Dysplasia of the hip joints in children

Diseases of the musculoskeletal system, which can lead to persistent gait disturbance, are often found in babies of different ages. It is better to treat such pathologies as early as possible before serious complications arise. Dysplasia of the hip joints in children is also quite common in children.

What it is?

This disease develops due to the effects of various provoking reasons, which lead to adverse effects on the joints. As a result of congenital structural disorders, the hip joints cease to perform all the basic functions that are imposed on them by nature. All this leads to the appearance and development of specific symptoms of the disease.

This pathology is more common in babies. In boys, dysplasia is much less common. Orthopedists usually find this disease in every third out of hundreds of babies born. There are also geographical differences in the incidence of hip dysplasia in babies born in different countries.

For example, in Africa, cases of this disease are much less. This can easily be explained by the way the babies are carried on their backs, when the legs are wide apart in different directions.

Causes

Various factors can lead to the development of the disease. Large joints, including the hip, begin to form and form in utero. If certain disorders occur during pregnancy, this leads to the development of anatomical anomalies in the structure of the musculoskeletal system.

The most common causes of dysplasia include:

Genetic predisposition. In families in which close relatives have manifestations of the disease, there is a higher probability of having a child with this disease. It is over 30%.

Infringement of the formation of the baby's joints during pregnancy as a result of an unfavorable environmental situation or exposure to toxic substances on the body of the expectant mother.
High hormone levels during pregnancy. Oxytocin, which is produced in the body of the expectant mother, improves the mobility of the ligamentous apparatus. This property is required before childbirth. Oxytocin also affects the improvement of the mobility of all joints, including further provoking excessive range of motion. The hip joints are most susceptible to this effect.
Tight swaddling. Excessive lifting of the legs during this daily procedure leads to the formation of dysplasia. Changing the type of swaddling improves the functioning of the joints and prevents the development of the disease. This is also confirmed by numerous studies conducted in Japan.
The birth of a child over the age of 35.
The baby's weight at birth is more than 4 kilograms.
Prematurity.
Breech presentation.
Close location of the fetus. This usually occurs with a narrow or small uterus. If the fetus is large, then it can fit quite tightly to the walls of the uterus and practically not move.

Development options

Doctors identify several different variants of this disease. Various classifications allow for the most accurate diagnosis. It indicates the variant of the disease and the severity.

Dysplasia options for violation of the anatomical structure:

Acetabular. The defect is located in the area of the limbus cartilage or along the periphery. Excessive intra-articular pressure leads to impaired mobility.
Epiphyseal (Mayer's disease). With this form, there is a strong compaction and punctate ossification of the cartilage. This leads to severe stiffness, progression of pain syndrome, and can also cause deformities.
Rotary. There is a violation of the anatomical arrangement of the elements that form the joint, in several planes relative to each other. Some doctors attribute this form to a borderline state, and do not consider it an independent pathology.

By severity:

Lightweight. Also called preluxation. Small deviations are formed, in which there is a violation of the architecture in the structure of the largest joints of the child's body. Disorders of active movements appear insignificantly.
Medium. Or subluxation. In this variant, the acetabulum is somewhat flattened. Movement is significantly impaired, characteristic symptoms of shortening and gait disturbance are observed.
Heavy current. Also called dislocation. This form of the disease leads to numerous deviations in the performance of movements.

Symptoms

In the early stages, it is difficult to determine the disease. Usually, the main clinical signs of the disease become possible to identify after a year from the moment the baby is born. In infants, the symptoms of dysplasia are easily determined only with a sufficiently pronounced course of the disease or consultation with an experienced orthopedist.

The most basic manifestations of the disease include:

Sound "click" when dilating the hip joints while bending the baby's knee joints. In this case, there is a slight crunch when the femoral head enters the joint. In the opposite direction, a click is heard.
Abnormalities of abduction. In this case, incomplete dilution occurs in the hip joints. In case of moderately severe course or dislocation, severe movement disorder is possible. Even if the angle of separation is less than 65%, this may also indicate the presence of persistent pathology.

