Ossification in the joints of the pelvis occurs during the first twenty years of a person's life. Even during pregnancy, embryos of the ossification nucleus appear in the fetus hip joints, the norm at birth is 3-6 mm.
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Anatomical features
The rudiments of nuclei in the articular bag of the hip joint appear during the third to fifth months of pregnancy. Since it is during this period that the formation bone tissue person. In newborns, the ossification nuclei reach three to six mm in diameter. There are cases of development of nuclei only by the eighth month of pregnancy. That is why it is so important that the baby is born full term.
In three to ten percent of cases of normal development and timely delivery, the child does not have balls in the hip joint. Or they are very small. But normally, the balls can grow to the desired size by 4-6 months. The full development of the hip joint lasts up to 20 years. But by the age of five or six, the nuclei should be ten times larger than at birth. In the absence of this standard, there is a need to check for developmental pathologies.
Role and functions in the body
The absence of nuclei of ossification of the hip joints in infants or their insufficient growth up to a year can provoke problems with the development of the musculoskeletal system. The normal growth and functioning of the balls of articulation affects the proper development of the pelvis as a whole. To allow the child to learn to walk, keep the torso in a level position.
Pathological state of the nuclei
The delay in the formation of nuclei of ossification of the hip joint or their complete absence in the newborn in most cases is a serious pathology. Which subsequently significantly affects the development of the joint. When examining a baby, the doctor looks at the state of his health, which determines in which cases the slow growth of the nuclei is a pathology, and when it is the norm.
In the absence of hip dislocation, the slow growth of balls in the joint is generally not regarded as dangerous pathology. But in case of serious violations of the musculoskeletal system, the presence of dislocation due to the absence of balls in the joint, it is necessary to immediately begin treatment.
Causes of deviation from the norm
Cases when ossification nuclei appear late or their growth is delayed can be triggered by a number of reasons. The basis of this pathogenesis is:
- diabetes;
- pathological disorders in metabolism;
- thyrotoxicosis;
- rickets (found in half of newborns);
- artificial food.
In most cases, insufficient development of the nuclei is accompanied by such congenital pathology as pelvic joint dysplasia. Most often, girls are prone to such a dislocation of the hip joint. In this case, the femoral head and the center of the nucleus do not coincide, there is an underdevelopment of the cavity and the proximal part of the femoral bone.
Causes that cause dysplasia and underdevelopment of the nuclei:
- infectious lesions during pregnancy;
- hereditary factors;
- advanced age of the mother;
- severe toxicosis during pregnancy;
- the position of the child buttocks forward.
Dangerous symptoms with underdevelopment of the nuclei
Dysplasia develops during pregnancy, but after birth, against the background of this pathology, a dislocation of the femoral head occurs as a result of a load on the joint. It is dislocations that are a dangerous symptom in case of problems with the development of the pelvic nuclei.
There are such types of displacement:
- Pre-dislocation - there is a limited ability to spread the child's legs, which previously bend at an angle of ninety degrees. The tone of the muscle tissue of the legs is increased, there is no symmetrical arrangement of folds on the hips and buttocks.
- Subluxation - shortening of the leg in relation to the other, a feeling of a click when adducting the femur (there is a slippage of the head of the bone in the cavity of the joint).
- Dislocation - obvious violations during the walking period (tension of muscle tissue, limited functionality of the thigh at the time of abduction of the leg, etc.).
With the formed displacement of the joint, weakness of the buttocks is observed, as a result, one limb is shorter than the other. Up to a year, children can limp, and with a bilateral lesion, the baby has a duck gait.
With bilateral pathology of nuclear development, doctors do not consider this a serious problem. What can not be said about the unilateral underdevelopment of the joint.
Diagnostics
If you observe the symptoms of pelvic disorders described above in a child, you should immediately contact an orthopedist. He examines the child, interrogates the anamnesis of complaints, especially the course of pregnancy. Next is an ultrasound scan. It is the safest for the baby and informative. With the help of ultrasound, you can get data on the presence and size of the ossification nuclei, determine their functionality.
In rare cases, the doctor prescribes an x-ray. With its help, the zones and parameters of ossification of the hip joint are more clearly visible. But X-rays have harmful radiation on the children's body, so it is not recommended for children, and especially up to three months.
Treatment Methods
After diagnosis, appropriate treatment is prescribed. An important point is that the baby is forbidden to sit or walk on his own, resting on his feet. These actions contribute to the loss of acquired results of treatment. Therefore, the task of parents is to organize a safe pastime for the child.
Treatment measures:
- Prevention or treatment of rickets (drink vitamin D, ultraviolet radiation also helps).
- It is necessary to wear a special splint, with the help of which the correct arrangement of the parts of the hip joint between themselves, as well as their adequate development, is achieved.
- Electrophoresis with phosphorus, calcium and bischofite in the area of the joint.
- Massages and exercise therapy.
