Dyslexia of the hip joints. Hip dysplasia in children: causes, signs, treatment. Gymnastics and physiotherapy exercises

Physiotherapy for pelvic joint dysplasia

Defects in the development of bones and connective tissues of the skeleton without adequate treatment can cause severe pathology and significantly reduce the patient's quality of life. Dysplasia hip joints(DTS) or congenital subluxation of the joint is a common diagnosis that is noticeable even during fetal development, and can also occur in adults.

Description of the disease

The acetabulum or femoral bed is a joint of the ilium covered with cartilage. In the cavity is the head of the femoral joint, around which there are ligaments.

The thigh bed is a natural capsule that holds the head of the pelvis femur inside the cavity when it is tilted. All defects in the biomechanics of the hip joint - increased joint mobility, incomplete ossification of the cartilage head, deformity of the hip axis - are called hip dysplasia.

Hip dysplasia provokes deformation of the structure of the hip joint, as a result of which a disproportion of the head of the cartilage and the acetabulum develops, a dislocation of the joint of the right or left occurs.

Toddlers

It is a defect in the formation of one or both hip joints, the cartilage becomes less elastic, the femoral cavity becomes less deep, and the femoral head softens.

Over time, it joins, the bone becomes shorter or grows in a different direction. This complication is called a dislocation or subluxation.

In pregnant women

Dysplasia during pregnancy carries a number of threats:

• Early termination (miscarriage or premature birth);
• Opening of bleeding after childbirth;
• Violation of the development of the embryo;
• Baby hypoxia;
• Premature discharge of amniotic fluid;
• placenta insufficiency.

The course of pregnancy and method of delivery (natural or cesarean section) depend on the severity of the disease. If the gynecologist allows natural childbirth, local anesthesia is performed and the condition of the baby and the opening of the cervix are monitored.

In adults

What is hip dysplasia in adults - a violation of the structure of the hip joint due to injury or a consequence of childhood diseases. Pathology develops due to a violation of the intrauterine development of the embryo, as a complication after a difficult birth or dysfunction of the endocrine system.

Interesting!

Code for hip dysplasia according to ICD 10 (International Classification of Diseases 10th revision) - M 24.8.

Treatment of DTS in adult patients is much more complex and takes more long time than in babies. Often conservative therapy is not enough. In this case, surgical intervention is indicated - replacement of the joint with an endoprosthesis.

Causes and classification

There are many causes of hip dysplasia in adults. Poor ecology, genetic predisposition, strong emotional experiences (stress) can provoke the disease. The main causes of the disease include:

• Breech presentation of the baby;
• Large body weight of the child;
• Transferred pregnant infection;
• Wrong swaddling (tight);
• Joint injury;
• Defects in the formation of the spinal column;
• flat feet;
• Endocrine system disorders;
• The age of the future mother is more than 35 years.

Interesting!

There are two forms of DTS - unilateral and bilateral. The latter type is extremely rare.

Classical medicine classifies dysplasia into three subspecies:

• Acetabular dysplasia. With such a pathology, the femoral cavity decreases and flattens, and its cartilaginous dome is underdeveloped;
• Dislocation of the hip joint occurs when the angle of connection of the femoral neck with the trunk changes. Normally, it is 40 degrees in adults and 60 in children;
• The rotational form is an anatomical defect in the formation and location of the bones of the hip joint. It develops against the background of clubfoot and shortening of the leg.

Degrees of pathology and its consequences

It is customary to distinguish several degrees of DTS depending on the severity of the course of the disease. Distinguish:

• Initial or 1 degree of dysplasia, in which structural defects are not yet noticeable during a visual examination of the diseased limb;
• Predislocation, a characteristic feature of which is an increase in the joint capsule and a slight displacement of the femoral head;
• Subluxation, in which the head of the hip joint is significantly displaced from the cavity, catching the rim and stretching the ligaments of the thigh;
• Dislocation - the head of the joint goes beyond the boundaries of the acetabulum (outward and upward). The rim is compressed and bent inward. And the ligaments of the thigh lose their elasticity.

On a note!

The lack of timely diagnosis and adequate treatment of DTS is dangerous with systemic disorders of the structure of the hip joint, accompanied by pain and limitation of movement.

The consequence of hip dysplasia in adults is arthrosis and dysplastic coxarthrosis. Specified pathologies appear in deterioration motor activity, deformation of adjacent soft tissues, bouts of pain in the back, lower back and legs.

Another complication of DTS is neoarthrosis, in which there is an increase in the false joint at the point of contact of the femoral joint with the pelvic bones. Pathology is accompanied by severe pain, lameness, shortening of the limb. The diagnosis of neoarthrosis in most cases leads to disability.

Signs and Diagnosis

The diagnosis is usually made within the first seven days after birth. At risk are babies with breech presentation, newborns with a lot of weight, as well as those whose mothers suffered from late toxicosis. Usually doctors pay attention to three symptoms of congenital dysplasia:

• Asymmetrical folds of skin on the back of the thighs, in the groin and under the knee. They can vary in depth and length. However, one should not make a diagnosis on their own, since a slight asymmetry is also found in healthy babies, and with bilateral pathology, the gluteal folds can be identical;
• The click is noticeable only during the first three weeks of life. The indicated sign appears when the leg is moved to the side and indicates the slipping of the head from the capsule of the hip joint;
• Hip abduction angle is a common symptom in adults and toddlers. With DTS, the patient cannot spread their legs 90 degrees while lying on their back.

For grade II and III dysplasia, the abduction angle is less than 60 degrees. With an increase in muscle tone, the symptom manifests itself brighter.

In adults, signs of hip dysplasia may be less noticeable, therefore, without diagnostic methods - radiography and ultrasound. If they turn out to be uninformative, magnetic resonance or computed tomography is prescribed.

Radiography

Translucence of the bones with special rays, although it irradiates the body, but allows you to fix the clinical picture of the formation of the femoral cavity and articular head. The resulting image is cut horizontally and vertically to form an angle.

The main indicator of the state of the hip joint is the acetabular angle, which forms the Hilgenreiner line and the tangent drawn through the edge of the cavity. The larger the angle, the more severe the degree of pathology.

Ultrasound procedure

The safest way to diagnose DTS. With the help of ultrasound, you can track:

• The condition of the bones of the thigh;
• Cartilaginous protrusion;
• The location of the head at rest and during movement;
• Deviation angle of the acetabulum.

On a note!

Specialized tabular norms allow interpreting the information received.

With ultrasound diagnostics, a picture is formed that resembles an X-ray in direct projection. When conducting an ultrasound examination, pay attention to the following indicators:

• Angle alpha - the degree of deviation of the rim of the femur;
• Angle beta is the angle of deviation of the cartilage of the acetabulum.

Interesting!

Ultrasound is the safest and most informative research method recommended for children and adults. But most often, doctors prescribe an x-ray examination as the easiest and fastest way to make a diagnosis.

Treatment of pathology

Treatment of hip dysplasia in adults is aimed at eliminating pain and relieving inflammation. For this, it is recommended to take drugs from the group of NSAIDs (non-steroidal anti-inflammatory drugs) - Ibuprofen, Ketoprofen, Diclofenac.

Chondoprotectors are prescribed to prevent severe complications, the occurrence of osteoarthritis, neoatrosis, coxarthrosis. In this case, drugs such as Arteparon and Rumalon are recommended in the form of intramuscular injections. Physical therapy, massage and physiotherapy are used as auxiliary methods.

exercise therapy

Exercise therapy for hip dysplasia in adults helps to normalize the load on the joint and restore its mobility. Therapeutic exercises are shown at all stages of treatment. The only prohibition is a surgical operation and a period of rehabilitation.

Exercise should be done two to three times a day. Finish the course with a relaxing massage. Orientation complex:

• Lying on your back, bend your knees. Perform the exercise "bicycle" 10-15 times for each leg;
• Lying on your back, move your feet as close as possible to each other;
• From the same position, alternately bend and unbend the legs, making sure that the load is even.

Massage

Therapeutic massage is part of the treatment of hip dysplasia without surgery. A course of massage helps to increase blood flow, strengthen thigh muscles, and normalize tissue nutrition. The technique includes light stroking, tapping and rubbing.

Carry out the procedure every day. Start from the inside of the thigh, gently bend and take the legs to the sides. Finish with soft strokes.

Physiotherapy

The course of treatment for DTS for adults necessarily includes physiotherapy procedures. They normalize metabolic processes in soft tissues, improve blood flow, provide nutrition to damaged parts of the joint.

Physiotherapy treatment eliminates pain and muscle spasm. Usually recommend:

• Relaxing baths;
• UV treatment;
• Applications with paraffin or ozocerite;
• Electrophoresis using iodine, phosphorus and calcium.

