Congenital hip dislocation (CHD) occurs when a child is born with an unstable hip. It's caused by abnormal formation of the hip joint during their early stages of fetal development. Another name for this condition is “developmental dysplasia of the hip.” This instability worsens as your child grows.
Anterior hip dislocations are classified as either superior-anterior (pubic) or inferior-anterior (obturator). Pubic-type dislocations result from abduction, extension, and external rotation of the hip. Obturator-type dislocations result from abduction, flexion, and external rotation of the hip.
Causes
Dislocations of the hip can be classified as congenital or acquired. Congenital dislocations result from the physiologic position of the fetus in utero pressed against the abdominal wall of the mother, with the additional component of the posterior force acting against a dysplastic hip joint in flexion.6 Both factors together result in a partial or complete dislocation in a neonate; however, this topic is beyond the scope of this paper. Acquired hip dislocations are either native dislocations or dislocations after total hip replacement (Figure 1).3,7-10 The majority of native hip dislocations result from motor vehicle collisions.
Motor vehicle collisions are the most common cause of traumatic hip dislocations. The dislocation often occurs when the knee hits the dashboard in a collision. This force drives the thigh backwards, which drives the ball head of the femur out of the hip socket.
The Ortolani test is part of the physical examination for developmental dysplasia of the hip, along with the Barlow maneuver. Specifically, the Ortolani test is positive when a posterior dislocation of the hip is reducible with this maneuver.
The Barlow Test is considered positive if the hip can be popped out of the socket with this maneuver. The dislocation will be palpable [5]. 2. Ortolani Test In this test, the baby is placed in a supine position with flexed hips at 90 degrees.
What is telescopic test?
The telescoping test is used to check for hip dislocations. To perform the test the patient lies down flat on their back. The physical therapist then raises one of the patient's legs up so that the knee is bent at a 90 degree angle.
Treatment
Babies with CDH often require the help of a respirator to breathe after birth. Serious cases may need to be treated with extracorporeal membrane oxygenation (ECMO), a lung bypass machine that allows gas exchange (taking in oxygen and giving off carbon dioxide) while the baby's lungs are resting.
There is a wide range of severity and outcomes for CDH. In the best cases, some infants do very well with treatment after birth, surgery and care in an intensive care nursery. In the most severe cases, some will not survive no matter how hard we try.
CDH is a birth defect, occurring while the fetus is developing. The opening caused by this defect causes some of the organs that are usually found in the baby's abdomen to move into their chest cavity.
Prevention of congenital hip dislocation
You can't prevent CHD. It's important to bring your child to regular checkups so their doctor can identify and treat the condition as soon as possible. You may want to verify their doctor examined your newborn for signs of hip dislocation before you leave the hospital following delivery.
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