U Assessment

HISTORY. When the condition is a result of injury, elicit complete details of the injury from the patient, significant others, or the life squad. Note the time of injury, as well as the description, angle of force, and the patient's immediate sensations. Always ask if the patient felt any numbness immediately after the injury. In an acquired dislocation or subluxation, note a complete history of recent alterations in mobility, pain, or any other changes. For traumatic or acquired displacements, it is important to obtain information about any previous dislocations of this joint or any other joint.

DDH can range from a minor instability to total dislocation. In moderate to severe DDH, diagnosis can be made at birth during the physical examination. However, for less severe conditions, symptoms may not occur until the child starts to crawl or walk. Elicit a developmental history from the parents covering the child's mobility.

PHYSICAL EXAMINATION. With traumatic or acquired dislocation, the immediate clinical manifestations may include severe pain, inability to move the extremity, a change in the length of the extremities, abnormal contour of the joint, and ecchymosis (bruising). The symptoms of subluxation are the same, but usually less severe. Make sure to remove all of the patient's clothing to observe skin surfaces. Assess joint range of motion unless there is suspected cervical spine injury. In that situation, defer motion until radiographs are completed. Palpate all extremities and note pain, crepitus, instability, and deformity.

Monitor the neurovascular status of the patient with a dislocation before and after reduction or other interventions. Impairment in circulation or neurological deficits may occur during injury, before the reduction, because of pressure from bleeding or edema, and after the reduction, or as a result of interventions. The impairment may occur at the joint, but it may also occur distal to the injury. Serial neurovascular assessment includes critical data related to the 5 Ps: pain, pallor, paralysis, paresthesia, and pulselessness. Normal pulses do not rule out compartment syndrome.

Signs of congenital hip dislocation include asymmetry of gluteal and thigh folds, limited hip abduction, and apparent shortening of the femur with knees in flexion. If the child is beginning to walk, gait abnormalities occur. In the infant, a positive Ortolani-Barlow maneuver is an indication of dislocation. This maneuver involves placing the hands on the knees of the baby with fingers on the upper portion of the femur and abducting the hips while the infant lies on her or his back. Resistance to abduction, or the presence of a click as the femur slips out of the acetab-ulum, is considered a positive response.

PSYCHOSOCIAL. If the dislocation resulted from an injury, the sudden impact may have disrupted the individual's routines and created certain losses. If dislocation or subluxation is a result of a chronic disease process, the deficit may be a reminder of the deterioration of the body; depression may follow as a result of the decreased mobility or role change. With any congenital or developmental problem, parents may experience anxiety, guilt, or depression.

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