Congenital hip dislocation in children: causes and treatment

Congenital dislocation of the hip: signs and treatment / Mama66.ru

Congenital dislocation of the hip is a fairly common disorder, which for a variety of reasons is difficult to diagnose in the early stages.

Nevertheless, the earlier it is determined, the earlier treatment is prescribed, the easier it will be to eliminate pathology and reduce the risk of further changes.

But violations in the bone system are always very serious.

It is known that among girls the dislocation of the hip occurs up to ten times more often than among the boys. Perhaps this is due to differences in the structure of the femoral joint. The joints in the pelvic region in women are by definition more mobile.

The dislocation of the hip can be one-sided, and maybe two-sided. In the second case, both joints will be affected. Fortunately, bilateral defeat is several times less common. However, the treatment in both cases is no different.

Causes of congenital hip dislocation

For a long time it was believed that the congenital dislocation of the hip joint is the result of injuries in the genus period, and therefore, the wrong actions of the doctor.

Less talked about various inflammatory processes.

However, recent studies of pathology have shown that its cause lies in the violation of the intrauterine development of the child - dysplasia.

Various factors may provoke the deviation, for example, infectious diseases of the mother during the period of gestation, abuse medical treatment, an unfavorable ecological situation in the place where the future mother lives or in the place of her work. All this negatively affects the development of the fetus, in particular, it can cause disturbances in the development of the musculoskeletal system.

Underdevelopment of the pelvic bones leads to partial or complete dissociation of the joint surfaces, and the head gradually exits from the joint cavity.

In addition, dysplasia significantly affects the speed of ossification, reducing it.

There are three degrees of dysplasia:

1. Disturbances can affect only the articular cavity, with the neck and the head of the thigh completely normal. In this case, it is too early to talk about a dislocation.
2. Dysplasia plus congenital subluxation of the hip, when the head is somewhat displaced relative to the articular cavity, but completely out of it has not yet emerged.
3. Congenital dislocation of the hip, when the articular surfaces are disconnected, and the head of the thigh emerged from the articular cavity completely.

Possible complications

If the congenital dislocation is not healed in time, then there is a risk of encountering very serious complications, both in childhood and in adulthood.

First of all, children with this pathology, as a rule, begin to walk much later. At the same time their gait is changed.

In case of unilateral dislocation, the child limps to a painful leg, and when two-sided, his gait begins to resemble a duck.

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Because of the constant lameness and the inclination of the body in one direction, the child may developscoliosis- rachiocampsis.

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Naturally, untreated hip dislocation causes gradual deformation of bone tissue, flattening of the joint bones, reduction of the joint gap, further displacement of the joint head. In adults, such disorders are treated only through surgical intervention and complete replacement of the joint head with a metallic analog.

Symptoms and Diagnosis of Pathology

It is very important to diagnose the congenital dislocation of the hip joint in a child in time.

However, the process of diagnosis is complicated by the fact that the hip joint lies deeper than any other. It is tightly covered with muscle and fat tissue.

This means that it is impossible to feel it with your hands. We have to rely on not the most accurate signs of the disease.

There are several symptoms, according to which you can suspect the presence of a hip dislocation already in the hospital, in the first days after birth. However, they are all very arbitrary, and, alas, are not at all obligatory.

Therefore, the newborn is examined very carefully.

The first time it is done in the maternity hospital, the second time - in the first days after the return of the mother and the child to their home, then on preventive examinations in a month, six months and a year.

As a rule, after the child begins to walk, the presence of a hip dislocation becomes obvious. But, alas, it is already quite late. Bony changes have already begun, and fixing the thigh without consequences is problematic, this process is long and complicated.

However, it is important to remember that the blame for this situation can be not only a dislocation of the hip, but also a temporary tonus of the muscles of the child's legs. During the inspection it is quite natural, because the child is tense.

Another symptom of a congenital dislocation of the thigh is calleda symptom of Marx, or a symptom of a click. The doctor's actions will be similar to the previous version.

However, in this case, more attention is paid not to how exactly the legs are bred, but to the sounds. On the side of the dislocation, a dry click will be heard.

Usually it is quite quiet, but sometimes it can be heard from a distance.

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If you put the baby on his tummy and pull out his legs, then in case of a hip dislocation, you can observe someasymmetry of skin foldson the buttocks. From the affected side, the fold can be located below and have a greater depth.

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Another symptom -short legs. However, in the first days after birth, this is difficult to notice, since the difference in the length of the legs will be insignificant.

In order to determine this symptom, the child is again placed on the back, flexes the legs in the knees and in the femoral joint and looks at the knees.

If they are at different levels, then we can assume a dislocation.

It often happens that the congenital dislocation affects the neighboring joints. In this case, it can be determined by the so-called external rotation of the lower limbs:The foot is slightly turned outward.

As already mentioned, at an older age, a hip dislocation can also be determined by a modified gait.

In addition, the child can detect several other characteristic symptoms, named after those researchers who have identified the relationship between the symptom and the disease.

These include the symptom of gluteus glandular insufficiency (it is called the Duchesne-Trendelenburg symptom), a symptom of a non-vanishing pulse, and a number of others. But the pain in children with a hip dislocation is usually not observed.

How to help the child?

There are two possible methods of treatment of congenital dislocation of the hip joint - conservative and operative. Fortunately, even in severe cases of bilateral dislocation with timely diagnosis, as a rule, you manage with a conservative method.

That is why it is considered the leading and consists in individual selectionspecial bus, which fixes the legs of the newborn in one position: bent at the knees and in the hip joints and diluted slightly to the side.