- Electrophoresis procedure with eufilin on the lower back and sacrum.
- Add sea salt to baths.
- Paraffin overlays at the location of the joint.
- Periodic ultrasound - diagnostics to study the dynamics of the course of the disease.
If all the doctor's prescriptions are followed, all disorders with the development of nuclei usually disappear within seven to eight months. To prevent problems, it is worth adhering to a couple of preventive measures:
- balanced diet for pregnant and lactating mothers;
- the correct diet of the child (complementary foods are introduced from five to seven months, no later);
- massages for babies;
- walks in the open air;
- take vitamin D during autumn, winter and spring;
- monthly visits to the pediatrician.
Video "Dysplasia according to Dr. Komarovsky"
On the video you will see Dr. Komarovsky's opinion on hip dysplasia.
The formation of the human skeleton normally stretches for long time- some of its elements mature up to the age of 25 years. This feature of the processes is due to the general growth of the body, which allows the bones to freely increase in length and width. If ossification was completed in childhood, then serious anomalies of the skeleton could be observed, leading to a violation or complete loss of its functions.
Due to the uneven growth processes, those parts of the musculoskeletal system that are subjected to the greatest axial load mature faster. These include the majority of tubular bones, especially in the area of the articular ends and muscle attachment sites. On these segments there are ossification nuclei, the timely appearance of which indicates the normal development of these formations.
These nuclei are of greatest interest in the region of the hip joint - their role in the mechanisms of occurrence has already been proven. With the help of timely diagnosis - ultrasound - in children, the structure of the joint is assessed. And the combination of ultrasound results and even the slightest clinical signs of damage to the hip joints allows you to start treatment that prevents the development of irreversible changes.
concept
The ossification nuclei are a purely diagnostic sign that characterizes the normal or pathological development of the hip joint. The external signs of this process are invisible, but the result is always obvious - the complete maturation of all elements of the articulation. It occurs through the implementation of the following mechanisms:
- The ossification of all elements of the musculoskeletal system does not occur simultaneously - initially only those parts that will take on the first load are strengthened.
- The hip joint in children up to about 6 months is practically not involved in the implementation of any significant movements. Therefore, for crawling and sitting, at least the formation of bone nuclei in the head of the femur is necessary in order to exercise minimal mobility.
- The ossification nuclei in the acetabulum of the pelvis first appear only along the upper part, which in anatomy is called the roof. If it is formed on time, then the baby will be able to calmly stand on his legs, as well as walk.
- Therefore, initially these bone nuclei should appear in in large numbers namely in the head of the femur and the upper part of the acetabulum. A decrease in their number leads to a delay in the development of the articulation, which becomes a risk for the development of congenital dislocation in children.
If ultrasound does not determine the ossification nuclei at all in the hip joint, then this condition is called the term aplasia (absence).
normal process
Since the formation of nuclei is a physiological mechanism, normally it occurs imperceptibly for the child himself and his environment. Unlike teething, bone growth is not accompanied by any discomfort. The result of all processes is the partial maturation of the hip joint, preparing it for further loads. The following three stages of normal development are distinguished:
- The first period lasts from the laying of articulation elements in the fetus until the first months of the child's life. During it, the anatomical structures consist of only cartilage tissue, and their shape differs significantly from the structure of the hip joint in an adult.
- The second stage is the most important - it starts from about 6 months and ends by a year and a half of the baby's life. It is at this time that the maximum development of bone nuclei is observed, which gradually replace the cartilage tissue.
- The third period goes before puberty - during it, all individual nuclei merge into strong plates. Later, in the norm, ossification of the lower and central sections of the acetabulum occurs.
The correct development of the nuclei is combined with the stages of increasing the activity of the child - at first he only learns to crawl and sit, and soon he is already able to stand and walk easily.
In the fetus
Given the opportunities for early diagnosis of many diseases at the present time, often the parents of a future baby want to know the risk of developing congenital hip dislocation. They assume that screening (ultrasound) during pregnancy will give them such information. But in the fetus, such a diagnosis will be useless due to the following reasons:
- The formation of the hip joint can be assessed in late pregnancy, when all parts of the body are well visualized in the fetus.
- The detection of large bone nuclei in this case is not a physiological process - by the time of birth in children, the articulation is formed only by connective and cartilaginous tissue.
- The joint in the fetus and newborn does not play a significant role in movements, so the first signs of maturation are observed only in the interval from 3 to 4 months.
Ultrasound examination during pregnancy will show only gross anomalies in the development of the hip joint - its complete absence or serious congenital deformities.
In children
Immediately after birth, building processes begin in the baby's body, allowing all organs and systems to be prepared for new conditions. First of all, they concern the musculoskeletal system, the elements of which begin to grow under the influence of movements. Therefore, the formation of nuclei begins due to the following factors:
- With active movements of the legs, the thigh muscles actively contract, which contributes to increased blood flow in the deep sections of the bone.
