Congenital Dislocated Hip

Congenital dislocated hip is an abnormality that is seen at birth. The role that podiatrists play in pediatrics is remarkable. With the first sign of stance or walking abnormality, a parent's concern will be great enough to rush their child off to the doctor. We will learn about the many tools and techniques, which cater to the pediatric patient, that allow a congenital dislocated hip to be diagnosed and treated.

Children are born with a congenital dislocated hip. The word congenital means to be born with. It is a condition in which the head of the thigh bone, the femur, is detached from the pocket that it sits in, which is called the acetabulum. Studies have shown that females are affected more than males and occur 1 in every 1000 births. Oddly enough it has even been shown that the left hip is dislocated more often than the right.

A child's birth position can cause a dislocated hip. The most common birth position for congenital dislocated hip is a breech position. This is where the child presents buttocks first. The defect can also be seen with the transverse position, where the child presents other than head first. If the child presents feet first, there is opportunity for defect due to the doctor pulling the legs. Other factors that can cause a dislocated hip are:

  • Deformed Acetabulum
  • Acetabulum Slope
  • Ligament Laxity

So how would you know if the child has a dislocated hip? Well, on the effected hip you will see shortening of that limb. The child will present with a limp while walking. The child will also have limitation of abduction (moving the thigh out from the body) with the thigh flexed. The telescoping sign will be present. This is where the podiatrist would be able to push the leg beyond the hip joints normal articulation. The side of the deformity will present with increased skin folds on the child's buttocks.

There are tests which diagnose and confirm congenital hip dislocation. The first test is Ortolani's Sign. In this test the knees are bent and a "clunk" sound is heard as the femoral head is repositioned over the acetabulum. Now you don't necessarily have to hear a clunk sound, but you will be able to feel the relocation. The other test is Barlow's Sign. This is with the infant's knee flexed. The podiatrist will apply thumb pressure over the anterior thigh. The femoral head should displace posteriorly.

Now that we know what a congenital dislocated hip is and how to identify it, let's talk about how podiatrist treat and fix the problem. The main goal of hip relocation is to abduct the thighs and force the head of the femur back into the acetabulum. A cast called a bachelors cast, which extends from the groin to the ankles, can be applied. The knees on this casting procedure are joined by a cross bar to hold the correct abducted procedure. The best recognized treatment for congenital dislocated hip is the Pavlik Harness. With this harness the legs are held in and abducted position as well as allowed to move in flexion. This allows the child to be able to crawl.

If you are experiencing any of the symptoms addressed, we strongly recommend that you seek the advice of your podiatrist for proper diagnosis.