in and out like a telescope, the hip is probably dislocated.

Dislocations that are complications of polio or cerebral palsy can seldom be corrected without surgery. But often it is better not to operate, because the operations do not always turn out well, and the children who have the possibility of walking will walk in spite of the dislocated hips.




This page was updated:19 Jan 2018