Surgery

In the absence of the effect of conservative treatment, a closed reduction of the dislocation is recommended. This method of bloodless surgery is used to treat babies 2-3 years old. In the future, such a procedure is not possible, so older patients are recommended skeletal traction to reposition the head of the hip joint.

At the end of the procedure, the leg is rigidly fixed with a plaster cast, which should be worn for at least six months. In severe forms of dysplasia in adults, surgical treatment and replacement of the joint with an artificial prosthesis are indicated.

Disease prognosis

A favorable prognosis of hip dysplasia is possible only with timely diagnosis and adequate treatment. If the prescribed treatment was ineffective, the result depends on the degree of pathology.

The initial degree of DTS in adults may be asymptomatic. And in adulthood, lead to the occurrence of dysplastic coxarthrosis, which is characterized by a sudden onset and an acute course with increasing symptoms. The disease is accompanied by severe pain and stiffness of movements.

At a severe stage of DTS, a defective rotation of the hip is possible, in which the limb in adult patients turns outward, flexes and adducts. And movement becomes impossible.

Adequate and timely treatment in adult patients avoids serious consequences and enables the patient to lead a normal life.

Hip dysplasia is a congenital inferiority of the joint that can lead to its damage. Dysplasia in newborns is the direct cause of congenital dislocation of the hip. This pathology, in turn, can lead to a change in gait, chronic pain syndrome and significantly limit mobility in the future.

The newborn itself (a newborn is a child in the first 28 days of life) is not disturbed by dysplasia; parents and doctors identify the disease by external symptoms, and not by crying or worrying the baby. If the pathology is not treated on time, it leads to deformation of the musculoskeletal system, impaired formation of the musculoskeletal system and disability. The disease can affect one leg (more often) or both. Boys suffer from hip dysplasia 7 times less than girls.

What it is?

To date, hip dysplasia is considered the most common pathology of the musculoskeletal system in newborns and infants. "Dysplasia" in translation means "improper growth", in this case, one or both hip joints.

The development of the disease is associated with a violation of the formation in the prenatal period of the main structures of the joint:

• ligament apparatus;
• bone structures and cartilage;
• muscles;
• change in the innervation of the joint.

Most often, hip dysplasia in newborns and the treatment of this pathology is associated with a change in the location of the femoral head in relation to the bone pelvic ring. Therefore, in medicine, this disease is called congenital hip dislocation.

Treatment must begin from the moment the pathology is diagnosed, the sooner the better, and before the baby begins to walk - from that moment irreversible complications appear. They are associated with an increasing load on the joint and the exit of the head of the bone completely from the acetabulum with a displacement upward or to the side.

The child develops changes when walking: "duck" gait, significant shortening of the limb, compensatory curvature of the spine. Correct these violations can only be through surgical intervention. With pronounced changes in the joint, the baby can remain disabled for life.

Statistics

Hip dysplasia is common in all countries (2 - 3%), however, there are racial and ethnic features of its distribution. For example, the frequency of congenital underdevelopment of the hip joints in newborn children in the Scandinavian countries reaches 4%, in Germany - 2%, in the USA it is higher among the white population than African Americans, and is 1 - 2%, among American Indians hip dislocation occurs in 25- 50 per 1000, while congenital dislocation of the hip is almost never found in South American Indians, South Chinese and Africans.

The relationship of morbidity with environmental problems has been noted. The incidence in the Russian Federation is approximately 2-3%, and in ecologically unfavorable regions up to 12%. The statistics of dysplasia are contradictory. So, in Ukraine (2004), congenital dysplasia, subluxation and dislocation of the hip occur from 50 to 200 cases per 1000 (5-20%) newborns, that is, significantly (5-10 times) higher than in the same territory during the Soviet period.

A direct connection between increased morbidity and the tradition of tight swaddling of straightened baby legs was noted. Among peoples living in the tropics, newborns are not swaddled, their freedom of movement is not restricted, they are carried on their backs (while the child's legs are in a state of flexion and abduction), the incidence is lower. For example, in Japan, as part of a national project in 1975, the national tradition of tight swaddling of straightened legs of babies was changed. The training program was targeted at grandmothers to prevent traditional baby swaddling. As a result, there was a decrease in congenital dislocation of the hip from 1.1-3.5 to 0.2%.

More often this pathology occurs in girls (80% of detected cases), family cases of the disease account for about a third. Hip dysplasia is 10 times more common in children whose parents had signs of congenital hip dislocation. Congenital dislocation of the hip is detected 10 times more often in those born with a breech presentation of the fetus, more often during the first birth. Often, dysplasia is detected during drug correction of pregnancy, during pregnancy complicated by toxicosis. The left hip joint is most often affected (60%), less often the right (20%) or both (20%).

Until the first half of the last century, only a severe form of dysplasia, congenital hip dislocation (3-4 cases per 1000 births) was taken into account. In those years, "mild forms" of dysplasia were not detected and not treated. From the 70s - 90s. use the term "hip dysplasia", meaning by this not only dislocation, but also pre-luxation and subluxation of the hip joint. The incidence rates have increased tenfold.

It should be noted that the lack of clear standards and the fear of missing a severe orthopedic pathology is the reason for overdiagnosis (20-30% at the predislocation stage). The dilemma "immature hip joint and preluxation" is usually resolved in favor of dysplasia, which increases the incidence figures.

Causes of dysplasia

Underdevelopment and improper formation of the hip joint occur when the intrauterine development of the child is disturbed due to violations of the laying, development and differentiation of the baby's musculoskeletal system (from 4-5 weeks of intrauterine development to the formation of a full-fledged walk).

Causes that adversely affect the fetus and disrupt organogenesis:

• gene mutations, as a result of which orthopedic deviations develop with violations of the primary laying and the formation of defects in the hip joints of the embryo;
• the impact of negative physical and chemical agents directly on the fetus (ionizing radiation, pesticides, the use of drugs);
• large fetus or breech presentation, causing displacement in the joints due to a violation of the anatomical norms of the location of the child in the uterus;
• violation of water-salt metabolism in the fetus with kidney pathology, intrauterine infections.

Factors that negatively affect the development of the fetus and cause the formation of dysplasia on the part of the mother are:

• severe somatic diseases during pregnancy - heart dysfunction and vascular pathology, severe kidney and liver diseases, heart defects;
• beriberi, anemia;
• violation of metabolic processes;
• transferred severe infectious and viral diseases during pregnancy;
• unhealthy lifestyle, unhealthy diet and the presence of bad habits (smoking, drug addiction, drinking alcohol);
• early or late toxicosis.

In risk groups for the development of this pathology, contributing to the early diagnosis of dysplasia in infants. At the same time, even in the maternity hospital, a neonatologist and a pediatrician at the site observe the baby more actively.

This group includes, first of all, premature babies, large children, with a breech presentation of the fetus, pathologically proceeding pregnancy and with a aggravated family history. It should be noted that in girls this pathology is realized more often than in boys.

Also, in addition to true dysplasia in infants (disturbances in the development of the joint), immaturity of the joint (developmental retardation) may appear, which is considered a borderline state of the development of a dislocation of the hip joint.

Symptoms of dysplasia

When examining a baby, pay attention to the following signs (see photo):

• position and size of the lower limbs;
• the position of the skin folds in the thigh area (symmetrical or asymmetrical);
• muscle tone;
• volume of active and passive movements.

Hip dysplasia in infants presents with characteristic symptoms.

1. Restriction of hip abduction. Childhood hip dysplasia is manifested by the presence of abduction restriction to 80 degrees or less. The symptom is most characteristic of a unilateral lesion.
2. Slip symptom (synonym: click symptom). The child is laid on his back, bending his legs both at the knee and hip joints at an angle of 90 degrees (the examiner's thumbs are placed on the inner surface of the thighs, the remaining fingers are on the outer surface). When the hips are abducted, pressure is applied to the greater trochanter, resulting in the reduction of the femoral head. The process is accompanied by a characteristic click.
3. External rotation of the lower limb is a sign characterized by the rotation of the thigh on the side of the lesion outwards. May also occur in healthy children.
4. Relative shortening of the limb. The symptom is rare in newborns, observed with high dislocations.
5. The asymmetric position of the femoral and gluteal folds is detected during an external examination.

Secondary (auxiliary) signs of hip dysplasia in a newborn:

• atrophy of soft tissues (muscles) on the affected side;
• the pulsation of the femoral artery is reduced from the side of the dysplastically changed joint.

Asymptomatic cases of congenital hip dislocation are rare.

