CIRUGIA PERCUTANEA DEL PIE

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CONGENITAL DISLOCATION OF THE HIP

normal hip (ecography)

This name includes all those problems that the hip can present in a newborn. They can go from a dislocation to a Displasia. Basically we can find three situations:

DISLOCABLE HIP | DISLOCATED HIP | DISPLASIC HIP

"AMERICAN ACADEMY OF PEDIATRICS" CRITERIA

1

DISLOCABLE HIP

One of the first routines done by paediatricians to newborns around the world is the exploration of the hips. During the exploration we can find the following situations:

• The hip gets in and out producing specific noises that in the medical jargon we call the Ortolani and Barlow´s sings

• Asymmetry of the folds

• Indefinite noises

This situation requieres:

• To use a triple nappy to favour that the thighs are always opened to the maximum (abduction)

• When the newborn is one month or a month and a half old it is compulsory to practice a ECOGRAPHY OF THE HIPS

• If the sonogram is normal: we won’t do anything and we will repeat it when the baby is six months old

• If still exists instability or Displasia we must use an orthopaedics device that will maintain the legs permanently separated. For this purpose we use the l’DENNIS-BROWN´S device for the hips until the sonogram becomes normal

• We must carry out tests until the child walks

Ortolani´s Sign

EXPLORATION OF THE BABY´S HIPS

Barlow´s Sign

2

DISLOCATED HIP

This is a more severe case. The clinical exploration of the newborn shows us one hip, or both, very rigid, with limitation in its mobility. In these cases we ask for an urgent ECOGRAPHY or a X-rays.

• If the hip is reduced easily: we must put the pelvis in a plaster cast for at least one month. After this, three months with the Dennis-Brown's device.

• If we can not reduce the hip, the baby will need to be hospitalized, and we will need to do cutaneous traction, subsequent reduction with anaesthesia and plaster cast. After this we must place the Dennis-Brown´s device.

And, of course, the control of these patients must be followed until adolescence.

ABDUCTION´S LIMITATION

CONGENITAL DISLOCATION OF THE HIP PRESENTATION

3

DISPLASIC HIP

The most dangerous thing about displasia is that doesn’t give any symptom. It doesn’t make any noise. Sometimes we discover it because it goes with a dislocable hip or an already dislocated hip, but quite often goes unnoticed.

Displasia leads to osteoarthritis in the hips at a certain age. In some countries with a big index of these cases, they make systematically sonograms to all the babies.

We are guided by risk factors.