Developmental Dysplasia of the Hip (DDH)

Dr. G. Ying Li

Hip dislocation is part of a range of hip problems found in an infant or young child, usually called Developmental Dysplasia of the Hip (DDH). This is the condition where the ball part of the hip joint, (femoral head), is not held firmly in the hip socket (acetabulum). The baby’s hip may not be dislocated but may have some looseness causing it to slip or sublux in the joint. Usually the pediatrician notices a hip click or looseness of the hip when examining the baby at well child check-ups. One or both hips can be involved but it usually occurs in the left hip. Other findings may include:

  • Uneven thigh folds
  • One leg shorter than the other
  • Tightness with flexibility of the hip
  • Walking with a limp
  • Breech presentation
  • Firstborn child
  • Family history of hip dysplasia

 

Diagnosis

Diagnosis is made with a combination of physical examination and ultrasound or x-rays of the hips, depending on the age of the child. Children with a diagnosis of DDH will need to be followed for many years until their hips are finished growing.

Treatment

Pavlik Harness, Wheaton Brace Co.

Treatment will be determined depending on the age of the child when the diagnosis is made. If left untreated, the child will likely develop hip arthritis and pain at an early age.

  • Pavlik Harness - Newborns and young babies may be treated in this brace which holds the hips flexed and out to the sides, to allow the ball to fit well into the socket. The position is maintained while the baby’s hip grows and develops. This treatment usually lasts for 2-3 months, with interval checks until the hip is stable.
  • Closed Reduction - older babies will need to go to the operating room for anesthesia to allow the surgeon to put the hip in place and put the child in a body cast. Sometimes a very small incision is needed to release a tendon in the groin to allow the hip to go into the socket.
  • Open Reduction - when the hip will not reduce, the surgeon will need to open the hip joint to allow it to stay in the socket and then put the child into the hip spica cast.
  • Hip osteotomies - additional surgery may be needed if the hip joint does not develop well after it has been reduced. Usually these surgeries happen after the age of 2-3 and involve cutting the pelvis and/or femur to obtain good coverage of the femoral head.

SPICA CAST CARE INSTRUCTIONS

Your child is in a spica cast for treatment of a fracture or after hip surgery. Here are some tips to help you care for your child at home.

Diapering:

We recommend 3 layers of protection to help keep the cast as clean and dry as possible.

  • Use a small adult incontinence pad (Poise or Depends) to place into the diaper opening. These pads are sold in the store next to adult size diapers.
  • Place a small baby diaper over the incontinence pad and tuck it under the edges of the cast in the diaper opening. Usually a size 1 or 2 will work. You can cut off the Velcro tabs to make it fit better. Use a large baby diaper, size 5 or 6, on the outside of the cast to help hold the small diaper and pad in place.
  • Check the child for wet diapers every hour during the day and at least once during the night. Change a wet or soiled diaper as soon as possible to avoid urine/stool from soaking into the cast.

Preventing Soiling of Casts:

  • Use plastic tape on the edges of the diaper area - this will act as a barrier to prevent wetness from soaking into the cast padding.
  • Position the child with the upper body elevated to promote urine to flow down into the diaper instead of up under the cast. A pillow can be placed under the mattress for elevation during sleep times.
  • Damp or wet casts can be helped to dry by using a hair dryer on the cool air setting to blow air under the padding.
  • A small amount of spirits of wintergreen or peppermint oil on a cotton ball can be dabbed onto the outside of the cast to cover up odors.

Positioning:

  • Change your child’s position every 2 hours to prevent pressure on the skin under the cast.
  • The child can be placed on the stomach 2-3 times per day to relieve pressure on the back side.
  • Use pillows or blanket rolls to give support when positioned on the side or stomach.
  • A bean bag chair is a good positioning device because it will mold around the cast and will allow the child to be more upright.
  • Make sure the heels are propped off the bed to prevent sores from developing under the cast.

Bathing:

Sponge bathing is the only method to bathe your child while in the cast and keep the cast from getting wet. You can use baby wipes in the diaper area to clean the best you can.

Feeding:

Your child should be positioned in an upright position for eating. Cover the cast with a t-shirt or bib to prevent crumbs or drinks from lodging under the cast.

Clothing:

Longer shirts or dresses for girls work the easiest. A ‘onesie’ in a larger size than usual may also work well. Some sweat pants or stretchy shorts may fit over the cast. The cast will be warm once it is dry so be careful not to overdress the child.

Car Seat:

Most children do not fit into their car seat while in a spica cast. A specially made car seat called a Hippo Car Seat can be rented through MedEquip to make traveling safe. Bigger children may need to use the Modified EZ On Vest to be secured lying flat on the rear bench seat if they are too large for the Hippo Car Seat. These arrangements will be made in the hospital. Many insurance plans do not cover the fees for the car restraints.

What to watch out for!

Circulation:

Check circulation in the toes several times a day. The child should move her toes in response to your touch. The nail beds should be their normal coloring. You can put light pressure on the toenail which will cause the color to be paler. When you release the pressure, the coloring should quickly return. Circulation problems and swelling in the toes can be relieved with elevation of the legs. If the circulation does not improve with elevation, call your doctor’s office.

Skin:

Check the skin around all the edges of the cast every day. Watch out for bright red areas, blisters or sores. If you see any of these problems, call your doctor’s office. Be careful not to pull out any padding from under the cast as this can make a rough edge. A rough edge of the cast can be covered with plastic tape to make it smoother.

Signs of Infection:

Incision areas are often under the cast and cannot be seen. A fever of 101 degrees F or more, unusual fussiness, pain not controlled by pain medication or an unusual odor from under the cast could be sign of infection and needs to be reported to your doctor’s office.