Severity of DTS

1. I degree - pre-dislocation. Deviation of development, in which the muscles and ligaments are not changed, the head is located inside the oblique cavity of the joint.
2. II degree - subluxation. Inside the articulation cavity there is only a part of the femoral head, since its upward movement is observed. Ligaments are stretched and lose tension.
3. III degree - dislocation. The head of the femur is completely out of the cavity and is located higher. The ligaments are in tension and stretched, and the cartilaginous rim enters the inside of the joint.

Diagnostics

In a baby, signs of hip dysplasia in the form of a dislocation can be diagnosed even in the maternity hospital. The neonatologist should carefully examine the child for the presence of such abnormalities in certain complications of pregnancy.

The risk group includes children who belong to the category of large, babies with deformed feet and with a burdened heredity on this basis. In addition, attention is paid to the toxicosis of pregnancy in the mother and the sex of the child. Newborn girls are subject to mandatory examination.

Examination methods:

1. Ultrasound diagnostics is an effective method for detecting abnormalities in the structure of the joints in children during the first three months of life. Ultrasound can be performed repeatedly and is allowed when examining newborns. The specialist pays attention to the condition of cartilage, bones, joints, calculates the angle of deepening of the hip joint.
2. Arthroscopy, arthrography are performed in severe, advanced cases of dysplasia. These invasive techniques require general anesthesia to obtain detailed information about the joint.
3. CT and MRI provide a complete picture pathological changes in the joints in various projections. The need for such an examination appears when planning an operative intervention.
4. The radiograph is not inferior in reliability to ultrasound diagnostics, but has a number of significant limitations. The hip joint in children under seven months of age is poorly visible due to the low level of ossification of these tissues. Irradiation is not recommended for children of the first year of life. In addition, it is problematic to put a moving baby under the apparatus in compliance with the norms of symmetry.
5. External examination and palpation is carried out in order to identify the characteristic symptoms of the disease. In infants, hip dysplasia has signs of both dislocation and subluxation, which are difficult to detect clinically. Any symptoms of deviations require a more detailed instrumental examination.

Effects

If there is no treatment, then at an early age it can threaten the child with serious troubles. Children develop limping while walking, it can be both subtle and pronounced. Also, the baby will not be able to move his leg to the side, or will do it with great difficulty. The child will be disturbed by constant pain in the knees and in the pelvic area with a possible distortion of the bones. Depending on the severity of the symptoms of dysplasia, children experience muscle atrophy of varying severity.

Gradually, with the growth of the child, the consequences of untreated dysplasia will be aggravated and expressed in the development of the so-called "duck walk", when the baby rolls from one leg to another, sticking his pelvis back. The motor activity of such a child will be limited, which will entail the underdevelopment of not only other joints, but will also affect the work of all organs and overall physical development. In the future, the muscles of the leg can completely atrophy, the person will begin to pursue constant incessant pain. In adult patients, hyperlordosis of the spine in the lumbar region is observed. All organs located in the pelvic region also suffer.

All this can be avoided if you start treatment on time and follow preventive measures.

Treatment of hip dysplasia in newborns

Modern conservative treatment of hip dysplasia in newborns is carried out according to the following basic principles:

• giving the limb an ideal position for repositioning (flexion and abduction);
• the earliest possible start;
• maintaining active movements;
• long-term continuous therapy;
• the use of additional methods of influence (therapeutic exercises, massage, physiotherapy).

Quite a long time ago, it was noticed that when the child's legs are in the abducted state, self-adjustment of dislocation and centering of the femoral head are observed. This feature is the basis of all currently existing methods of conservative treatment (wide swaddling, Freik's pillow, Pavlik's stirrups, etc.).

1. Without adequate treatment, hip dysplasia in adolescents and adults leads to early disability, and the result of therapy directly depends on the timing of the start of treatment. Therefore, the primary diagnosis is carried out even in the hospital in the first days of the baby's life.
2. Today, scientists and clinicians have come to the conclusion that it is unacceptable to use rigid fixing orthopedic structures in infants under six months of age that limit movement in abducted and bent joints. Maintaining mobility helps center the femoral head and increases the chances of healing.

Conservative treatment involves long-term therapy under the control of ultrasound and X-ray examination.

Wide baby swaddling

Wide swaddling can rather be attributed not to therapeutic, but to preventive measures for hip dysplasia.

Indications for wide swaddling:

• the child is at risk for hip dysplasia;
• during an ultrasound scan of a newborn child, the immaturity of the hip joint was revealed;
• there is hip dysplasia, while other methods of treatment are impossible for one reason or another.

Wide swaddling technique:

• the child is laid on his back;
• two diapers are laid between the legs, which will limit the bringing of the legs together;
• these two diapers are fixed on the third child's belt.

Free swaddling allows you to keep the baby's legs in a divorced state by about 60 - 80 °.

Massage and exercise therapy

Exercises and massage are performed before feeding: these procedures stimulate blood circulation, improve the nutrition of the structures of the hip joint. As a result, the growth processes of cartilage and bone tissue, nerve conduction increases - and the joint is formed correctly.

Massage movements are performed smoothly and gently. Apply stroking, rubbing and kneading the muscles of the thighs, buttocks, lower back. The newborn is laid out both on the back and on the stomach. The duration of the massage is about 5 minutes. After the procedure, you can leave him to lie down for some time on his stomach so that the legs hang down to the sides. It tempers and additionally strengthens the body.

A set of exercises is selected by an exercise therapy doctor or a pediatrician according to the degree of development of the disease. Most often this is: abduction of bent legs to the sides (contraindicated in slippage syndrome), flexion and extension in the hip and knee joints. The movements are very smooth. At first, they are recommended to be done in water, when bathing. The duration of gymnastics is also about 5 minutes.

To deal with a newborn at home, parents need to attend massage and exercise therapy courses at the clinic.

Wearing various orthopedic appliances

Freik's pillow, Pavlik's stirrups and others. All this also helps to keep the child's legs in a divorced and bent state. It is this method of treating hip dysplasia in infants that seems blasphemous to many parents, since they have to constantly see their baby “chained” in orthopedic struts.

It is worth remembering that this measure is necessary, but temporary, and should be treated with patience and understanding. The initial discomfort in the child disappears within about a week, then he gets used to it and no longer feels uncomfortable from wearing the splint. The duration of the use of such devices is determined by the doctor on the basis of periodic examinations and ultrasound diagnostics.

Physiotherapy

Many physiotherapeutic procedures are used that eliminate the inflammatory reaction, improve joint trophism and reduce joint pain. The most commonly used procedures are:

Features of care for newborns with dysplasia

At right approach to treatment and care, dysplasia in newborns is surmountable. If your baby has disorders in the development of the hip joints, then he needs daily care and constant adherence to special rules when carrying, feeding, and going to bed.

1. Hip dysplasia in newborns excludes vertical loads on the legs.
2. If the child is in a lying position, then his feet should hang down a little, in this way tension is better relieved from the thigh muscles.
3. Transportation by car in a special child seat that does not interfere with the wide spreading of the legs.
4. The correct position during carrying in your arms: hold the baby in front of you by the back, while his legs should tightly wrap around you from behind.
5. Make sure that when feeding and sitting, the hips are separated as far as possible.

The hip joint is an important supporting element of the human skeleton. He is constantly exposed to heavy loads when carrying heavy loads, running, long walking. It is necessary to follow the correct full development of this joint from infancy, otherwise in adulthood the disease will still make itself felt, but it will be much more difficult to cure it than dysplasia in newborns.

Reduction of congenital hip dislocation

Indications for reduction of congenital dislocation of the hip:

1. The child is over 1 year old. Prior to this, the dislocation is relatively easily reduced using functional techniques (splints and orthoses, see above). But there is no single unambiguous algorithm. Sometimes a dislocation after 3 months of age can no longer be corrected by any means other than surgical intervention.
2. The age of the child is not more than 5 years. At an older age, you usually have to resort to surgery.
3. The presence of a formed dislocation of the hip, which is determined by radiography and / or ultrasound.

Contraindications for closed reduction of congenital hip dislocation:

1. Severe underdevelopment of the acetabulum;
2. Strong displacement of the femoral head, inversion of the articular capsule into the joint cavity.

Closed reduction in congenital dislocation of the hip is performed under general anesthesia. The doctor, guided by the X-ray and ultrasound data, carries out the reduction - the return of the femoral head to the correct position. Then, for 6 months, a coxite (on the pelvis and lower limbs) plaster cast is applied, which fixes the child's legs in a divorced position. After removing the bandage, massage, therapeutic exercises, and physiotherapy are performed.

However, some children develop a relapse after closed reduction of congenital hip dislocation. The older the child, the more likely it is that eventually you will still have to resort to surgery.

