In our time, the number of children with congenital diseases is gradually increasing. Defective underdevelopment of the hip joints is considered the leading one among congenital pathologies in many regions of the country. Dysplasia of the hip joints in children is a common disease, what is it?
What is Hip Dysplasia in Infants?
Dysplasia of the hip joint in newborns is its immaturity with impaired development of all the links that form the hip joint: bones and cartilage that make up the base, and soft tissues (ligaments, capsules, muscles) around.
Unfortunately, despite the examination of infants up to six months of age, it is not always possible to identify an early disease. But the early start of treatment is the key to its effectiveness and success.
If the course of treatment is started up to three months, almost all patients have very good results. In the age range from 3 to 6 months, only 80% of patients achieve good treatment results. When treatment is started from the second half of the year, a good result is seen in only half of the children.
Dysplasia of the hip joints in infants and their causes
One phrase "dysplasia of the hip joint" is used to describe the violation of the correct interaction between the components of the joint in babies.
The following factors are considered the reasons for the formation of dysplasia in children:
- Teratogenic factors (harmful, causing defects) - mechanical, chemical, physical and food. They damage the embryo in the early stages of development.
- Heredity. In 14% of sick children inherited a congenital pathology from their parents.
- Pre-dislocation of the hip. Stretching of the joint capsule causes the femoral head to slip out of the joint cavity. This is due to the special structure of the joint and the fact that the baby becomes cramped in the uterus by the end of pregnancy (the baby's legs are brought and pressed against the body), as well as with tight swaddling.
- Inadequate or slow development of the hip joint. Closer to the birth of the baby, ossification of the components of the hip joint slows down, and its cartilaginous elements are sufficiently developed. If the newborn is properly cared for, ensuring the correct abduction position in the joint, the hip joint achieves the desired development on its own.
- Weak joint ligaments.
- Injury during pregnancy or during childbirth, when the baby is not lying in the uterus correctly.
- Weak joint muscles.
Factors that increase the risk of dysplasia:
- Dysplasia of the hip joint in adult parents.
- Breech presentation of the fetus.
- Large fruit.
- Deformation of the feet.
- Pregnancy toxicosis.
Grades of hip dysplasia
Dysplasia of the hip joints according to ICD 10 (international classification of diseases of the tenth revision) has three stages:
- Pre-dislocation of the hip joint. Pre-dislocation is the immaturity of a joint that has not yet reached the desired level of development. Further, the joint can form correctly, and a cure occurs, or a subluxation is formed. Due to the stretched articular capsule, the femoral head is adjusted quite simply and quickly, and then a dislocation reappears. X-ray shows abnormal development of the joint, but there is no displacement of the hip. In newborns, pre-dislocation occurs most often.
- Subluxation of the femoral head. Subluxation is characterized by a change in the joint. In cases of subluxation, the femoral head is displaced, but within the joint. On the X-ray, decentering (displacement) of the head is visible, which does not go beyond the cavity.
- Congenital dislocation of the hip. A dislocation occurs when the head of the femur is completely displaced, it is outside the acetabulum.
Congenital dislocation is the most recent degree of dysplasia. A child is born already with a dislocation, or it can develop in a one-year-old baby with delayed diagnosis and therapy.
Dysplasia of the hip joint in children and its diagnosis
The diagnosis is made during examination when signs of dysplasia are seen. In time, a doctor who examines him in the maternity ward should suspect dysplasia in a baby, so that he can then be sent for examination to an orthopedist. The orthopedist prescribes treatment for all children, sick and with suspected disease, until an accurate diagnosis is established.
Suspecting dysplasia, the child, in addition to examination, is prescribed instrumental studies, according to the results of which a diagnosis is made. The introduction of new diagnostic methods has increased the chances of accurate and timely diagnosis. The condition of the joints is determined using the method of ultrasound, radiography and computed tomography.
Dysplasia of the hip joints in children and its symptoms
With the diagnosis of "hip dislocation", babies have certain difficulties, because newborns often experience pre-dislocation, the initial stage of the process.
To have a good examination of the child, you need a warm room. Before examining it, it is better to feed him. Under these conditions, it is easier to identify the symptoms of dysplasia.
The main symptoms of hip dysplasia are:
- slipping symptom;
- restriction of abduction in the hip joint;
- shortening of the limb;
- asymmetry of folds on the skin.
Slip symptom
The most important symptom of pre-dislocation is slipping. It is explained by a rather slight reduction and reverse dislocation of the femoral head from the joint cavity due to a stretched capsule and joint ligaments. The symptom of slipping cannot be heard during examination, it is felt with the hands as if the head of the bone is moving.
To identify it, the baby's legs must be bent at the knee and hip joints, forming a right angle. At this moment, the doctor's thumbs rest on the inner thigh, and the remaining fingers on the outer side of the thigh. Slowly begin to spread the hips to the sides. At this time, the femoral head slides into the acetabulum, a push is felt.