- Normal mobility contributes to the launch of dormant cells - some begin to destroy cartilage tissue, while others form bone beams in its place.
- Usually, several nuclei are formed, which makes it possible to speed up the replacement mechanisms. The largest formations are determined in the central sections of the femoral head, from where they spread to the surface.
- The acetabulum begins to form simultaneously with the head of the femur, but takes its final form only after the start of standing and walking.
- For ossification to become noticeable, a certain time must pass - on ultrasound, signs of nuclei normally become noticeable in the period from 4 to 6 months after birth.
The normal development of the hip joint is always accompanied by the natural course of periods of development - children learn to stand and walk in time.
How to determine?
The correct formation of the articulation can be assessed without resorting to special diagnostic methods. For this, a number of special tests are carried out in medicine:
- Externally, the symmetry of the skin folds on the thigh and under the buttocks is assessed. If they are at different levels, then - this indicates a delay in the development of the joint.
- A hip abduction test is performed - the child's legs are bent and pressed against the stomach, after which they are gently spread apart. Normally, in babies, due to the small size of the articular cavity, they can be easily pushed apart. With the pathology of the development of the hip joint, dilution is limited.
- Simultaneously with the previous test, slippage is evaluated - if a click is felt when the legs are removed from one side or the other. The slowing of ossification contributes to such a crunch, which is caused by poor fixation of the femoral head in an unformed cavity.
Such tests are easy to carry out at home, taking precautions so as not to injure the child. If at least one of them is positive, then it is necessary to conduct an assessment of the ossification nuclei.
Pathological variants
Violation of the physiological mechanisms of bone tissue formation in the elements of the hip joint primarily affects the development of the child. When the muscles and soft tissues are fully formed, it is time for the implementation of the supporting and motor function of the joint. But anatomically, he is not ready for such work, which causes his gradual deformation.
Such changes are preceded by anomalies in the formation of ossification nuclei in the femoral head and acetabulum. They are based on the following changes in the body of the child:
- Most often, the mechanism is broken already in the womb, which leads to errors in the laying of cells that are the source of bone tissue. This is facilitated by various endocrine diseases, infections or intoxications during pregnancy.
- Currently, the incidence of congenital hip dislocations caused by rickets in children has decreased. But this problem still remains relevant, since vitamin D and calcium deficiency in babies leads to various lesions of the skeleton (including the hip joints).
- It is also not uncommon for a premature baby to be born. Due to the immaturity of all organs and systems in such children, various developmental deviations are often observed.
Absolutely all infants do not undergo ultrasound of the hip joints - it is performed only according to indications based on external examination data.
slowdown
The delay in the formation of foci of ossification in the femoral head and articular cavity until the baby's first steps rarely becomes noticeable. The slowdown in the formation of nuclei in the hip joint is accompanied by the following symptoms:
- Outwardly, up to a year, the changes may not be noticeable - the symmetry of the skin folds is preserved, the hip abduction is slightly limited.
- The main manifestations become noticeable only on ultrasound - at the age of about 6 months, the bone nuclei are small.
- When observed in dynamics, they gradually increase, which still lags behind the growth and development of the child.
- Over time, a gradual enlargement of the nuclei, as well as their partial fusion, should be observed. When slowing down, by the time the walk begins, only a partial connection in the central sections is determined.
Since the processes of bone tissue formation still occur, the result of a delay in ossification without treatment is usually congenital subluxations of the hip.
Absence
In some cases, there is complete aplasia of the bone nuclei in the constituent parts of the hip joint. A serious anomaly becomes an obstacle to the development of its supporting and functional qualities, after which the body tries to turn off the defective connection from work. Accompanied by aplasia the following violations:
- Even without a support function, damage to the joint becomes noticeable - outwardly, the legs lose their symmetry, any movements are difficult or impossible.
- By the time the first nuclei appear on ultrasound, their signs are not detected - the articular cavity and the femoral head are formed only from cartilaginous tissue. They have a characteristic homogeneous appearance (without additional dense inclusions).
- When observed in dynamics, signs of ossification are not determined - gradually the joint begins to lose its original configuration, deforming under the influence of muscles and ligaments.
- The acetabulum is gradually flattened, since its roof, due to its softness, is not able to withstand constant pressure. The femoral head shifts higher, after which it begins to gradually lose its rounded shape.
The outcome of this type of violation always becomes - an excessively soft joint cannot withstand the load, which leads to its gradual destruction. Due to regular damage, cartilage tissue is replaced by a scar, which gradually takes on the appearance of a callus. Therefore, the only option for assistance in this case is the prosthesis of the joint.
On TV
Dr. Komarovsky devoted one of his programs to the development of the hip joint, where he explained in diagrams and pictures the mechanisms of development of the ossification nuclei in normal and pathological conditions. In the show, he addressed the following questions:
- Physiological processes occurring in the hip joint during the growth and development of the child.