Prevention of pathology

If you do not want dysplasia to appear in your baby, you must follow certain precautions:

1. Taking vitamins, proper nutrition, light physical activity during pregnancy.
2. Constant implementation of the doctor's recommendations during pregnancy. at the same time, an important element of the examination is ultrasound, which can show health problems even at an early stage of fetal development.
3. Postpartum examination by an orthopedist, as well as ultrasound of the hip joint.
4. It is necessary to eliminate those causes that can lead to the appearance of pathology and provoke dislocation.
5. The use of therapeutic exercises and regular physical activity, which will help to put and fix the bone in place.
6. Wearing a baby in a sling, as well as the use of wide swaddling.
7. If the diagnosis of "dysplasia" is nevertheless made, then you can not put the baby on its legs until the doctor allows it.

Modern methods of diagnosis and treatment of hip dysplasia are still far from perfect. In outpatient institutions (polyclinics), cases of underdiagnosis (diagnosis is not made on time with existing pathology) and overdiagnosis (diagnosis is made to healthy children) are still common.

Many orthopedic constructions and options have been proposed surgical treatment. But none of them can be called completely perfect. There is always a certain risk of recurrence and complications. Different clinics practice different approaches to the diagnosis and treatment of pathology. Research is currently ongoing.

hip dysplasia- This is a congenital disorder of the formation of the joint, which can cause dislocation or subluxation of the femoral head. There is either underdevelopment of the joint, or its increased mobility in combination with connective tissue deficiency. At an early age, it is manifested by asymmetry of skin folds, shortening and limitation of hip abduction. In the future, pain, lameness, increased fatigue of the limb are possible. Pathology is diagnosed on the basis of characteristic signs, ultrasound data and X-ray examination. Treatment is carried out using special means of fixation and exercises for muscle development.

ICD-10

Q65.6 Q65.8

General information

Hip dysplasia (from the Greek dys - violation, plaseo - form) - a congenital pathology that can cause subluxation or dislocation of the hip. The degree of underdevelopment of the joint can vary greatly - from gross violations to increased mobility in combination with weakness of the ligamentous apparatus. To prevent possible negative consequences, hip dysplasia must be detected and treated at an early stage - in the first months and years of a baby's life.

Hip dysplasia is one of the most common congenital pathologies. According to experts in the field of traumatology and orthopedics, the average frequency is 2-3% per thousand newborns. There is a dependence on race: in African Americans it is observed less often than in Europeans, and in American Indians it is more often than in other races. Girls get sick more often than boys (about 80% of all cases).

Causes

The occurrence of dysplasia is due to a number of factors. There is a clear hereditary predisposition - this pathology is 10 times more common in patients whose parents suffered from a congenital disorder of the development of the hip joint. The likelihood of developing dysplasia is 10 times increased with a breech presentation of the fetus. In addition, the likelihood of this pathology increases with toxicosis, drug correction of pregnancy, large fetus, oligohydramnios, and some gynecological diseases in the mother.

Researchers also note the relationship between the incidence rate and unfavorable environmental conditions. In ecologically unfavorable regions, dysplasia is observed 5-6 times more often. The development of dysplasia is also influenced by national traditions of swaddling babies. In countries where newborns are not swaddled and the baby's legs are in abduction and flexion most of the time, dysplasia is less common than in countries with a tradition of tight swaddling.

Pathogenesis

The hip joint is formed by the head of the femur and the acetabulum. In the upper part, a cartilaginous plate is attached to the acetabulum - the acetabular lip, which increases the contact area articular surfaces and depth of the acetabulum. The hip joint of a newborn baby even normally differs from the joint of an adult: the acetabulum is flatter, located not obliquely, but almost vertically; ligaments are much more elastic. The femoral head is held in place by the round ligament, articular capsule, and labrum.

There are three forms of hip dysplasia: acetabular (impaired development of the acetabulum), dysplasia of the upper femur and rotational dysplasia, in which the geometry of the bones in the horizontal plane is disturbed.

If the development of any of the departments of the hip joint is impaired, the acetabular lip, articular capsule and ligaments cannot hold the femoral head in place. As a result, it shifts outwards and upwards. In this case, the acetabular lip also shifts, finally losing the ability to fix the femoral head. If the articular surface of the head partially extends beyond the cavity, a condition occurs, called subluxation in traumatology.

If the process continues, the femoral head moves even higher and completely loses contact with the articular cavity. The acetabular lip is below the head and is wrapped inside the joint. A dislocation occurs. If untreated, the acetabulum is gradually filled with connective and adipose tissue, which makes reduction difficult.

Symptoms of dysplasia

Hip dysplasia is suspected in the presence of hip shortening, asymmetric skin folds, limited hip abduction, and Marx-Ortolani slipping. Asymmetry of the inguinal, popliteal and gluteal skin folds is usually better detected in children older than 2-3 months. During the inspection, they pay attention to the difference in the level of location, shape and depth of the folds.

It should be borne in mind that the presence or absence of this symptom is not enough to make a diagnosis. With bilateral dysplasia, the folds may be symmetrical. In addition, the symptom is absent in half of the children with unilateral pathology. The asymmetry of the inguinal folds in children from birth to 2 months is of little information, since it sometimes occurs even in healthy infants.

The symptom of hip shortening is more reliable in diagnostic terms. The child is laid on the back with the legs bent at the hip and knee joints. The location of one knee below the other indicates the most severe form of dysplasia - congenital hip dislocation.

But the most important sign indicating congenital dislocation of the hip is the “click” or Marx-Ortolani symptom. The baby lies on his back. The doctor bends his legs and clasps his hips with his palms so that the II-V fingers are located on the outer surface, and the thumbs are on the inner. Then the doctor evenly and gradually takes the hips to the sides. With dysplasia, a characteristic push is felt on the diseased side - the moment when the femoral head from the dislocation position is set into the acetabulum. It should be borne in mind that the Marx-Ortolani symptom is not informative in children in the first weeks of life. It is observed in 40% of newborns, and subsequently often disappears without a trace.

Another symptom that indicates the pathology of the joint is the limitation of movements. In healthy newborns, the legs are retracted to a position of 80-90 ° and freely placed on the horizontal surface of the table. When the abduction is limited to 50-60°, there is reason to suspect a congenital pathology. In a healthy child of 7-8 months, each leg is retracted by 60-70°, in a baby with congenital dislocation - by 40-50°.

Complications

With minor changes and no treatment, any painful symptoms at a young age may be absent. Subsequently, at the age of 25-55 years, the development of dysplastic coxarthrosis (arthrosis of the hip joint) is possible. As a rule, the first symptoms of the disease appear against the background of a decrease in motor activity or hormonal changes during pregnancy.

Characteristic features of dysplastic coxarthrosis are acute onset and rapid progression. The disease is manifested by discomfort, pain and limitation of movement in the joint. In the later stages, a vicious position of the hip is formed (the leg is turned outward, bent and adducted). Movement in the joint is severely limited. In the initial period of the disease, the greatest effect is provided by properly selected physical activity. With a pronounced pain syndrome and a vicious installation of the hip, endoprosthetics is performed.

With unreduced congenital dislocation of the hip, a new defective joint is formed over time, combined with shortening of the limb and dysfunction of the muscles. Currently, this pathology is rare.

Diagnostics

A preliminary diagnosis of hip dysplasia can be made even in the hospital. In this case, you need to contact a pediatric orthopedist within 3 weeks, who will conduct the necessary examination and draw up a treatment regimen. In addition, to exclude this pathology, all children are examined at the age of 1, 3, 6 and 12 months.

Particular attention is paid to children who are at risk. This group includes all patients with a history of maternal toxicosis during pregnancy, a large fetus, breech presentation, as well as those whose parents also suffer from dysplasia. If signs of pathology are detected, the child is sent for additional studies.

A clinical examination of the baby is carried out after feeding, in a warm room, in a calm, quiet environment. To clarify the diagnosis, methods such as radiography and ultrasonography are used. In young children, a significant part of the joint is formed by cartilage, which is not displayed on radiographs, therefore, this method is not used until the age of 2-3 months, and then special schemes are used when reading images. Ultrasound diagnostics is a good alternative to X-ray examination in children during the first months of life. This technique is practically safe and quite informative.

It should be borne in mind that the results of additional studies alone are not enough to make a diagnosis of hip dysplasia. The diagnosis is made only when both clinical signs and characteristic changes on radiographs and/or ultrasonography are identified.

Treatment of hip dysplasia

Treatment should begin as soon as possible. Various means are used to hold the child's legs in the position of flexion and abduction: devices, splints, stirrups, panties and special pillows. In the treatment of children in the first months of life, only soft elastic structures are used that do not interfere with the movements of the limbs. Wide swaddling is used when it is impossible to carry out a full-fledged treatment, as well as during the treatment of babies at risk and patients with signs of an immature joint, identified during ultrasonography.

