Diagnóstico, tratamiento y cuidados de la displasia de desarrollo de cadera. Nuestra experiencia y resultados en 36 pacientes pediátricos / Diagnosis, treatment and care of developmental dysplasia of the hip: experience and results in 36 pediatric patients

Introducción. La displasia de desarrollo de cadera (DDC) es una patología que abarca desde una sutil displasia acetabular hasta luxaciones de cadera irreductibles. Ampliar el conocimiento sobre la DDC y sus posibilidades terapéuticas puede mejorar los cuidados de estos niños. Para ello, se aporta nuestra experiencia en el complicado cuidado de estos pacientes en nuestro centro hospitalario. Material y métodos. Se realizó un estudio descriptivo retrospectivo mediante la revisión de las historias clínicas de 36 pacientes diagnosticados de DDC y se recogieron datos epidemiológicos, antecedentes personales, clínicos de la exploración física y pruebas complementarias, tipo de tratamiento, complicaciones y resultados. Resultados. La DDC fue más frecuente en niñas (94 %) y la edad media al diagnóstico fue de 15 semanas de vida. Un 61 % se trató de forma conservadora, mientras que el resto requirió cirugía. Las complicaciones más frecuentes del arnés de Pavlik fueron debidas al roce con los tirantes. Hubo dos casos de necrosis avascular de cadera. Las complicaciones más frecuentes de la tracción percutánea y el yeso pelvipédico fueron dermatológicas. En la reducción abierta fue la fiebre y la anemia. Discusión. El tratamiento de la DDC es multidisciplinar e implica la colaboración de distintos profesionales sanitarios. Son precisas un gran número de intervenciones enfermeras en el cuidado de estos pacientes. Conclusiones. Los enfermeros tienen un papel significativo en el cuidado de estos pacientes y es fundamental su asesoramiento y apoyo a los padres de estos niños en tratamiento (AU)

Introduction. Developmental dysplasia of the hip (DDH) includes a wide spectrum of pathologic conditions, ranging from subtle acetabular dysplasia to irreductible hip dislocations. Expanding knowledge about DDH and its therapeutic possibilities can improve care for pediatric patients. We therefore provide our experience in the complicated care of these patients in our hospital. Method. A restrospective descriptive study was performed by means of the review of clinical records of 36 patients diagnosed with DDH. Epidemiological data, medical history, physical examination and additional tests, treatment modalities, complications and results were collected. Results. DDH was more common in girls (94 %) and the mean age at diagnosis was 15-weeks-old babies. 61 % of the cases were treated conservatively, and the rest of the patients were treated by means of surgery. In the case of Pavlik Harness, complications were more frequent due to friction with straps. There were two cases of avascular necrosis of the hip. In cases of percutaneous traction and closed reduction with spica cast, the most frequent complication was dermatological. In the case of open reduction, fever and anemia were the most common complications. Discusion. The treatment of DDH is multidisciplinary and involves the collaboration of different health professionals. A large number of nursing interventions are required in the care of these patients. Conclusions. Nurses have a significant role in the care of DDH patients. Their advise and support of these children’s parents during treatment is essential (AU)

Exploring the experiences of parents caring for infants with developmental dysplasia of the hip attending a dedicated clinic.

Specialised DDH (developmental dysplasion of the hip) clinics are developing around Ireland but are, however, variable in how they are operated. A DDH clinic was set up in the South-east of Ireland in 2002 with the goal of achieving an integrated care pathway between the orthopaedic surgical team and nursing team, working to an explicit protocol while also fostering a strong collaboration with the ultrasound department. This paper aims to explore the effectiveness of this dedicated clinic in the Southeast of Ireland.

Total hip replacement for developmental dysplasia of hip and postoperative nursing.