- The reasons that affect the correct formation of the musculoskeletal system in babies, as well as adverse factors slowing growth mechanisms.
- Methods of diagnosis and treatment in case of delayed formation of bone nuclei, as well as timely prevention to prevent the formation of congenital hip dislocation.
The program will allow not only to assimilate the theoretical material on the physiological processes of growth, but also provide a visual representation of them. In this form, it will be much easier for parents to understand what is required for the birth and upbringing of a healthy child.
The nuclei of ossification of the hip joints are normally formed by the 6th month of a child's life. This process is very important in the body, so you need to know how the process of ossification proceeds in newborns and what deviations can lead to.
The rate of development of ossification nuclei
Ossification is the process of ossification of the femoral heads. Ossification of the hip joints takes a long time. How younger child, the faster the process of tissue ossification occurs. Sometimes a child may have abnormalities and nuclei do not appear or develop. It is necessary to notice deviations in time in order to avoid pathologies in the future.
Ossifications of the hip joint are formed during pregnancy, about the middle of the term (5 months). At birth, the joints consist entirely of cartilaginous tissue, but already have ossification nuclei, they are located near the femoral head, on average, their size is 3-6 mm. In children on breastfeeding bone tissue development is faster, and pathologies are less common than in children who are fed with artificial mixtures.
In the first year of a child's life, ossification occurs rapidly, and by six months, full-fledged nuclei should form. In boys, development may lag up to one month.
For reference! The absence of nuclei of ossification of the hip joints in newborns may be in early childbirth, when the nuclei did not have time to form in the womb.
If the foci do not form by 6 months, this is not a reason to worry. If there is no dislocation of the hip or other pathologies, this may be a natural process. But you need to see a doctor for advice and further control of development. If the ossification nuclei are absent due to dysplasia, appropriate therapy will be prescribed.
It is the development of bone tissue that allows the child to start walking by the age of one. Further, the process of ossification is not so rapid, it decreases with age and stops completely by the age of 20.
Fact! Already by the age of five, the nuclei increase by almost 10 times in comparison with their initial size in newborns.
Ossification delay
Delayed ossification of the femoral heads may be due to the following factors:
- artificial feeding;
- disturbed metabolism;
- diabetes;
- rickets;
- hypothyroidism (lack of thyroid hormones);
- thyrotoxicosis (increased thyroid hormones).
Also, the health of the parents, especially the mother, affects the condition of the child. If the family is diabetic, the child may also develop this disease and, as a result, ossification may be delayed.
The absence of ossification nuclei, aplasia can arise from a large lack of vitamins in the mother's body during pregnancy. In the absence of the necessary material, the ossification nuclei may not appear.
Fact! Lack of vitamins can affect the further physical and psycho-emotional development of the child.
But most an important factor risk is genetics. If the parents of the child have had problems with ossification, it is likely that the child will also encounter such a problem. Therefore, it is important to know the diseases of the child's parents (childhood and chronic) in order to prevent their occurrence.
Aplasia of the ossification nuclei of the hip joints
Aplasia is a pathology in which a part of the body or internal organ may be missing. When there is no ossification of the hip joints in children under the age of six months, this is normal, but nuclei in the rudiment must be present. If the nuclei did not begin to develop in due time, the child is examined pediatrician and orders x-rays to confirm the diagnosis. Next, you need to consult an orthopedist who will prescribe treatment for the child.
Treatment of aplasia may include the following procedures:
- Massage (light, to improve blood circulation).
- Limitation of loads on the legs (it is forbidden to stand at the support).
- Electrophoresis (treatment by the action of an electric field, when a medicine is applied to the electrodes, and the active substances enter the body due to the action of the electric field).
- Frejka pillow (special clothing that immobilizes the lower half of the child's body).
- Coniferous baths (promote blood circulation).
After treatment, you need to conduct an ultrasound to examine the hip. If the problem is not solved, the treatment is carried out further. After 3 months of treatment, a second x-ray is taken.
Interesting! A similar treatment regimen is used in the case of dysplasia.
heterotopic ossification
Heterotopic ossification is a bony neoplasm in soft tissues organism, where they should not appear. The disease appears most often due to spinal cord injuries or craniocerebral lesions. Occurs mainly in the joints, often in the femur. Pathology begins to develop 2-3 months after the injury.
The following symptoms appear:
- Pain at the site of injury.
- Body temperature may rise.
- Swelling of the joint.
- Redness of the skin.
An x-ray is used for diagnosis, but it is not informative in the first week from the onset of heterotopic ossification. To immediately identify the disease, a three-phase scanning method is used, which helps to see an increase in blood circulation at the site of ossification.
Treatment consists of the following methods:
- medications;
- special exercises;
- surgery (rare).
Heterotopic ossification can occur in both children and adults. To prevent the development of the disease, you need to monitor the condition of the joints and bones. The body must have enough vitamins for a quick recovery.