One of the most effective ways to treat young children is Pavlik's stirrups - a soft fabric product, which is a chest bandage, to which a system of special straps is attached to keep the child's legs laid aside and bent at the knee and hip joints. This soft construction keeps the baby's legs in the right position and, at the same time, provides the child with sufficient freedom of movement.

Special exercises to strengthen the muscles play an important role in restoring the range of motion and stabilizing the hip joint. At the same time, for each stage (breeding the legs, keeping the joints in the correct position and rehabilitation), a separate set of exercises is compiled. In addition, during the treatment, the child is prescribed a massage of the gluteal muscles.

In severe cases, one-stage closed reduction of the dislocation is performed, followed by immobilization with a plaster cast. This manipulation is performed in children from 2 to 5-6 years. When the child reaches the age of 5-6 years, reduction becomes impossible. In some cases, with high dislocations in patients aged 1.5-8 years, skeletal traction is used. With the ineffectiveness of conservative therapy, corrective operations are performed: open reduction of the dislocation, surgical interventions on the acetabulum and the upper part of the femur.

Forecast and prevention

With an early start of treatment and timely elimination of pathological changes, the prognosis is favorable. In the absence of treatment or with insufficient effectiveness of therapy, the outcome depends on the degree of hip dysplasia, there is a high probability of early development of severe deforming arthrosis. Prevention includes examinations of all young children, timely treatment of the identified pathology.

The health of children is a great happiness for parents. Unfortunately, this is not always the case. Newborn babies from 5 to 20 cases are diagnosed with hip dysplasia. phrase "hip dysplasia" shocks all parents. However, you should not panic, it is important to correctly diagnose this disease and take immediate action.

What is hip dysplasia?

The baby has an unformed hip joint, this is a physiological phenomenon. As a result, it is mobile and can come out of the articular cavity. This affects the fact that it can develop incorrectly, and then a diagnosis of hip dysplasia is made.

In the international classification of this disease (ICD-10 code), it is assigned a separate group and class Q 65.0 - 65.5. This is a congenital dislocation of the hip joints.

With this pathology, serious medical intervention is required. Rather, a painstaking and attentive attitude on the part of the parents in order to avoid future complications in the form of inflammation, acute pain and lameness.

The structure of the hip joint

The hip joint differs from many joints in that it carries a large range of motion. It can move and rotate in different directions. The femur has a thin neck and head. In a normal state, there is a distance from the head to the cavity itself. The head should be in the center and clearly fixed with ligaments.

In utero, the fetus does not experience stress on the joints, and at birth, the baby has no stress. These ligaments and muscles do not form. Sometimes at birth they find that the head is not where it should be.

AT early term head needs to be put back in place. It is important to do this before walking, while there is no load on the joint. Otherwise, hip dislocation is possible. It is called innate. Although practice shows that children with such a pathology are not born. It is possible to foresee the development of some problems with the joint in the future.

Dislocation of the hip joint

Dysplasia exists in mild, moderate and severe.

It is referred to as pre-luxation, subluxation, dislocation of the hip:

• preluxation characterizes a mild form of the disease. It belongs to the first degree. Means not the full dynamics of the development of the joint. In this situation, the displacement of the head does not occur in relation to the cavity.
• Subluxation characterizes the second degree of dysplasia. With this disease, there is an incomplete displacement of the head in relation to the articular cavity.
• hip dislocation- this is the third degree of the disease and is characterized by a 100% displacement of the head in relation to the articular cavity.

Degrees of joint dysplasia

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Causes of the disease

Some time before childbirth and in the process itself, the woman in labor produces a special hormone, relaxin, which makes the ligaments more elastic. It is produced so that the mother can give birth. It makes the hip joint of the woman in labor mobile.

Relaxin acts simultaneously on mother and fetus. And if the fetus is a girl, then her ligaments are more affected by this hormone than boys. Therefore, dysplasia is more common in girls than in boys. According to the most conservative estimates, there are 5 girls for every 1 boy with dysplasia. More often this ratio is 1:9.

In primiparas, the concentration of this hormone is maximum. Therefore, when a woman gives birth to a girl as her first child, such a child is closely monitored.

Other reasons are:

• Heredity.
• Often it is a large fruit. The baby may not have enough space in utero, and the leg is often pressed down, so the joint does not develop normally.
• With malnutrition of the mother in labor, the child may receive less nutrients for full development.
• Infection of the child due to illness of the mother.
• Taking toxic drugs that affect the bone and destroy it.
• Tight swaddling of the baby in the first days.

Forms of development of dysplasia

There are the following types or forms of dysplasia:

• Acetabular(acetabular dysplasia). It is characterized by the pathology of the acetabulum of the pelvic bone, its flattening occurs, and disturbances occur in the cartilage of the limbus. The joint, together with the head and muscles, do not develop normally.
• rotary appears when the child's joints are delayed in development. Two important joints function poorly among themselves - the hip and knee. Manifested in the form of a child's clubfoot.
• epiphyseal(dysplasia of the proximal femur). Characterized by the appearance of pain symptoms and deformities of the legs. Disturbed movement in the hip joint. The head of the joint ossifies, and it becomes brittle. Therefore, there are changes in the position of the femoral neck.
• Transient dysplasia is a change in the shape of the femoral head. This stage is considered the most dangerous. It happens more often with girls. In this case, there is a violation of the anatomy of the joints. The state of the connections is broken. Sometimes the head goes beyond the cavity.

The disease can be unilateral or bilateral, depending on the involvement of one or both joints.

Ways to determine dysplasia at home

There are 3 important indicators so that mom can recognize the first signs:

1. Folds. their symmetry. Buttocks and on the thigh. If they are not the same, but of different depths and at different levels, this is a signal! We urgently need to show the baby to a specialist.
2. Same knee height. The child is laid on his back, and his legs are bent at the hip joint and at the knee. The height of the knees should be the same. If not, this is a reason to turn to a specialist.
3. The uniformity of the breeding of the legs. Breeding the legs of the child should be even in both directions. This is the norm. If one leg is divorced more than the left one, this is a reason to contact a specialist. Most often this happens with the left leg.

If the baby has the same folds, and the knees are at the same level, and the legs are bred the same way, this does not mean that you need to ignore a visit to a specialist. Because there is bilateral dysplasia, when both legs are crooked. In such a situation, everything will be symmetrical, but the situation will be bad.

Therefore, you need to regularly visit preventive examinations of specialists in order to identify and detect signs at an early stage!

Signs of dysplasia

Diagnosis of dysplasia

In some babies, in a certain position, when the legs are spread, they hear a click. This suggests that the femoral head is in an unstable position. An appeal to an orthopedist is also indicated.

With the age of the child, the data changes. Already from 4 months, with the likelihood of a violation of the hip joint, the baby is recommended for x-ray diagnosis, in order to exclude or confirm it.

Diagnostics means:

• Careful examination by a pediatrician. In case of suspicion of pathology, the doctor sends for examination:
• and .
• If dysplasia is suspected, the doctor may refer you for an X-ray examination.. X-ray diagnostics will show the whole picture of the condition of the joints.

Definition of angles

Hip abduction angles

After the ultrasound, the doctor draws three lines on the result of the image, which form the angles alpha and beta:

• Emphasizes the formation of ossification nuclei.
• The data is compared with the graph table, where the alpha angle shows the correct development of the acetabulum in a child.
• When the doctor examines the beta angle, he has information about the degree of development of the cartilage zone.
• In infants up to 3 months, the alpha angle is greater than 60 degrees, the beta angle is less than 55. This is considered normal.

Hip abduction angles

Deviation from the norm and interpretation of the results

In the case when the alpha angle is 43 and its limits do not go beyond 49 degrees, and the beta is more than 77, the baby, according to the results of the X-ray examination, is given a subluxation verdict, and when the alpha angle is less than 43 degrees - dislocation.

The breakdown of the results looks like this.

1 kind	Norm	A - the hip joint is formed correctly, B - the cartilage plate is expanded, has a limited length
2nd view	Delay	A - delayed formation (up to 3 months), B - delayed formation (after 3 months), orthopedic treatment is indicated, C - predislocation.
3 view	Subluxation	A - the head of the femur is displaced, the cartilage structure is normal. Presence of structural changes
4 view	Dislocation	The hip joint has a pathology, the cartilaginous protrusion does not cover the head of the femur.

Read also

Dysplasia in children older than 6 months

Orthopedists adjust the femoral head. At the same time, the leg is pulled out and fixed with a plaster cast. Works efficiently. After this procedure, which is performed without anesthesia, the legs are fixed for 4 months or more.

After removing the plaster, a spacer bar is installed on the baby's legs. Its width changes. Over time, the distances between the spacers decrease. It is removed when the joint is fully restored.