This study was designed to determine the clinical effect of total hip replacement for the treatment of developmental dysplasia of the hip (DDH) and analyze the postoperative nursing. Sixty patients (78 hips) aged 18-75 years (average 58.6±2.31 years) who received total hip replacement for treatment of DDH at the Zhengzhou People’s Hospital, Henan, China, from April 2013 to June 2016 were selected as research subjects. Twenty-four patients were male (30 hips) and 36 were female (48 hips). Of the 60 patients, according to Crowe typing, 24 were type I (30 hips), 26 were type II (34 hips), 6 were type III (8 hips) and 4 were type IV (6 hips). According to the Harris hip score system, the score of all hips was 39.46±3.56 points average (18-56 points) before treatment and resulted as 89.60±4.25 points (79-98 points) at the last follow-up, showing a statistically significant difference (P < 0.05). Complications such as wound infection, dislocation, fracture of femoral shaft, femoral nerve and injury of sciatic nerve were not found after treatment. A total of 48 cases (58 hips) obtained excellent curative results (93.33% recovery), 8 cases (14 hips) good (92.31% recovery), and 4 cases (6 hips) medium. Total hip replacement proved to be effective in treating DDH and secondary osteoarthritis. Moreover, soft tissue release and an optimum degree recovery of anatomic form and physiological function of the diseased hip is an important basis for reconstructing the acetabulum and stabilizing acetabulum prosthesis.

Examination of the newborn: the key skills. Part 3: the hips.

Midwives are increasingly performing the examination of the newborn. his article considers the importance of the examination of the hips in the screening process. The significance of history taking, knowledge of risk factors and the hip examination will be explored. The necessity for early detection and treatment of hip abnormalities, along with referral pathways that the National Screening Committee quires will be highlighted. The impact of late detection of developmental dysplasia of the hip (DDH) on the lives of families and children will also be considered.

Developmental dysplasia of the hip.

The close interaction between community practitioners and young families provides an invaluable opportunity for prevention, education, support and even diagnosis in cases of developmental hip dysplasia. This article provides a brief overview of the condition, including clinical findings, screening protocols, 'hip safe' practices, and common treatments that may be encountered in the community.

The knowledge, attitude and practice of the primary and secondary care nurse-midwife practitioners on developmental dysplasia of hip.

A detailed clinical examination of the newborn performed by nurse-midwife practitioners has been recommended as a standard practice throughout the most western countries. The purpose of this study was to evaluate and compare the knowledge, attitude and practice of the primary and secondary care nurse-midwife practitioners on developmental dysplasia of hip (DDH) before and after a structured lesson. The study was designed as a cross-sectional, pre- and post-test. The number of participants from primary care and secondary care nurse-midwife practitioners were 155 and 208, respectively. A structured questionnaire consisting of 28 statements of medical and practical knowledge, and traditional attitudes with regard to DDH was administered. The results determined that the pre-test scores were much lower than the post-test scores of both primary and secondary care practitioners. Although there was a lack of knowledge about DDH in both groups, the pre-test and post-test scores were higher in the primary care group compared to the secondary care group. In conclusion, the knowledge, attitude and practice of the primary and secondary care nurse-midwife practitioners on developmental dysplasia of hip are in need of improvement. This improvement may be provided by continuing education programmes.

[Knowledge and attitude of nursing and midwifery college students on developmental dysplasia of the hip]. / Hemsirelik ve ebelik bölümü ögrencilerinde gelisimsel kalça displazisi konusundaki bilgi ve tutumun degerlendirilmesi.