Komarovsky about ossification nuclei
About how the ossification nuclei should form and develop, says Dr. Komarovsky. Most of all, he talks about dysplasia, its occurrence and treatment.
First of all, the doctor says that doctors are afraid to miss dysplasia and other abnormalities in a child, so they pay excessive attention to the ossification nuclei. This is good, because it is better to find the disease in its infancy and cure it. But often, when such a diagnosis is made, and doctors prescribe treatment, this is not necessary. Often the reason for the delay in the processes of ossification are individual characteristics that pass over time.
For the prevention of treatment, Komarovsky advises not to swaddle the baby tightly, as many do, but, on the contrary, to give more freedom to the legs and movements. Swaddling should be in the first three months of life, always weak, so that the legs are not pressed tightly. You can learn more about the methodology using the video.
The formation of the human skeleton begins with its individual parts in the womb and lasts almost up to 25 years. During this time, the body grows, and the bones gradually increase in length and width.
A feature of the formation of the skeleton is the unevenness and phasing of its growth and the distal direction from top to bottom. Those parts of the musculoskeletal system that receive the maximum axial load mature faster than others. Meaning tubular bones with their articular ends, where the muscles are attached. Here are the ossification nuclei, which also appear as the body develops. If this happens in a timely manner by age, then the development process occurs normally.
One of the most important segments are the bones of the hip joint (hip joint). With a delay in the development or ossification of the nuclei, congenital dislocation of the hip may occur.
General idea of the kernels
The ossification nuclei are only a diagnostic sign indicating the development of the joint. There are no external signs, but the result is the complete maturation of all elements of the joint.
This process has its own characteristics:
- Ossification first occurs where the first load occurs.
- The ossification nuclei in the head of the femur must appear in order for the child to begin to crawl and sit.
- The nuclei are first formed along its upper part (anatomically, this is the roof of the joint). With its timely formation, the baby begins to stand freely on his feet, and then gradually learns to walk.
- The first nuclei of ossification of the hip joints should appear precisely in the head of the femur and the upper part of the acetabulum. Otherwise, TBS is delayed in its development and the risk of congenital dislocation in a child increases. The diagnosis becomes synonymous with hip dysplasia.
If there are no ossification nuclei in the hip joint on ultrasound, then this is called aplasia.
Statistics
Dysplasia is common in all countries (2-3%), but in different ways, depending on racial and ethnic characteristics. For example, in the United States, the likelihood of its occurrence is significantly reduced in African American children.
In the Russian Federation, in ecologically unfavorable regions, the probability of having a child with such a diagnosis reaches 12%. A direct connection between the occurrence of dysplasia and the tight swaddling of the straightened legs of the baby was noted.
In the population of tropical countries, newborns are not swaddled, they are carried on the back, and the incidence rate is noticeably lower here.
The proof is that in Japan, for example, the tradition of tight swaddling was changed by a national project in 1975. As a result, the probability of congenital dislocation of the hip decreased from 3.5 to 0.2%.
Pathology is most common in girls (80%), a third of cases are family diseases.
Congenital dislocation of the hip is detected many times more often with breech presentation of the fetus, toxicosis. The left hip joint is most often affected (60%), less often the right hip joint (20%) or both (20%).
Bone nuclei of TBS
Bone tissue is formed in the fetus even in the womb, at 3-5 months of pregnancy. Then the formation of TBS begins. At the birth of a child, the size of the nuclei is 3-6 mm - this is the norm.
In premature babies, the nuclei of ossification of the hip joints are smaller in size. But normal children can also have small nuclei. If the nuclei are absent, this is considered a pathology. If the nuclei did not appear during the first year of life, the functioning of the TBS will not be correct.
Core pathologies
If the newborn does not have a dislocation in the pelvic area and the joint is working normally, then with the slow development of the nuclei, this is not considered a pathology. If violations and dislocation are found, the bone nuclei are absent, then this is a pathology dangerous to health.
normal process
There are 3 stages of normal development:
- From the laying of HBS elements in the fetus to the first 3-4 months of life. The norm of nuclei of ossification of the hip joints in the first months of a child's life is 3-6 mm in diameter.
- The second stage takes place at the age of 6 months to 1.5 years. Bone nuclei develop from maximum speed, and cartilage begins to gradually be replaced by bone.
- The third stage lasts until adolescence. Here already individual nuclei merge into strong plates. The lower and central sections of the acetabulum ossify.
The correct development of the nuclei of ossification of the hip joints goes hand in hand with the development of the child, at first he learns to crawl and sit, and soon he can stand and walk.
In the fetus
Ultrasound during this period can show only gross anomalies in the development of hip joint in the form of a complete absence of ossification nuclei or other deformities. Dysplasia on it is not defined.