If the phenomena of residual dysplasia remain, then it is necessary to engage in physiotherapy exercises with specialists.

In children under 1 year old and one-year-olds, manifestations of dysplasia are observed:

• Impossibility of uniform abduction of the hips.
• Asymmetry of skin folds.
• The presence of a click when breeding joints.
• Different leg lengths.
• The diseased limb is turned outward. Observed in the state of sleep.

Treatment

Fixative orthopedic aids

When the diagnosis is confirmed, doctors recommend using it to keep the child's joints in a divorced position. Pavlik's stirrups, splints, Freik pillows, special panties and others are used. Recommend constant wearing up to 1 year of life of the baby.

They are important for the baby both in the present tense and as a manifestation of the future of the child. To prevent diseases in adulthood, such as scoliosis and osteochondrosis.

Stirrups Pavlik Fixation with plaster

Wide swaddling required:

• It is strictly forbidden to wear and lay the baby when his legs hang down or are pressed tightly.
• With this method, the baby's arms are tightly fixed to the body line, and the legs can be in free "flight".
• Orthopedic devices fix the hip joint of the child. The legs are bent and spread apart.

Gymnastics and physiotherapy exercises

How dangerous is hip dysplasia?

There will be a dislocation of the hip joint, and a person can limp for life if not cured in early period. An inflammatory process appears, and this is acute pain and limited mobility.

If it is not prematurely treated with conservative methods - massage, special orthopedic stirrups, plastering, splints, then surgical interventions are possible in the future to eliminate this problem.

IMPORTANT! The specificity of dysplasia is that timely intervention eliminates the great consequences that may arise in the future. At 1.5-2 years, dysplasia threatens with lameness if it is not diagnosed and treated.

Prevention

The main goal in this disease is fixation of the head of the hip bone in the articular cavity. It is necessary to give her the opportunity to acquire ligaments so that in the future she does not move. If the child's legs are fixed in the correct position (flexed and separated), the femoral head rises into its desired position and is strengthened by this position.

Today, such a device for carrying babies called a sling has come into fashion. It is convenient for mother and baby, and besides this, it helps to avoid problems with dysplasia in the future, since in the sling the child's legs are widely separated and pressed against the mother.

Sling can help prevent hip dysplasia

Tips for the prevention of dysplasia Dr. Komarovsky

The advice of Dr. Komarovsky will always help the child:

• If the child was diagnosed with dysplasia, do not panic, and take good care of the baby.
• Wide swaddling shown And the diaper is a size bigger. Do not encourage standing and the desire to walk, let the child crawl longer.
• Use buttocks massage, do gymnastics.
• Take targeted action for the prevention of dysplasia.
• Mandatory visit to the orthopedic doctor every 3 months. In 2-3% of people in adolescence, there may be problems with the hip joint. At an older age, something that has not been cured in younger age before walking. Early correction allows you to solve this issue once and for all.
• Apply doctor's advice which he will give based on the condition of the child
• There should be a dialogue between parents and the doctor. You are both responsible.
• If parents like to dress their baby in overalls, instead of the usual diapers and blankets, it is important to know that at the bottom of the overalls there should be enough space so that the baby can freely move his legs.

Hip dysplasia in children today is a fairly common disease. It does not always appear immediately, so remember that it is necessary to systematically examine the child with a doctor. Why is the disease dangerous? The fact is that with age, if timely treatment is not started, a person can become disabled.

Do not neglect the advice of a doctor, listen to his recommendations. Remember, the disease is easier to prevent at the very beginning than to engage in long-term treatment later. Get diagnosed with your child in a timely manner.

Hip Dysplasia - Description

Hip dysplasia is a fairly common pathology, but parents often have a question: why is an outwardly absolutely healthy child forced to wear stirrups, spreading devices and other orthopedic devices that cause a lot of inconvenience to the baby and delay his motor development?

The fact is that undiagnosed or undertreated in infancy, hip dysplasia in adulthood leads to disruption of its functioning, up to disability.

Dysplasia is the congenital inferiority of the hip joint, associated with the abnormal development of its constituent structures: the muscular-ligamentous apparatus, the articular surfaces of the pelvis and the head of the femur.

Due to a violation of the growth of joint structures, the femoral head is displaced relative to the articular surface of the pelvis (subluxation, dislocation). Surgeons and orthopedists under the concept of "hip dysplasia" combine several diseases:

• congenital predislocation - a violation of the formation of the joint without displacement of the femoral head;
• congenital subluxation - partial displacement of the femoral head;
• congenital dislocation is an extreme degree of dysplasia, when the femoral head does not come into contact with the articular surface of the acetabulum of the pelvic bone;
• X-ray immaturity of the hip joint is a borderline condition characterized by a lag in the development of the bone structures of the joint.

In newborns and children in the first months of life, predislocation is most often observed - a clinically and radiologically determined violation of the development of the hip joint without displacement of the femoral head.

Without proper treatment, as the child grows, it can transform into subluxation and dislocation of the hip. Due to the violation of the ratio of articular surfaces, cartilage is destroyed, inflammatory and destructive processes join, which leads to the occurrence of a severe disabling disease - dysplastic coxarthrosis.

Unilateral dysplasia occurs 7 times more often than bilateral, and left-sided - 1.5-2 times more often than right-sided. In girls, violations of the formation of the hip joints occur 5 times more often than in boys.

Types of hip dysplasia

The frightening name "hip dysplasia" is heard by many parents of children up to a year old, getting on scheduled examinations to an orthopedist. From Greek, "dysplasia" is translated as "developmental disorder", "educational deviation from the norm."

That is, the diagnosis of "hip dysplasia" could be more simply called - deviation, pathology, underdevelopment in the hip joint, which in the future bears all the load when walking.

Let's imagine the hip joint figuratively.

It consists of a femur, the end of which resembles a ball. This "ball" needs to get into the house - the acetabulum of a semicircular shape - and gain a foothold there with muscles and joints. That's all there is to the hip joint. Depending on whether the head is located correctly in the cavity: at what depth, at what angle, how it turns, how the joints hold it, the degree of development of hip dysplasia in children depends.

preluxation

If the head is correctly located in the cavity, dysplasia is not observed.

If the underdevelopment of the cavity is noticeable - it is small, but at the same time the head (ball) hit the house at the right angle, the first degree of dysplasia is suspected - predislocation. A presumptive diagnosis is often made in newborns.

The fact is that at birth, the cavity is still underdeveloped - it is shallow. Parents whose children have been diagnosed with 1st degree of dysplasia - pre-luxation, need to be especially careful about the prevention of dysplasia: wide swaddling, special exercises, massages. In this case, it is better to play it safe if your baby is predisposed to dysplasia.

Subluxation

With a partial miss of the femoral head, subluxation is diagnosed - the second degree of hip dysplasia in children.

This is a more serious diagnosis that requires special treatment, most often with the use of devices that help fix the head in the cavity - Velinsky's splint, spacers, plaster casts, but most often - Pavlik's stirrups.

Back in the 20th century, the Czech orthopedist Pavlik developed a method for treating dysplasia. Special stirrups fix the head of the femur at the right angle in the cavity. The fixed head does not fall out of the cavity, is in the correct position.

You can't take the stirrups off! It is important to comply with this condition, since undertreated dysplasia leads to a more severe form - dislocation and requires repeated longer treatment.

Some of my friends, whose daughter was assigned to wear Pavlik's stirrups, did not take them off for 3 months. Then the parents felt sorry for the girl, and for the next 3 months they “released” the baby for a while. To the great joy of her parents, the girl began to walk almost at the age of one. And not just walk, but walk evenly and run. But at a scheduled examination a year, the girl was diagnosed with dysplasia.

Parents did not believe, turned to several orthopedists. The diagnosis was confirmed each time - the child has hip dysplasia.

The stirrups were put on the girl again. And as her mother says, now that the girl has already tried to walk and run, everything is much harder to endure psychologically and physically.

So it is very important that if your child is assigned to wear Pavlik's stirrups or other similar device, follow the time limits recommended by the doctor. It is impossible to load the joint by walking before the head is in place.

If you feel sorry for the child or you doubt the correctness of the diagnosis, contact several specialists. Thankfully, it's possible these days. Think that you are helping your child, not torturing him.

Dislocation

With a complete displacement (not falling or falling out) of the femoral head from the cavity, the third degree of hip dysplasia develops in children - dislocation. This is the most severe form of this disease.

To put the head of the bone in place, treatment is often prescribed by position - the baby's legs are plastered or fixed with plastic devices. In the worst case, an operation is prescribed.

Causes

The causes of hip dysplasia in children are not fully understood.

