Common pediatric hip diseases in primary care by ProQuest

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									                                                             ■ 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
                           FEATURE


                    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.


                                                                                                        T
                                                                                                                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
                                  CME
                                   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
        
								
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