In children
After the birth of a newborn, the processes of building a skeleton start. And this is due to the movements of the baby. active movements legs develop thigh muscles. This causes blood flow to the deep parts of the bone. Sleeping cells are put into operation, destroyers and builders of bone beams appear. The replacement mechanism is accelerated by the fact that several bone nuclei appear.
The largest ossification nuclei are in the head of the femur, in its central sections. Simultaneously with the head of the femur, the acetabulum begins to form. It acquires its final form when the child stands on its feet. The norms of the ossification nuclei, which, as already mentioned, are 3-6 mm, can be checked by ultrasound, but not earlier than in the 4th month of the baby's life.
How to determine?
Such a diagnosis as hip dysplasia is made on the basis of clinical manifestations and the results of ultrasound and x-rays. These are extremely important and informative diagnostic methods, but they are secondary to the clinic.
The orthopedist should suspect dysplasia in a timely manner while still in the maternity hospital and register the child. Such children are given special treatment.
The correct formation of the joint can be determined by a number of tests:
- Skin folds on the thighs and under the buttocks are visually visible. Normally they are symmetrical.
- Abduction of the hip - the legs of the child are bent with pressing to the stomach and then gently spread apart. Normally this happens easily. With dysplasia, dilution is limited - this is a pre-dislocation, while the tone of the thigh muscles is increased.
- At the same time, slippage is noted - when the legs are abducted from the affected side, a click is noted. This is a symptom of Ortolani-Marx, and he speaks of poor fixation of the head. It is a subluxation, and the dislocation itself is determined already when the child begins to walk. The baby may be limping or will have
- Shortening of one limb may occur. Even if one of these tests shows positive result requires an ultrasound.
If there is no ossification on both sides, this is not considered a serious pathology, since osteogenesis is still noted. But the unilateral process of delaying the ossification nuclei requires immediate inpatient treatment.
No cores
In some cases, there is aplasia or the absence of ossification nuclei in the components of the hip joint. In such cases, the body itself tries to exclude the joint from work. In this case, the violations are as follows: the legs are asymmetrical, any movements are sharply limited or impossible.
On ultrasound, the ossification nuclei are absent and the components of the joint remain at the level of the cartilage. They do not contain dense inclusions and are homogeneous. The joint is deformed. The acetabulum gradually flattens and is no longer able to bear pressure.
The femoral head emerges from the cavity and its roundness disappears. The outcome is arthrosis - the joint is destroyed. The cartilaginous tissue is scarred, a callus appears. Therefore, the only way out is joint prosthetics.
Etiology of ossification
Ossification usually occurs in 50% of rickets. This is due to the lack nutrients, B vitamins and minerals (calcium, iron, iodine, phosphorus) in the tissues of muscles, ligaments and bones. The lack of formation of ossification nuclei in children is also associated with this.
The appearance of dysplasia may be associated with an incorrect presentation of the fetus; in children on artificial feeding when immunity is reduced. A lot depends on the health of the mother and father: for example, the presence of diabetes, thyroid disorders, hormonal disruptions. In this case, the child's metabolism is disturbed. The reason for the absence of bone nuclei can be a twin pregnancy, gynecological pathologies in the mother in the form of uterine hypertonicity, infections and viruses during pregnancy, the mother's age is over 40 years, severe toxicosis, heredity (every fifth case), premature birth, spinal diseases in the mother, large fruit.
Development of TBS
The formation of the nucleus of ossification of the femoral heads is noted at 5-6 months, and by 5-6 years the process accelerates tenfold. At the age of 15-17, cartilage is completely replaced by bone tissue. The femoral neck continues to grow until the age of 20, and only then the cartilage is replaced by bone.
Dysplasia therapy
Therapy should be prescribed only by a doctor, and parents must strictly follow his recommendations. Parents need to be patient and strong, because the treatment process will be lengthy.
The process of establishing the normal development of nuclei in the area of TBS includes:
- treatment and prevention of rickets with the help of UV radiation and vitamin D intake;
- use of a splint to reduce the joint;
- electrophoresis with phosphorus and calcium, aminofillin on the lower back, procedures with bischofite;
- paraffin applications;
- massage and therapeutic exercises.
After therapy, an ultrasound scan is repeated in order to evaluate the effectiveness of the treatment. During treatment, the baby can not sit down and put on his feet. The sooner therapy is started, the better the outcome will be. Exercise therapy and massage are used to strengthen and develop muscles.
Exercise therapy makes sense to apply even if the child does not have dysplasia as such, but there is a genetic predisposition. Then the exercises are carried out lying down, without putting a load on the joints.
Massage
It can be carried out even in the presence of tires without removing them. With aplasia, stroking and rubbing are shown.
Massage rules:
- the child should lie on a changing table with a flat surface;
- cover the table with a diaper, because the child can describe himself;
- the mood of the baby should be cheerful and calm;
- the child should not be hungry;
- massage is performed once a day, a course of 10-15 procedures.
