Congenital Hip Dysplasia Nursing Care Plans

Caught early, hip dysplasia corrects well. Caught late, it means surgery, casts, and a child who walks with a limp. Your work centers on keeping the reduction device or cast doing its job, protecting skin and circulation underneath it, and keeping an immobilized child developing and connected. This guide covers the assessment, goals, and interventions you actually use at the bedside.

What is Congenital Hip Dysplasia?

Congenital hip dysplasia (also called developmental hip dysplasia) is abnormal hip development that can begin in fetal life. It spans a range: hip instability, a shallow acetabulum (preluxation), incomplete dislocation (subluxation), and a femoral head fully out of the acetabulum (dislocation). It is usually unilateral but can involve both hips, occurs far more often in females, and is typically caught in the newborn. It responds best to treatment started before 2 months of age.

Treatment depends on the child's age and severity, ranging from a reduction device to traction and casting to surgical open reduction. Casting and splinting are usually unworkable after 6 years of age.

Nursing Care Plans and Management

Care planning targets physical mobility, family and social support, patient and family education on self-care and safety, and prevention of complications like compartment syndrome and hip dislocation.

Nursing Problem Priorities

1. Promote optimal hip development and stability.
2. Manage orthotic devices correctly.
3. Support age-appropriate developmental milestones.
4. Provide psychosocial support.
5. Educate and support patient and family.
6. Collaborate with the healthcare team.

Nursing Assessment

Assess for the following subjective and objective data:

• Discomfort or pain in the hip region
• Limited range of motion
• Abnormal gait (limp or waddling)
• One leg appearing shorter than the other
• Hip instability
• Uneven folds on the legs and buttocks on leg extension
• Positive Ortolani and Barlow tests
• A clicking or clunking sound on hip manipulation

Assess for factors related to the cause:

• Movement restriction imposed by the splint, harness, cast, or traction
• Inability to move purposefully, including bed mobility and ambulation
• Untreated or incorrectly treated dislocation

Nursing Diagnosis

Formulate the diagnosis from your assessment and clinical judgment, naming the actual and high-risk problems you can act on through nursing interventions.

Nursing Goals

The child moves in bed with a traction bar and walks the hallway and back twice a day. Traction holds, the Pavlik harness sits properly, and the skin stays free of irritation under the spica cast. The child passes soft, formed stool every 1 to 3 days without straining. The parent stays with the infant and provides social interaction, the infant responds to it, and the child is included in family activities.

Nursing Interventions and Actions

1. Enhancing Physical Mobility

A malformed or malpositioned hip joint cuts range of motion and stability, which makes it hard for a child to crawl, walk, and hit age-appropriate milestones.

1. Assess muscle mass, strength, and tone; ability to move; and activity level in ADLs. Reads the condition and function of the musculoskeletal system.

2. Assess sensory and motor function of the extremities and any surgical correction already done. Identifies conditions or treatments that affect mobility.

3. Assess activity restrictions, bed-rest status, and immobility imposed by braces, casts, traction, and splints. Rest during acute stages promotes healing.

4. Allow all age-appropriate activities that promote mobility, and encourage the infant to crawl. Supports mobility within the limits of the condition and gives the child an outlet for the frustration of forced immobility.

5. Do not restrict activity unless ordered; assist with daily activities and give pain medication before activity. Supports independence and normal development.

6. Apply the harness or splint and provide aids such as a wheelchair, crutches, and supports for reading, eating, and other ADLs as needed. Builds autonomy and supports mobility.

7. Maintain body alignment during bed rest and reposition every 2 hours or as needed; give the child a drawing to follow for position and placement in bed. Prevents contractures and deformity.

8. Encourage and assist muscle-strengthening and passive stretching exercises as appropriate. Conserves muscle strength and prepares for mobility aids.

9. Alternate rest with periods of mobility. Prevents fatigue and conserves energy.

10. Teach parents and child about the complications of immobility. Drives adherence to the mobility program.

11. Teach parents and child to use mobility and ADL aids. Supports safe use and added protection.

2. Preventing Trauma and Injury Risk

Untreated or incorrectly treated dysplasia leaves the child at risk for hip dislocation and other injury, with long-term complications and impaired mobility.

1. Assess infants up to 2 months of age for frank breech or cesarean birth, hip joint laxity or dislocation (Ortolani or Barlow test), degree of dysplasia or dislocation, a shortened limb on the affected side (telescoping), broadened perineum, asymmetric thigh and gluteal folds with extra folds, and flattened buttocks. Establishes the presence and degree of dysplasia, whether preluxation, subluxation, or dislocation. Catching it at this age gives the highest rate of complete correction.

2. In the older infant or toddler, assess for a shortened leg from telescoping (palpate the femur as the extended thigh is pushed toward the head and pulled distally), delayed walking, a limp that lurches toward the affected side, a downward pelvic tilt toward the unaffected side on weight-bearing (Trendelenburg sign), and lordosis and waddling gait if both hips are affected. Identifies deformity once the child stands or walks, by which point the limb is shortened and adductor and flexor contracture has set in, requiring closed reduction (traction and cast) or open reduction (surgery, cast, splint).

3. Maintain skin traction for an abduction contracture in infants up to 6 months, with a spica cast after traction; in children 6 to 10 months, use skin traction to gradually reduce the hip adductor and flexor muscles, then a spica cast for immobilization. Holds hip abduction until stable. A spica cast applies when reduction will not otherwise hold for 3 to 6 months; after cast removal, an abduction brace protects the hip.