Asymmetrical position of skin folds. On this basis, it is often possible to suspect the presence of a disease even in newborns. When examining skin folds, you should also pay attention to their depth and level, where and how they are located.
Shortening of the lower limbs on one or two sides.
Excessive turn of the foot on the outside of the injured side. So, if the left hip joint is damaged, the foot on the left side turns around strongly.

Gait disorder. The child, sparing the injured leg, begins to tiptoe or limp. Most often, this symptom is recorded in babies at 2 years old. If the child has a complete dislocation, then his movements become more elaborate.
Pain syndrome. It usually develops in babies with a fairly severe course of the disease. The long course of the disease leads to the progression of pain syndrome. Pain usually requires medication.

Muscle atrophy on the affected leg. This symptom can occur with a severe course of the disease, as well as with prolonged development of the disease. Usually the muscles on the other leg are more strongly developed. This occurs in connection with a compensatory response. Usually, there is increased pressure on the healthy leg.

Diagnostics

In order to establish a diagnosis of dysplasia in the early stages, additional examination is often required. Already in the first six months after the birth of a child, a pediatric orthopedist must consult him. The doctor will be able to identify the first symptoms of the disease, which are often nonspecific.

The most common examination method is ultrasound. This diagnostic method allows you to accurately establish all anatomical defects that occur with dysplasia. This study is highly accurate and informative enough. It can be applied even to the smallest children.

Also, to establish dysplasia, it is quite successfully used X-ray diagnostics... However, the use of X-rays in early childhood is not indicated. Such research in infants is dangerous and can cause adverse effects.

The use of X-ray diagnostics can be quite informative in babies who can lie quietly for some time without strong movement. This is necessary for the correct adjustment of the apparatus and for the accurate conduct of the study.

When establishing a diagnosis and conducting all previous examinations, in some cases, additional computed or magnetic resonance imaging is required. Often, these studies are used before performing surgical operations. Such methods make it possible to describe as accurately as possible all the structural and anatomical anomalies of the joints in the child. These surveys are very accurate but very expensive. Instrumental studies of joints are not widespread.

Arthroscopy - This is an examination of the joint cavity using special devices. It is not widely used in our country. This research is quite traumatic. If the tactics of conducting arthroscopy are violated, a secondary infection can enter the joint cavity, and severe inflammation can begin. The presence of such a risk has led to the fact that such studies are practically not used in pediatric practice for the diagnosis of dysplasia.

With the timely determination of the specific symptoms of the disease and an accurate diagnosis, treatment can be started on time. However, with a severe course of the disease or with a late diagnosis, the development of dysplasia can lead to the appearance of various adverse abnormalities.

Effects

A fairly frequent unpleasant result of the long development of the disease and poor-quality treatment is gait disturbance. Usually babies start to limp. The degree of lameness depends on the baseline level of damage to the hip joints.

With a complete dislocation and untimely provision of medical care, the child subsequently severely limps and practically does not step on the damaged leg. Walking causes increased pain in the baby.

In children aged 3-4 years, pronounced shortening of the lower extremities can be observed. With a two-way process, this symptom can manifest itself only in a slight delay in growth.

If only one joint is affected, shortening can also lead to gait disturbance and lameness. The kids begin not only to limp, but also to jump a little. With this they try to compensate for the impossibility of walking correctly.

This pathology of the musculoskeletal system can cause the establishment of a disability group. The decision to issue such an opinion is made by a whole commission of doctors. Doctors assess the severity of violations, take into account the nature of the damage, and only then make a conclusion on the establishment of a group. Usually, with moderate dysplasia and the presence of persistent complications of the disease, a third group is established. With a more severe course of the disease - the second.

Treatment

All medical procedures that can help prevent the progression of the disease are prescribed to the baby as early as possible. Usually, already at the first visit to the orthopedist, the doctor may suspect the presence of dysplasia. Prescription of drugs is not required for all variants of the disease.