There should be only 3 courses, with breaks lasting 1.5 months.
The massage complex is selected individually by a specialist. After consultation with the doctor, the mother can massage the child on her own and at home. Massage is not carried out if the child:
- heat;
- SARS;
- hernia;
- congenital heart defects.
Carrying out gymnastics
You can learn to do gymnastics yourself. The conditions are the same as for massage. Exercises are done during the day 3-4 times. Children usually love this kind of gymnastics.
Any exercise should be done very carefully. Gymnastics in the absence of ossification of the hip joint includes the following actions:
- Formation of the frog posture in the supine position. Ideally, when breeding the legs, the knees should reach the surface.
- Simulate a crawling position by turning the baby on his stomach.
- Turn the baby back on its back, bend straight legs. They need to touch the baby's head.
- Straight, straightened legs spread apart.
- Pull straight legs to the head and spread apart.
- Fold the child's legs into the lotus position, placing the left leg on top.
- Alternately bend the legs at the knees and at the pelvis.
Paraffin applications
They warm the tissues and remove toxins. For the procedure, only special processed paraffin is used. The duration of the first procedure does not exceed 1/4 hour, then the application time can be gradually increased up to 30 minutes. Baths with sea salt are also useful.
Orthopedic splints
- Bus Koshlya - helps to fix the head of the femur in the center, fixes the hips in a divorced state, but does not limit the movements of the pelvic joints.
- Pavlik's stirrups are a fabric chest brace that strengthens the ligaments of the hip joint. The legs do not straighten, but other movements are possible. Effective up to a year.
- Bus Freyka - used for mild dysplasia under the age of 6 months. Do not use for dislocation. The splint holds the hips at a 90 degree angle.
- In the treatment of other types of pathology, Koshlya, Vilensky, Mirzoeva, Orlett tires, the Gnevkovsky apparatus, and plastering are used.
- After a year, gypsum is more often used to fix the legs. If the child is 1.5 years old, and the dysplasia is not cured, an operation is usually prescribed (according to Salter). The essence of Salter's pelvic osteotomy is that they change the spatial position of the acetabulum without changing its size.
Forecast
The prognosis for early medical attention is good. In case of insufficient prevention, it is formed for the treatment of which joint arthroplasty is required.
Preventive measures for the mother
A woman should eat well during pregnancy and lactation. At 7 months, the baby's diet should already include additional foods.
In addition to food, great importance have regular walks in the fresh air, massage, exercise and hardening. In autumn and winter, to prevent hypovitaminosis of vitamin D, the child should receive it in drops. Also, preventive measures include wide swaddling of the baby so that the child can freely move his legs.
Medical statistics of newborns says that congenital hip dysplasia occurs in 2-3% of cases. In 80% of them, pathology is found in girls. The delay in the formation of nuclei of ossification of the hip joint begins to develop in utero. During the first year of life, the pelvic bones should stabilize and begin to develop, but this does not always happen, so pediatricians pay special attention to the formation of bone tissue in the first six months of life.
A more serious pathology is hip aplasia. In this case, any part of the joint is missing - the head of the femur or the acetabulum.
Anatomical features
The pelvic bones begin to form at the 6th week of fetal development and complete their growth when a person is 19-20 years old. The most important and responsible period is the prenatal and first year of life. Since the ligamentous apparatus in infants is still weak, the hip joint is unstable. In premature babies, it is immature, since it finishes its final formation at 8–9 months of intrauterine development.
The next three months show how the joint develops:
- does the angle decrease? vertical arrangement acetabulum - normally it should decrease from 60 degrees to 50;
- whether the head of the femur coincides with the center of the round cavity and the degree of entry.
With dysplasia, ossification (the formation process) of the hip joints in infants is delayed. The process can develop in different ways:
- in the form of infection of the acetabulum or filling it with adipose tissue;
- increase or decrease in the size of the femoral head.
This leads to a discrepancy between the size of the femoral head and the cavity. If the parents of the child do not see a doctor in time, the joint can be completely destroyed, which threatens with an operation to replace it.
Development rate by months
At birth, the nucleus of ossification of the hip joints in children is 3 to 6 mm in size, but may appear later - up to 6 months.
The first three months it is difficult to determine the problem, because the joint is cartilage that is not visible on x-rays and ultrasound. The first information about the condition of the joints can be obtained in other ways.
At 4 months, signs of ossification of the femoral head appear. In girls, the centers appear earlier than in boys. In the absence of ossification nuclei of the hip joints for 6-7 months, the process of joint formation is considered belated, and doctors suggest corrective gymnastics or wearing devices that hold the baby's legs in a bent, divorced position.
If within 6 months the child does not develop a nucleus of ossification, his musculoskeletal system is at risk.
Normally, with the development of nuclei of ossification of the hip joints up to 5-6 years, the increase in bone tissue should increase 10 times.
