■ LEARNING OBJECTIVES :
CME • Recognize infants who are most susceptible to developmental dysplasia of the hip.
• Explain the treatment of choice for developmental dysplasia of the hip.
• Identify risk factors associated with slipped capital femoral epiphysis.
CE • Name the factor that has the most inﬂuence on the course of Legg-Calvé-Perthes disease.
■ COMPLETE THE POSTTEST: Page 58
■ ADDITIONAL CME/CE: Pages 43, 55
BY RAYMOND W. KLEPOSKI, MSN, CPNP; KATHY ABEL, MSN, CRNP; AND KRITI SEHGAL, BA
Common pediatric hip
diseases in primary care
Left untreated, these childhood conditions could have lasting effects. Our
experts explain three of the most common hip disorders you’ll see.
he hip combines structural features that not
only permit an extensive range of motion
but also allow for the transmission of great
forces through the thighs, pelvis, and lower por-
tion of the spine, all while helping to support the
weight of the body.1
The top of the femur—the femoral head—is
spherical and usually well-situated in an area of
the pelvic bone called the acetabulum, which is a
smooth, cup-shaped socket. A capsule surround-
ing the joint is made up of a series of ligaments
that support the hip’s stability. This joint capsule
ensures that the femoral head remains snugly in
the acetabulum when the upper legs move. The
cartilage at the center of the acetabulum and at the
proximal femoral head, combined with the synovial
ﬂuid (better known as joint ﬂuid), allow the femoral
© ISM / PHOTOTAKE
head and acetabulum (thigh and hip) to slide past
each other much like a ball bearing.1,2
Most femoral growth during childhood takes
place in the epiphysis (proximal and distal regions
FIGURE 1. X-ray shows dislocation of the left hip in a 5-year old girl. of bones), as is standard for most childhood bone
www.clinicaladvisor.com • THE CLINICAL ADVISOR • JUNE 2010 21
CE PEDIATRIC HIP DISEASES
The epiphysis is dependent on a steady supply
of oxygen and nutrients from the blood that runs
through vessels and channels to the bones.
growth.3 Children’s bones have a large component of car- Pathophysiology. DDH is most common in infants