It is only known for certain that dysplasia is more common in girls. This is explained by the fact that during pregnancy a woman begins to produce a hormone, the main task of which is to make the joints and muscles soft and elastic so that the woman can give birth. This hormone affects not only the joints and muscle tissues of the future woman in labor, but also the baby, especially the joints of the female child.

The second factor that predisposes to the development of hip dysplasia in children is the first birth. It has been proven that more of this hormone is produced during the first pregnancy than during each subsequent pregnancy.

Babies with breech presentation are more at risk. It is noted that left-sided dysplasia is more common. This arises due to the physiological characteristics of the location of the child in the womb. The left leg is bent more.

The larger the fetus, the higher the risk that there will be hip dysplasia in the child after birth.
Genetic predisposition, parental age and other factors also play a role in the development of dysplasia.

There are many causes for hip dysplasia. The main ones are hereditary predisposition, breech presentation of the fetus during pregnancy, pathology of the 1st trimester of pregnancy, oligohydramnios and many others.

Sometimes, a congenitally normal hip joint may lag behind in further development and not correspond to age - then this dysplasia is no longer congenital, but “acquired”.

There are several theories of the occurrence of hip dysplasia, but the most reasonable are genetic (in 25-30% there is heredity through the female line) and hormonal (impact on the ligaments of sex hormones before childbirth).

The hormonal theory is confirmed by the fact that dysplasia is much more common in girls than in boys. During pregnancy, progesterone prepares the birth canal for childbirth by softening the ligaments and cartilage of the woman's pelvis.

Once in the blood of the fetus, this hormone finds the same application points in girls, causing relaxation of the ligaments that stabilize the hip joint. In most cases, if you do not interfere with the process of tight swaddling, the restoration of the ligament structure occurs within 2-3 weeks after childbirth.

It has also been observed that the development of dysplasia is facilitated by the limitation of the mobility of the hip joints of the fetus even during intrauterine development. In this connection, left-sided dysplasia is more common, since it is the left joint that is usually pressed against the wall of the uterus.

In the last months of pregnancy, the mobility of the hip joint can be significantly limited if there is a threat of abortion more often in primiparas, in the case of breech presentation, oligohydramnios and a large fetus.

To date, the following risk factors for hip dysplasia are distinguished:

1. parents with hip dysplasia
2. anomalies in the development of the uterus,
3. unfavorable course of pregnancy (threat of abortion, infectious diseases, taking medications)
4. breech presentation of the fetus,
5. transverse position of the fetus
6. multiple pregnancy,
7. oligohydramnios,
8. natural childbirth with breech presentation of the fetus,
9. pathological course of childbirth,
10. first birth,
11. female,
12. large fruit.

The presence of these risk factors should be a reason for observation by an orthopedist and preventive measures(wide swaddling, massage and gymnastics).

Symptoms

There are five classic signs that help to suspect hip dysplasia in infants. Any mother can notice the presence of these symptoms, but only a doctor can interpret them and draw conclusions about the presence or absence of dysplasia.

Asymmetry of skin folds. The symptom can be checked by laying the child on his back and straightening the legs brought together as much as possible: symmetrical folds should be indicated on the inner surface of the thighs. With a unilateral dislocation on the affected side, the folds are located higher.

In the position on the stomach, pay attention to the symmetry of the gluteal folds: on the side of the dislocation, the gluteal fold will be located higher. It should be borne in mind that the asymmetry of the skin folds can also be observed in healthy infants, therefore, this symptom is given importance only in conjunction with others.

The symptom of slipping (clicking, Marx-Ortolani) is found almost always in the presence of hip dysplasia in newborns. The diagnostic value of this symptom is limited by the age of the infant: it can be detected, as a rule, up to 7-10 days of life, rarely it persists up to 3 months.

When breeding the legs bent at the knee and hip joints, a click is heard (the sound of the femoral head being repositioned). When bringing the legs together, the head comes out of the joint with the same sound. The click symptom indicates instability of the joint and is determined already in the initial stages of dysplasia, therefore it is considered the main sign of this pathology in newborns.

Hip abduction restriction is the second most common symptom of dysplasia. When breeding the legs bent at the knee and hip joint, resistance is felt (normally, they are bred without effort to the horizontal plane by 85-90º). This symptom is of particular value in the case of a unilateral lesion.

Restriction of abduction indicates pronounced changes in the joint and is not detected in mild dysplasia. Relative shortening of the lower limb is found in unilateral lesions. The legs of the child lying on their back are bent and their feet are placed on the table.

The shortening of the hip is determined by the different heights of the knees. In newborns, this symptom is found only with high dislocations with displacement of the femoral head upward and is not detected in the initial stages of dysplasia. It has great diagnostic value after 1 year.

External rotation of the thigh. As a rule, this symptom is noticed by parents during the baby's sleep. It is a sign of hip dislocation, and is rarely identified with subluxations.

Diagnosis of hip dysplasia

The neonatologist in the maternity hospital is the first to examine the child for the presence of dysplasia and, if symptoms are detected that indicate a violation of the formation of the hip joint, he refers to a pediatric orthopedist for a consultation. An examination by a pediatric orthopedist or surgeon is recommended at the age of 1, 3 and 6 months.

The most difficult is the diagnosis of predislocation. On examination, in this case, asymmetry of the folds and a click symptom can be detected. Sometimes there are no external symptoms.

With subluxations, asymmetry of the folds, a click symptom and limitation of hip abduction are detected. In some cases, there is a slight shortening of the limb.

The dislocation has a more pronounced clinic, and even parents can notice the symptoms of the pathology.

To confirm the diagnosis, additional examination methods are carried out - ultrasound and radiography of the hip joints.

Ultrasound examination of the hip joint is the main method for diagnosing dysplasia up to 3 months. The method is most informative at the age of 4 to 6 weeks. Ultrasound is a safe method of examination and therefore can be prescribed as a screening at the slightest suspicion of dysplasia.

An indication for ultrasound of the hip joints up to 4 months of age is the identification of one or more symptoms of dysplasia (click, limitation of hip abduction, asymmetry of the folds), aggravated family history, childbirth in breech presentation (even in the absence of clinical manifestations).

X-ray of the hip joints is an affordable and relatively cheap diagnostic method, however, to date, its use is limited due to the danger of radiation, and the inability to image the cartilaginous head of the femur.

During the first 3 months of life, when the heads of the femurs are made of cartilage, the radiograph is not an accurate diagnostic method. From 4 to 6 months of age, when ossification nuclei appear in the femoral head, radiographs become a more reliable way to detect dysplasia.

X-rays are prescribed to assess the condition of the joints in children with a clinical diagnosis of hip dysplasia, to monitor the development of the joint after treatment, and to assess its long-term results.

It is not worth refusing to undergo this examination, fearing the harmful effects of X-ray exposure, since undiagnosed dysplasia has much more severe consequences than x-ray.

Hip dysplasia in children - treatment

For hip dysplasia and congenital hip dislocation, treatment should be as early as possible; with age, it becomes more complicated and gives worse morphological and functional results.

Therapeutic measures according to the timing of their implementation are divided into the following stages: conservative treatment of newborns and infants in the first weeks and months of life up to 1 year, from 1 year to 2-3 years, and surgical treatment of dysplasia at the age of 2-3 to 8 years and adolescents .

Operative treatment of dysplasia and congenital hip dislocation should be preceded by conservative treatment.

In the first months of life, treatment should be carried out in order to improve the formation of the hip joint, this can be achieved through the use of manipulation techniques, physical procedures, and rehabilitation corrections.

Extraction in dysplasiaManipulation corrections are used to eliminate reflex reactions that interfere with tissue metabolism and affect muscle innervation.

Conditions are created for the correct morphological relationships of the articular surfaces and physiological mutual stimulation, which give impetus and further contribute to the normal development of the articular surfaces.

Particular attention is paid to the syndrome of functionally oblique pelvis, which aggravates the lateroposition of the femoral head, as a result of hypertonicity m. psoas.

In 30% of cases, when eliminating hypertonicity m. psoas, the lateroposition on the corresponding side leaves, in other cases, attention should be paid to functional blocking of the sacroiliac joint (which directly affects the acetabular angle), and other factors that lead to developmental disorders.

In the treatment of dysplasia, wide swaddling is additionally prescribed, it is possible to use a Sling (carrying a child with divorced legs), thanks to which the joint is fixed in the acetabulum, and conditions for formation are provided.

Remedial gymnastics is prescribed, aimed at stimulating metabolism, blood circulation in the hip joint. In the treatment of dysplasia, mandatory prevention of rickets is necessary, as this contributes to the aggravation of dysplasia. In the case of a genetic developmental defect and ineffective conservative treatment, surgical treatment is used.