Dysplasia is distinguished by degrees:
- Immaturity of TBS. May be seen in healthy children. It is not a pathology.
- Dysplasia of the first degree - preluxation. Pathology is visible on x-rays. Femur is in its place without displacement.
- Subluxation, in which the head is partially displaced, but is located in the acetabulum.
- Dislocation of the hip joint - the femoral head is separate from the cavity or above it.
It is noted that in the absence of tight swaddling with straight legs, dysplasia is able to resolve itself within the first six months of life.
Causes of violation of nuclear ossification
There are 4 groups of causes that affect the defective formation of the hip joints in children:
- Violations of intrauterine tissue laying. Pathology is difficult to treat, since some tissues are initially absent and cannot grow.
- genetic predisposition. It is transmitted through the maternal line.
- Congenital pathologies of the spine and nervous system. Usually have concomitant disorders of the musculoskeletal system.
- The effect of maternal hormones on the child's body. The assumption justifies itself, since in the first months after birth, the joint begins to develop normally. These problems are the easiest to treat and sometimes go unnoticed.
In addition to the main causes affecting the developmental delay of the femoral joint, there are factors that contribute to the onset of symptoms:
- increased tone of the uterus, breech presentation of the child, large fetus;
- insufficient intake of nutrients into the body - calcium, iodine, vitamin D, iron, vitamin E, B vitamins;
- multiple pregnancy;
- artificial feeding of a newborn;
- endocrine disorders - hypothyroidism, diabetes mellitus of one of the parents;
- the birth of a child in winter, when there is less sun and vitamin D is not produced in the skin, as a result, calcium is less absorbed.
Viral or bacterial infections of the mother during the period of gestation can provoke underdevelopment of the hip joint.
Diagnosis of pathology
It is necessary to detect the problem earlier, since the treatment is tolerated by the baby much easier than at an older age. At the first visit to an orthopedist or traumatologist, the child is examined:
- The folds on one leg are located higher, which means there is a risk of pathology on this side. A pronounced asymmetry is a sign of dysplasia. Slightly expressed is not a confirmation of the diagnosis.
- The click symptom is the most reliable sign by which the presence of dysplasia is determined without medical equipment. When spreading the legs and pressing on the greater trochanter, a slight crunch is heard - the femoral head is set into a round cavity. When mixing in the reverse order, the sound is repeated - the head comes out of the cavity.
- Normally, the baby is able to spread the legs 90 degrees. In pathology, both legs or one do not lie flat. One of the most reliable signs by which a problem is identified at the earliest stages.
- In children older than 1 year, due to untreated dysplasia, the limbs on the side of dislocation may be shortened. To determine, put the baby on his back. The legs are bent at the hip joint. The feet are on the table. The difference is determined by the height of the knees.
Children over the age of 4 months are prescribed x-rays or ultrasound.
Treatment Methods
Stirrups Pavlik
At the age of up to 6 months, babies are recommended to wear stirrups without limiting the mobility of the joints. After 6 months, in the absence of progress in the formation of nucleoli, a fixing structure is needed - a crossbar between legs apart. With a delay in the development of TBS, calcium preparations and outdoor walks, sunbathing are additionally prescribed. If the baby is breastfed, calcium supplements are given to the mother.
Massage
Massage begins to be carried out from the first days of life, if the examination reveals a lag in the development of the hip joint. With regular massage procedures, the pathology can disappear on its own by the age of three months.
Gymnastics
Physiotherapy exercises are also carried out early. This allows you to improve the blood supply to the joints, helps strengthen muscles and ligaments. Exercises are done in two positions: lying on your back and on your stomach. During the period of treatment, the child can not be planted and put on legs.
Paraffin applications
The temperature of the molten paraffin should be between 40 - 45 degrees for young children. The procedure is aimed at accelerating blood flow in the affected area. Muscle tissue develops better with thermal stimulation. Ozokerite is sometimes added to paraffin. For the treatment of hip dysplasia, a layer of paraffin is applied to children from the buttocks to the foot in the form of a boot. For newborns, the substance is kept on the body for 7 minutes. After 6 months - 10 minutes. After the procedure, a massage is performed. 20 paraffin wraps are recommended.
Prevention of pathology in children
Prevention begins with maternal nutrition during pregnancy. If joint diseases have occurred in the maternal family, it can be predicted that a newborn child may have similar problems. Especially if the child is a girl.
The baby should start giving complementary foods and vitamins on time if treatment is being carried out. Vitamin D is additionally prescribed in autumn and winter. Hardening and contrast procedures on the pelvic area help.
Timely early examination of the child - at 1 month, 3 months from birth. Tight swaddling can negatively affect the condition of the joints. As early as the end of the last century, a program was carried out in Japan that did not recommend swaddling infants. They tried to convey information to grandmothers caring for babies so that they would not use the old methods. As a result, cases of dysplasia in the country decreased to 0.1%.