When the changes in the joint increase, other symptoms appear.
Lead limitation
Abduction restriction is mainly observed with increased tone of the muscles responsible for hip adduction. It manifests itself during neurological diseases, therefore, if abduction is limited, a neurologist's examination is needed. Determining the abduction in the hip joints, the baby is placed on the back with the legs bent at the hip and knee joints.
To do everything right and identify this symptom, you need to relax the legs of the newborn, so it is better to examine the sleeping baby or wait until the baby gets used to the doctor's hands and completely relax.
Healthy joints allow the legs to be extended so that they touch the surface of the table with the outside of the thighs. The child grows, and the symptom loses its significance, it is detected inconsistently.
Shortening the leg
The shortening of the leg in children is difficult to reliably determine. The shortening is determined by the knee caps. The legs of the baby lying on the back are bent at the hip and as much as possible at the knee joints, placing the feet next to them on the table. In this position, it is clear that the patella on the side of the dislocation is lower.
Symmetry folds
Also, when examining a child, the symmetry of the folds of the thigh skin is taken into account.
On the side of the dislocation, the groin and buttock-femoral folds are deeper, and their asymmetry is visible.
In case of dislocation on both sides, this sign may not be present. And in newborns, the asymmetry of the folds is often observed with healthy joints.
In newly born babies, the symptoms of congenital dislocation are not very pronounced and are not always detected. Therefore, relying only on the clinic, it is quite difficult to make a diagnosis. Doubting, the doctor sends the child for an ultrasound scan for clarification.
Dysplasia of the hip joints in children and its treatment
It is possible to treat dysplasia of the hip joints in children under one year old with and without operations, using abduction devices.
Experts consider conservative treatment to be the best way if it is started on time.
In children under 6 months
Dysplasia should be treated immediately from birth, from the moment the symptoms indicating it were identified. The first week is crucial: a healthy joint will form, or a dislocation will occur.
Early treatment for dysplasia is abduction in the joints that maintains activity and mobility in the joints. Wide swaddling with dysplasia of the hip joints is practiced already in the maternity ward before an orthopedic examination for the purpose of prevention. It is not a treatment for dysplasia, but the earlier prevention is started, the better the prognosis.
To give the legs a flexion and abduction position, various abduction devices (splints, pants, bandages) are used. Pavlik's stirrups are considered the best spacer option for hip dysplasia. The duration of the course depends on the condition of the joints and lasts from 3 to 6 months.
In children over 6 months of age
Experienced orthopedists give preference to sparing anesthesia-free reduction of the femoral head by stretching the leg and fixing it with a plaster cast. This is the best and most effective method.
The legs are kept fixed for 4 to 6 months. When the plaster cast is removed, a splint is placed on the child's legs. The width of the spreader bar for dysplasia is changed during the course of treatment, gradually decreasing.
The splint is removed when the joint is fully restored. While children are growing, they are under the supervision of an orthopedist and periodically undergo rehabilitation treatment.
Prevention of hip dysplasia
- Each child should be examined by an orthopedist, a neurologist, and ultrasound of the joints is also performed.
- Free baby swaddling.
- Physiotherapy exercises, which are performed along with massage.
Hold the baby correctly. Hold the baby to you, holding him by the back, so that he hugs you, legs wide apart.
Exercises for dysplasia of the hip joints
Exercise therapy is the main method of building a healthy joint and the only method to support the development of motor skills.
Physical exercises for dysplasia are usually divided into general developmental and special ones. The first ones are used from birth, and when the child grows up, his psychomotor skills are taken into account. Special exercises increase metabolism and blood supply to the joints and muscles. Passive exercises are performed with children under one year old, and active exercises from one year to three years.
Gymnastics for dysplasia of the hip joints is done only after thermal procedures.
Initially, the exercises are aimed at eliminating the limitation of motion in the joint. For example, they lay the baby on the tummy in the frog pose or with the legs bent at the knees perform circular movements. The child in this period is in stirrups.
Further, when the dislocation is adjusted, exercises are carried out daily, adding active and mobile ones. For example, if you tickle the soles, the baby actively moves his legs. At this time, physiotherapy is added to the treatment. Electrophoresis for dysplasia of the hip joints in children is performed using calcium and phosphorus solutions. At least 10 sessions are carried out.
After removing the clamps, the muscles of the legs are strengthened using massage and gymnastics, not forgetting about swimming.
Massage for dysplasia of the hip joints in newborns is always combined with exercise. Generally, a general massage is prescribed using classical techniques.
Hydrokinesis therapy is the most effective rehabilitation method for children. Exercising in water has a positive effect on treatment and gives a positive attitude.
Conclusion
Today, hip dysplasia has become much more common. It is necessary to treat it from birth using complex techniques. Observing the rules of treatment, you can further achieve successful results, avoid disability and the consequences of hip dysplasia in children.
