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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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