OBJECTIVES: It is of special importance to educate families and health care providers, in particular midwives and nurses who are in close and frequent contact with families, for the prevention and early diagnosis of developmental dysplasia of the hip (DDH). A knowledge and attitude study was conducted concerning DDH among students of Nursing and Midwifery College of Kahramanmaras Sütçü Imam University. METHODS: A structured form was prepared consisting of 28 statements about medical and practical knowledge and traditional attitudes with regard to DDH and was administered to 232 voluntary students before and after an educational session of 60 minutes by a specialist in orthopedics. Prior to the study, the students of grade I and II had not received any theoretical or practical lectures about DDH, which were included in the curriculum of grades III and IV. RESULTS: The knowledge of the students about risk factors and prevention strategies for DDH was of a moderate level. They were not sufficiently furnished with information about traditional attitudes and applications that predispose infants to DDH. The mean test scores before and after training were 51.52+/-13.90 and 87.86+/-5.90, respectively (p=0.000). Compared to grade III and IV students, grade I students performed significantly less in the former test (p=0.00); however, the scores of the latter test did not differ significantly between the grades (p>0.05). CONCLUSION: The curriculum during the license education of midwives and nurses should include essential information on traditional attitudes. With sufficient knowledge and application skills, midwives and nurses may play an important role in the primary and secondary prevention of DDH in our country.

Bernese periacetabular osteotomy for hip dysplasia in young adults.

Hip dysplasia is one of the most common disorders of the hip, presenting in the first three years of life. Literature has shown that an association exists between developmental dysplasia of the hip and the development of secondary hip osteoarthritis in early adulthood. Treatment options are directed toward relieving symptoms and delaying or preventing the onset of arthritis in the affected hip. Total hip arthroplasty is a surgical option, but has been associated with a high rate of failure in younger, physically active patients. This article discusses the Bernese periacetabular osteotomy procedure as a treatment modality, which restores coverage of the femoral head with the acetabulum. Changing the anatomy allows the surgeon to increase the surface area of the femoral head that bears the patient's weight. Increasing the weight-bearing surface may prevent further damage to the hip's cartilage and delay the onset of osteoarthritis.

Practical primary pediatric orthopedics.

Pediatric orthopedic problems often puzzle the primary health provider and worry families. A thorough orthopedic history and examination by the primary care provider is all that is necessary to determine whether a problem requires further evaluation and referral. This article addresses a practical approach to common orthopedic problems, assessment, and management strategies from the specialist perspective. A general description of developmental dysplasia of the hip, foot misalignments, tibial torsion, toe-walking, genu varum (bowlegs), growing pains, sprains and fractures, and the child with a limp is provided. Management strategies before and after orthopedic referral are presented.

Necesidades de apoyo a padres de lactantes en tratamiento ambulatorio por displasia luxante de caderas: elecciones y decisiones en salud / Support needs of parents of children in ambulatory treatment of dysplasia: health decision and choice

Este es un estudio del área de la Enfermería Pediátrica y forma parte de una línea de investigación desarrollada por la Escuela de Enfermería de la Pontificia Universidad Católica de Chile, en conjunto con la Universidad de Otawa de Canadá. Es de tipo descriptivo, retrospectivo y transversal y se realizó en el servicio de traumatología infantil del Centro de diagnóstico terapéutico del Área Metropolitana Sur Oriente. Tiene como finalidad conocer las necesidades de apoyo en la toma de decisiones en salud y los conocimientos que tienen los padres de niños menores de un año con diagnóstico de DLC que se atienden en este servicio, con respecto al tratamiento ambulatorio y cuidados que requiere el niño en el hogar. El Universo del estudio esta compuesto por todos los niños menores de un año con diagnóstico de Displasia Luxante de Caderas (DLC) y en tratamiento ortopédico ambulatorio que consultan entre los meses de Septiembre-Diciembre de 1999, teniendo los siguientes criterios de inclusión:ser padres o tutores de niños menores de un año con diagnóstico de DLC, estar cursando con el tratamiento ortopédico y tener 2 o más controles en el policlínico de traumatología el día de la encuestra, la muestra fue intencionada con un n=34, lo que corresponde al 100 por cientos del universo

Impacto de la intervención de la enfermera en el análisis beneficio-costo del tratamiento ambulatorio de niños con displasia de caderas / Nurse impact in the cost-benefit analysis of ambulatory treatment of children with hip dysplasia