It is highly undesirable to prescribe Pavlik's stirrups, splints and Gnevkovsky's apparatus, which fix the hip joints in the Lorenz position, during the treatment. With prolonged use of these devices, the child's psyche is injured, contractures occur.

After the discontinuation of the use of orthopedic devices, “Psoas syndrome” appears, in which hyperlordosis develops in the lumbar spine, scoliosis develops, and osteochondrosis develops. Children who used stirrups and other devices in the future are provided with back problems, intervertebral hernias, sciatica, and other manifestations of osteochondrosis.

Traditional treatment

Even among orthopedists, traumatologists, surgeons there is no consensus and mutual understanding about dysplasia. Dysplasia manifests itself differently in all children and is not always detected immediately after birth. Joints may be "normal" at birth and in the first few months of development, but are later diagnosed as abnormal by 6-12 months of age.

During the initial examination immediately after birth, even a very experienced orthopedist cannot give an accurate diagnosis, although predisposition to hip dysplasia can be predicted from the first day. If you pay attention to torticollis, in which the child constantly keeps his head in one direction.

Each child is individual and develops according to the genetic characteristics of the parents. Parents are not afraid of the fact that a child at 7-8 months old does not yet have teeth and, for example, a large fontanel has not “closed” in time. Parents are sure that the teeth will grow and the fontanel will harden, although these two conditions can be compared with "mouth dysplasia" and "skull dysplasia."

But the signs of hip dysplasia must be constantly monitored, because in fact, dysplasia in children is a weak, incomplete development of the joint, in most cases it is a natural feature of the body of a small child, and much less often a sign of the disease - true dislocation.

Over the past 30-40 years, nothing has changed in the treatment of hip dysplasia, with the exception of various orthopedic devices and testing them on children. Pavlik's stirrups, Freik's splint, CITO, Rosen, Volkov, Schneiderov, Gnevkovsky's apparatus, etc. - these orthopedic devices are needed only with a true dislocation of the hip. And they are prescribed to almost every child from one month to one year of constant wear, with the exception of bathing.

Often, at the same time, the child's psyche is disturbed - at first he is whiny, restless, and then depressed, oppressed, withdrawn, indifferent to everything. Children were repeatedly brought to me in apparatuses at the age of 2.5 years, they differ sharply in physical and mental development. Although there were those who adapted and jumped and ran in the apparatus in a race with their peers.

Operational treatment

Finally, as the last possible measure for severe, undiagnosed during the first three years of life, or not subjected to more gentle methods of treatment of hip dysplasia, surgery remains.

With the so-called triple pelvic osteotomy, carried out, of course, under full anesthesia, the surgeon dissects the pelvic region in three places, separating the ilium, pubic and ischium bones with a medical chisel and saw.

After that, it becomes possible to turn the acetabulum so that it tightly and deeply covers the head of the femoral joint. Once the correct position is found, the surgeon reconnects the bones, fixing the new position. In this case, four screws are used, which are removed at the end of the restoration process, after about a year.

Quite rare complications of surgical intervention include disturbances in the further development of the femoral neck and necrosis of the femoral head. And, nevertheless, in severe cases of dysplasia, the operation is absolutely indicated, since the proportion and degree of complications without it are much higher.

Therapeutic gymnastics (LFK)

Therapeutic exercises are done 2 times a day, each exercise 10-15 times. We recommend the following exercises.

Exercises in the starting position lying on your back:

• Simultaneous flexion-extension of the legs.
• Alternate flexion-extension of the legs.
• Simultaneous breeding of bent legs to the sides. Grasp the ankle joints of the legs with both hands. Slowly bend at the knee joints and spread apart.
• Rotation of the hip outward and inward. The left leg is straight, the right leg is bent at the knee joint. With the right hand we fix the knee joint of the left leg, with the left hand we rotate the right bent leg in and out.
• Reduction and breeding of straight legs.
• "Bicycle" - bend the child's legs at the knees and hip joints and in this position imitate the movements when riding a bicycle.
• Touch the left hand with the right bent leg and vice versa.
• Reduction and breeding of straight and bent legs (imitation of breaststroke).

Exercises in the starting position lying on the stomach:

1. Touch the heel of the left leg to the buttocks, also perform with the right leg.
2. Touch the buttocks with the heels of the legs at the same time.
3. Pressure on the buttocks. Bend the legs at the knee joints, connect the feet, fix with the left hand, simultaneously press the hands on the buttocks and feet, gently pressing the feet down.

Exercises in the starting position lying on your side:

• Lifting the bent leg up.
• Straight leg up

When performing exercises, do not make sudden movements, you should not allow the child to be hurt, otherwise this will cause a negative reaction on his part to the procedure.

Massage

Massage for dysplasia is simply necessary. The procedure restores the joint to its normal state, corrects the dislocation, promotes the growth of strength in the muscles, and also restores absolute mobility in the joint area. In addition, massage makes the baby strong, improves immunity, improves mood.

The procedure is done in the evening, when the baby is relaxed and calm. During this session, children often fall asleep. Features of massage: a course of 10-13 sessions. Repeat the course in three months. The procedure is carried out once a day.

The duration of the therapeutic massage does not exceed 20 minutes, of which five are spent on warming up. If the baby needs to wear various orthopedic devices, then the massage is done without removing or removing them.

Technique: First, make elements of a general tonic massage, and then move on to its local form. Warm up. The child lies on the tummy.

With light strokes rub the lower back, arms and gluteal muscles. Turn the baby on its back, continue to stroke the stomach, sternum and limbs. After warming up, start intensive movements, namely, rubbing along spiral or circular paths of the legs, hands, tummy, buttocks.

Local massage begins with rubbing, pinching and light tapping on the gluteal muscles and thighs. With a little effort, use the pads of your fingers to work the ligaments and tendons on the injured side. With your index finger, start tracing the affected area.

The baby lies on its back. You abduct and bring the leg behind the knee joint, while the second leg is fixed with a brush.

Contraindications to the use of massage Do not start massage in the following cases: The baby has a high temperature. For babies, a temperature above 37 degrees is recognized as elevated. The child has an acute infection.

The baby has a hernia that cannot be repaired. Damage to the skin with diathesis or any other ailment. The child suffers from congenital heart disease. And now carefully watch the video on how to massage with dysplasia

If your child has been diagnosed with hip dysplasia, in no case should you panic, but you need to prepare for the fact that it will be difficult.

Children with splints, splints and Freik pillows can sleep worse and be more capricious, want to handle and, of course, parents have a completely natural desire to get rid of orthopedic structures as early as possible.

It is impossible to miss scheduled examinations by an orthopedic doctor, since early diagnosis of diseases in general and hip dysplasia in particular is a guarantee of a child's health in the future.

Don't take things lightly, like your child's hip restriction or uneven leg creases.

Even if your doctor said that everything is fine, but your parental heart is restless, in this case it is better to consult with another specialist and conduct an additional examination than to calm down and find a clear problem when it will be very difficult to correct it, and sometimes impossible.

Prevention of dysplasia in children

For early detection and prevention of displacement of the femur, all newborns in the maternity hospital or at 1 month of age undergo ultrasound of the hip joints.

When detecting immaturity of the hip joint, wide swaddling is used. One or two folded diapers are laid between the legs of the child, giving the legs a position of breeding and bending.

The third diaper fixes the baby's legs. It is quite possible to lay a diaper over a disposable diaper. It is only important to ensure that the baby's legs are not pressed against each other.

First of all, doctors recommend wide swaddling. You will need three diapers. The first diaper must be folded several times. So that you get a rectangle with a width of twenty centimeters. Place it between the baby's legs, divorced to the sides.

Fold the second diaper with a scarf. Wrap the baby's hips with its corners. Thus, the legs are fixed at an angle of 90 °. Wrap the baby's lower body with the third diaper. At the same time, with the help of a diaper, the legs are pulled up. This will not allow the baby to connect the feet.

Gymnastics is especially good as a preventive measure. At the same time, focus on the abducting-adducting movements produced in the hip joints. Of course, this must be done carefully, without the use of force.

With a mild degree of dysplasia, this will be enough for the hip joint to develop as expected.

Exercises to prevent the development of the disease in children

The baby lies on its back. Starting position - the child lies on his back, abduct the legs bent at the knees to the sides, like a little book, 150-200 times a day (but not at one time). It is necessary to place “free” fingers along the hips in order to control the abduction.

No need to try your best to forcibly spread the legs, if only they touched the surface of the changing table. Movement should not be painful! The main thing is not the force with which the legs are retracted, but the number of retractions. It is advisable to avoid strong rotational movements in the hip joints.

Baby on the tummy. Starting position - the baby lies on his stomach. You grab the child's feet and try to bring the heels to the buttocks. It should look like a frog. In this case, you can slightly press the buttocks to the table. The number of times a day is about 100-150.