[tri-med] Re: dislocated hip

Karen....you are amazing! Always know the answers and what to say.


Kathy s from South Africa.

-----Original Message-----
From: Karen [mailto:karens@xxxxxxxxxxxxxxxx]=20
Sent: Tuesday, October 28, 2003 1:16 AM
To: tri-med@xxxxxxxxxxxxx
Subject: [tri-med] Re: dislocated hip


----- Original Message -----=20
From: "Wright"
>>Cindy was very concerned about the dislocated hip.  The doctors told=20
>>her
it would be a 5 hour surgery and she doesn't think he could survive this.=
=20If they wait a year, it could cause him a lot of pain.  She is wonderi=
ng if any of your kids had this surgery and what the outcome was.

Hi Jayne,
This isn't a problem for Alex and my only experience with hip dislocation=
s has been through my work as an OT.

What is the cause of the dislocation? Children like our kids often suffer=
=20from hip dislocation because of the low tone and using standing frames=
=20is one way of helping to prevent the dislocation.

Technically the hip becomes dislocated through subluxation of the joint. =
Basically there is so little tone that the hip just slips out of the sock=
et. The muscles and tendons are not worked (because our children don't wa=
lk) to give the added support of keeping the hip in the socket, it also o=
ften confounded by having shallow acetabulums (the place where the ball f=
its into the hip)

Dislocations due to this reason generally give no or very little pain. Th=
e only time you get pain is if the bones manage to pinch some tissue, thi=
s can be avoided by proper handling and positioning of the limb.

This is not just guesswork or an assumption because our kids can't talk. =
The other common condition where subluxation / dislocation of joints occu=
rs is severe rheumatoid arthritis. Folk with arthritis actually say its l=
ess painful for them once the joint has completely subluxed. (and for the=
se guys its not just hips but wrists, fingers and shoulders)

What causes pain is if the leg is left dangling (it must be supported at =
all
times) as the weight of the leg pulls the nerve endings (legs are HEAVY) =
and puts pressure on the capsule and may lead to tearing of the capsule.

Their physical therapist should be able to show them how to carry Jonatho=
n, support the hip and position him so that he is comfortable. They shoul=
d also be able to show them how to modify his standing frame so that he i=
s still weight bearing on the other leg - important for bone strength and=
=20so that the other leg doesn't dislocate also.

I have worked with children who have had hip dislocations for many years =
with no measures take to surgically fix the joint. Usually they wont surg=
ically intervene unless there is a reason - eg the child walks or needs t=
o have use of the joint for weight bearing.

If there is surgical correction usually the just pin the leg into the ace=
tabulum. Its effective for a while but does limit the range of movement o=
f the leg. Often this surgery comes undone after a while (sometimes very
soon) because the bones are often weak and "soft" so the pin just falls o=
ut.

Similarly a full hip replacement is usually out of the question for the s=
ame reason - the bones are in such a state that there is nothing to cemen=
t the prosthesis to.

Not much help, but I hope that it gives her some reassurance that Jonatho=
n shoiuldn't be in pain if they don't go ahead with the surgery. All orth=
opedic surgery is risky, and this procedure is no different. Plus you hav=
e the added worry that the surgery may not be very effective. Hard call b=
ut from experience I would defer on the surgery unless it becomes evident=
=20that Jonathon is in pain (does happen infrequently when the dislocatio=
n manages to tear the joint capsule).

"I wanted a perfect ending. Now I've learned, the hard way, that some poe=
ms don't rhyme, and some stories don't have a clear beginning, middle, an=
d end. Life is about not knowing, having to change, taking the moment and=
=20making the best of it, without knowing what's going to happen next. De=
licious ambiguity."
- Gilda Radner -

Keep Looking For Rainbows!!
=20  _--_|\
=20/Karen \
=20\ _.--._ /
=20         v Karen, Mum to Alex (8 years, T-18 Mosaic) http://members.op=
tushome.com.au/karens


=20                 Building ___ooOOoo__ Rainbows
=20                      www.trisomyonline.org
=20                 Families Helping Families On-line

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