El presente estudio del área de administración en Salud, plantea un análisis de beneficio-costo entre un sistema de atención integral - interdisciplinario (Médico y Enfermera) y un sistema Tradicional - unidisciplinario (Médico) para el tratamiento Ortopédico Ambulatorio de lactantes con displasia de caderas. La Displasia luxante de caderas es una anomalía congénita, cuya importancia esta determinada por una pesquisa que permita un tratamiento ortopédico ambulatorio en el primer año de vida, ya que de lo contrario el tratamiento es quirúrgico, de un mayor costo y con probables secuelas, analizándose esta situación se concluye que el real beneficio de un tratamiento oportuno en cualquier modalidad es un niño sano, con el ahorro de costos que implica un tratamiento tardío. El sistema de atención integral analizado se desarrolla sólo en el Servicio de Pediatría del Centro Médico San Joaquín de la Pontificia Universidad Católica de Chile, en todos los demás centros se desarrolla el Sistema Tradicional analizándose en el Servicio de Salud Sur Oriente. En primer lugar se estimó el perfil de un "Niño Tipo" menor de un año con displasia de caderas, conformado por las características relevantes más frecuentes encontradas en el Servicio de Salud Sur Oriente. Luego se estimaron los procesos de asistencia y sus costos para este tipo, involucrado en los 2 tipos de tratamiento ortopédicos ambulatorios. Para estimar él perfil de "Niño Tipo" y sus procesos de asistencia se aplicó una encuesta con técnicas de estudio de mercado a todos los Médicos especialistas involucrados. Primero se concluyó que el perfil de "Niño Tipo" era un niño con Displasia Leve, que se le indica tratamiento a los 4 meses, el cual es acompañado por una persona que tiene estudios de enseñanza básica y cuya actividad es el Servicio Doméstico. Posteriormente se concluyó, que el tratamiento Integral es más económico para el usuario y para el prestador del Servicio de Salud. Por otro lado quedó establecido que existe un beneficio al contar con un profesional de Enfermería que apoye el área educativa, los especialistas señalaron que no tiene importancia el factor recursos económicos y la razón del fracaso del tratamiento, ocurre por el abandono de éste por no entender la importancia del tratamiento junto con la falta de motivación del acompañante...

The Inventory of Functional Status-Caregiver of a Child in a Body Cast.

The Inventory of Functional Status-Caregiver of a Child in a Body Cast (IFSCCBC), which was derived from the Roy Adaptation Model, includes subscales measuring the extent to which parental caregivers or their surrogates continue their usual household, social and community, childcare, personal care, and occupational activities while caring for a child in a body cast. Content validity was established at 90%. Internal consistency reliability ranged from 0.63 to 0.88, using item to subscale correlations. Subscale to total IFSCCBC score correlations ranged from 0.14 to 0.75. Initial construct validity testing was accomplished by examination of subscale to subscale correlations. The IFSCCBC may be used in research and clinical practice to assess the functional status of parents or their surrogates while they are caring for a child in a body cast.

Traction at home for infants with developmental dysplasia of the hip.

Early treatment of developmental dysplasia of the hip in infants is essential for optimal development of the hip joint. Orthopaedists commonly use a period of preliminary traction before hip reduction to stretch the soft tissues and reduce the risk of avascular necrosis. A program developed at the University of Michigan Medical Center allows the infant to receive traction at home instead of the traditional admission to the hospital. This program has been found to be clinically effective as well as cost effective, and less of an inconvenience to the infant and family than the traditional admission. Intensive involvement by the clinical nurse specialist in teaching and follow-up of each patient is essential for success.

Caring for a young child in a body cast: impact on the care giver.

Data from an open-ended questionnaire and the comments section of a structured questionnaire were combined and analyzed to determine the challenges faced and alterations in usual daily activities required by mothers caring for a young child at home in a body cast. The sample consisted of 35 mothers who identified themselves as the primary care givers of a child in a body cast. The challenges of caring for a child in a body cast required major adjustments in almost every aspect of the mothers' lives, including household activities, social and community activities, child care activities, personal care activities, occupational activities, and educational activities.