4. Apply the Pavlik harness to infants up to 6 months, worn continuously for 3 to 6 months to ensure hip stability; apply double or triple diapers or a Frejka pillow if ordered. Holds the femur abducted and reduced in the acetabulum.

5. Teach spica cast care: support the cast when moving, keep crumbs and small objects out, petal the edges, never insert anything to scratch, clean and dry it completely, and protect it from soiling and dampness. Do neurovascular checks every 2 hours for color, warmth, sensation, peripheral pulse, and capillary refill, and watch for nausea and vomiting from cast syndrome. Keeps immobilization safe and effective. A tight spica cast can compress the superior mesenteric artery against the duodenum, producing cast syndrome.

6. Provide traction care: correct limb alignment, the right weights hanging free, functioning pulleys with secure knots, and neurovascular checks every 2 hours for warmth, color, and sensation. Keeps traction to the affected hip safe and effective.

7. Change diapers frequently; use disposable diapers or plastic protection over the diaper. Keeps the harness, brace, or cast clean.

8. Educate parents on the type and extent of the deformity, its cause, the treatment plan, and prognosis, reinforcing physician information; explain surgical reduction for an older child or when soft tissue obstructs joint development. Grounds the family in the diagnosis and the planned regimen.

9. Teach parents to apply the splint or harness over the diaper and shirt, use disposable diapers or waterproof undergarments, remove the harness for bathing if allowed or sponge-bathe with it in place, pad the shoulder straps, reposition every 2 hours, and never adjust the harness themselves. Maintains the hip reduction.

10. Teach parents traction care: its purpose, the allowable movement, neurovascular assessment and what to report, the exact weights and how they hang, and how to maintain body alignment. Ensures accurate traction for gradual reduction and preoperative preparation.

11. Teach parents spica cast care: its purpose, keeping it clean and dry and shielded from stool and urine with waterproof tape or a plastic cover, supporting it during movement, padding the edges, lifting by the crossbar, keeping small objects and crumbs out, and signing the cast without leaving white space. Cover diapering and toilet use, tuck a diaper into the perineal opening, feed an infant supine with the head elevated or upright on a lap or in a car seat, and use a specially made car seat for casts and harnesses. Refer to a social worker if cost blocks access to the seat. Keeps the hip immobilized after surgical reduction.

12. Refer parents to community agencies that support children with disabilities. Connects the family to information and services.

3. Managing Constipation

Reduced activity and limited mobility, plus pain medication, make constipation common in these children.

1. Assess the child's stool: color, consistency, frequency, and amount. Normal stool varies with age and diet.

2. Encourage increased fluid intake as tolerated. Hydration supports regular bowel movements.

3. Provide a stool softener or mild laxative as needed. Prevents fecal impaction.

4. Provide privacy during defecation. Privacy lets the child relax, which promotes defecation.

5. Provide regular exercise and activity as appropriate. Movement drives peristalsis; abdominal exercise strengthens the muscles that aid defecation.

6. Increase dietary fiber: add apple juice to infant formula, and offer fruits, vegetables, and whole grains for older children. Adds bulk and eases passage.

7. Establish a regular toilet routine. Sitting on the toilet at consistent times, such as after meals, builds a bowel habit.

8. Teach parents why straining matters. Straining worsens constipation and stresses the hip joint; encourage relaxation and enough time.

4. Enhancing Social Interaction

Impaired mobility limits play with peers, which can leave the child isolated and slow social development.

1. Assess the infant's social interaction with parents. Reads infant stimulation.

2. Allow significant others to visit or stay. Supports interaction during prolonged treatment and cuts boredom.

3. Expose the child to other children: move the bed near activity or a window, wheel them on a stretcher, wheelchair, or stroller, and allow walking in a cast or brace if permitted. Provides environmental stimulation and social contact.

4. Offer age-appropriate toys to use in bed in a prone or sitting position depending on the treatment. Supports development and reduces boredom.

5. Position toys and items within reach. Gives access to diversion when needed.

6. Encourage parents to allow as much independence and self-care as possible. Builds independence and a sense of control.

7. Teach parents to include the child in family activities. Builds acceptance and wellbeing as part of the family.

8. Help parents adapt mobility aids to the needs of a child in a cast or appliance. Opens up a wider range of activities and stimulation.

5. Monitoring Laboratory and Diagnostic Procedures

Diagnosis combines physical exam with imaging to confirm dysplasia and grade its severity.

1. Ultrasonography

The standard for diagnosing hip dysplasia in infants younger than 6 months. It shows the hip joint, the position of the femoral head in the acetabulum, the shape of the socket, and any abnormalities. The Graf classification, based on ultrasound, grades the joint:

• Type I: Normal joint with a mature acetabulum and adequate femoral head coverage.
• Type IIa: Physiological immaturity, slightly shallow acetabulum and slight under-coverage, stable joint.
• Type IIb: Pathological immaturity, moderately shallow acetabulum and moderate under-coverage, stable joint.
• Type IIc: Pathological immaturity, severely shallow acetabulum and significant under-coverage, still a stable joint.
• Type III: Dislocated or unstable joint.

2. X-ray Imaging

Used for infants older than 6 months or when more detail is needed. X-rays clarify the joint and show the severity of dysplasia, bony abnormalities, and the degree of displacement.

3. Magnetic Resonance Imaging (MRI)

Used for more detailed images, especially when soft tissue abnormality is suspected or in older children and adults.

4. Arthrography

Helps evaluate joint stability when dysplasia is uncertain. Injecting contrast dye and imaging shows the extent of instability and whether the femoral head stays in the acetabulum.