I am an American occupational therapist providing wheelchairs to children in undeveloped countries. We are in a village now with a child who dislocated his hip two years ago. He can no longer walk. I can fit him with a wheelchair but he may be a candidate for treatment. If we do get him to a hospital, what kind of treatment must be available for this problem?

Untreated and unresolved hip dislocation is a rare problem. Treatment options are wide ranging from no treatment to closed reduction to open reduction or other surgeries.

If services are available, the first thing the child will need is an X-ray to assess the condition. The physician will have to look at the type of dislocation and the presence of any other complications. The first step in treatment may be to apply traction to pull the leg down and reset it in the socket. This is what's referred to as closed reduction.

The child must remain in a full hip spica cast (waist to foot) for about six weeks. Physical therapy is advised after the cast comes off to restore motion, function, and gait (walking). If that doesn't work, then surgery may be needed. Several operations can be considered.

The first one mentioned is an open reduction. This accomplishes the same thing as traction but requires making an incision and releasing the soft tissues around the hip to bring it back down into the socket.

If the hip doesn't stay in the socket and dislocates again, then a hip fusion may be needed. Bone graft is used around the joint to stop motion at the joint and hold the hip in place. Hip joint replacement is a final option but may not be available where resources are limited.