All therapeutic measures can be divided into several groups. Currently, there are more than 50 different methods that are officially used in medicine to treat dysplasia in babies of different ages. The choice of a specific scheme remains with the orthopedist. Only after a full examination of the child can an accurate treatment plan for the baby be drawn up.

All methods of treating dysplasia can be divided into several groups:

Freer swaddling. This option is usually called wide. With this swaddling, the baby's legs are in a slightly divorced state. A wide method allows you to eliminate the first unfavorable symptoms of the disease and prevent its progression. Becker's pants are one of the options for such swaddling.
The use of various technical means. These include a variety of tires, cushions, stirrups and many others. Such products allow you to reliably fix the baby's legs divorced.
The use of spreading splints when walking. They allow you to maintain the correct angle of expansion in the hip joints and are used only as directed by the attending physician. Usually used tires Volkov or Vilensky.
Surgical operation. It is rarely used. Usually in difficult cases of illness, when other methods have proved ineffective. Such orthopedic operations are performed in babies over a year old, as well as in cases of frequent relapses of the disease and the lack of effect from previous treatment.
Massage. Usually, almost all babies like this treatment. Even newborns perceive massage not as therapy, but as a real pleasure. It is carried out by a specialist who has not only specialized education in baby massage, but also has sufficient clinical experience in working with children who have been diagnosed with dysplasia. During the massage, the area of the hip joints, as well as the neck and back, are actively worked out.

Physiotherapy exercises. They have a pronounced effect in the initial stages of the disease. Doctors recommend performing such exercises 2-3 times a week, and in some forms of the disease - daily. Usually the duration of the session is 15-20 minutes. Exercises can be done by mom or nurse in the clinic. They should not be performed immediately after meals or before bedtime.
Electrophoresis in the area of the hip joints. Allows to reduce the severity of pain, improves blood supply to the cartilage that forms the joint. Electrophoresis is prescribed by the course. Usually 2-3 courses are applied during the year. The effect of the treatment is assessed by an orthopedic surgeon.

Gymnastics with newborns. Usually this method is used when detecting small deviations in the work of the hip joints. It allows you to prevent the development of dysplasia and can be used not only for medicinal purposes, but also as a prophylaxis.
Physiotherapy treatment. Various types of thermal and inductotherapy can be used to improve blood supply and improve the innervation of articular cartilage. Such methods are prescribed by a physiotherapist and have a number of contraindications. They are usually used for mild and moderately severe cases of the course of the disease. They are also quite successful after surgical treatment to eliminate adverse symptoms that arose during the operation.
Mud therapy. This method is widely used not only in sanatoriums and health centers, but can also be performed in the physiotherapy room of the children's polyclinic. The biologically active components of the mud, which are part of it, have a healing and warming effect on the joints, which leads to a decrease in the manifestation of adverse symptoms of the disease.

Prevention

In order to reduce the likelihood of developing dysplasia in babies, parents should pay attention to the following tips:

Do not try to swaddle the baby tightly and tightly.

Choose a wide swaddle. This method is mandatory if the baby has the first signs of dysplasia.

Hold your baby correctly. During the improper positioning of the child in the hands of adults, the legs of the baby often turn out to be strongly pressed against the body.This position can cause dysplasia or other pathologies of the hip and knee joints. Pay attention to the comfortable position of the baby during breastfeeding.

Choose special child seats for transporting your baby in the car. Modern devices allow you to maintain the functional and correct position of the children's feet while in the car during the entire trip.

Remember to visit your podiatrist. Conducting an orthopedic consultation is included in the mandatory list of necessary studies in babies in the first year of life.
Every mom can meet with dysplasia of the hip joints. Treatment of this disease is quite laborious and will require a huge concentration of efforts and attention of parents. It is possible to prevent the development of serious complications only with the daily implementation of all recommendations.
With timely diagnosis and treatment babies practically do not have negative consequences, and they lead a fairly active lifestyle.