Thus, the head of the femoral joint gradually fills into place. It is important that this happens slowly, without haste and sharpness. Otherwise, you can damage the bone tissue, which will lead to even greater problems.

It is believed that in the year of the dislocation has already been thoroughly launched, but even in such a situation, it is conservative methods that correct it. Only very old cases resort to surgery.

Additional recommendations

What else can you advise the parents who are faced with the problem of congenital dislocation of the hip joint of their young child? First of all, be careful. Now various gymnastics and massage for children are in fashion, however it is important to understand that not all exercises and massages are suitable for babies with congenital dislocation.

Forof massageIn the case of such pathology, a more thorough and intensive treatment of the lumbar and gluteal region is characteristic. Attention is also paid to the hip joints. However, it is important not to make sharp, jerking movements.

Separately it is necessary to say aboutswaddlingchildren. For a long time a tight swaddling was welcomed, when the baby's legs were pulled together. It was believed that in this case the legs will be straight.

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In fact, this position of the legs for the newborn is unnatural. Over the long months in the womb, babies get used to the position with bent legs.

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Especially harmful is a tight swaddling for children with a hip joint dislocation, but it does not have a positive effect on healthy children. Moreover, for development at such a small age, movements are of great importance.

Therefore, the ideal option will be to put the child in the sliders. If you still prefer to swaddle, do not try to twist the legs as tightly as possible, leave the child able to bend and move them at will.

A tight swaddling will only aggravate the situation with a dislocation of the hip joint, preventing the process of repositioning the head into the articular cavity.

Gymnastics for children with congenital hip dislocation

Children with such ailment and gymnastics will not hurt. Below are some simple and effective exercises. Remember that all of them should be performed without additional efforts.

Exercise 1.Put the baby on his tummy. Slightly rub the buttocks and the outer surface of the thigh. Now gently pull aside the child's bent leg and fix it in this position.

Exercise 2.The child lies on his stomach. Take him by the ankles and make the stops, the knees at the same time, on the contrary, should be divorced. The pelvis is pressed to the support.

Exercise 3.Put the baby on his belly on the ball, so that he had to hold the legs on the weight.

Exercise 4.Move the child to the back.

Gently and slowly bend and unbend the legs in the femoral joints, and also dilute them in the sides.

Do this carefully, in no case take your time, do not pull the child and do not push the legs with force. Movements should be natural.

As you can see, this gymnastics is aimed at relaxing the muscles. It has a lot of static positions, fixations and slow, smooth movements. But the fast and sharp are completely excluded. This is associated with the risk of further damaging the weakened joint.

Due to the deterioration of the ecological situation, negligent attitude of many women to bearing a child, congenital dislocation of the hip occurs more often.

Doctors pay a lot of attention to the timely diagnosis of this problem in children.

Carefully follow your baby and at the slightest suspicion of a congenital dislocation of the thigh immediately contact the pediatrician.

The doctor will examine the child and, if necessary, send him for examination to the orthopedist.

Only an attentive attitude to the child from the first days of life guarantees the timely identification of the problem and the cure of the baby before the development of serious complications.

Fortunately, a congenital dislocation of the hip is a violation, albeit frequent, but easily repairable. Therefore, do not panic when you hear this diagnosis. Simply perform the doctor's prescriptions clearly, and everything will be all right with your child very soon.

Consultation of a specialist on the signs of congenital dislocation of the hip in children

We advise you to read:Hypertonus of muscles in newborns: we master massage and other ways of helping the baby

A source: http://mama66.ru/child/1151

Hip fracture congenital

In children up to one year:

• asymmetry of the gluteal folds (gluteal and femoral folds with dislocation and subluxation of the hip are higher than usual);
• shortening of the lower limb;
• turn of the lower limb, especially during sleep (unnatural rotation of the foot outside);
• characteristic click of the slip of the femoral head into the acetabulum (articular basin of the pelvis) at bending of legs in knee and hip joints with subsequent hip removal (Marx-Ortholani syndrome);
• free movement of the head of the femur up and down (Dupuytren's symptom);
• restriction of the hip abduction (in young children, the abduction should be 70-90 °, that is, the thigh with effortless effort should touch the outer surface of the table);
• displacement of the femoral head when flexing the leg in the hip joint (Barlow test).

In children over the age of one year:

• the child begins to walk later (only to 12-14 months);
• with unilateral dislocation - lameness, unstable gait; at bilateral - a climbing gait (duck);
• physiological bending of the spine in the lumbar spine;
• the pelvic inclination towards the lesion, the lowering of the gluteal fold, the inclination of the child to the healthy side when standing on the affected leg, lifting the pelvis when standing on a healthy leg (Trendelburg symptom);
• increase in the amplitude of hip abduction in the hip joint (Chassenyak symptom);
• impossibility of probing the head of the femur in the region of the hip joint;
• X-ray manifestations of congenital dislocation of the femur (determination of signs of congenital dislocation of the femur relative to the location of the ossified parts of the pelvic and femur).

There are three degrees of congenital hip dislocation:

• predvivih -on the X-ray, a noticeably sloping location of the acetabulum (articular pelvic surface), later appearance of ossification points in the head of the femur, antitussia (deviation of the neck of the femoral head forward);
• subluxation -On the x-ray, the head of the femur is shifted outward and upward, which remains within the articular cavity (the center of the femoral head does not correspond to the center of the acetabular cavities);
• dislocation -the head of the femur is markedly shifted outward and upward, does not contact the acetabulum.

• The exact causes of underdevelopment of the structure of the hip joint (ligaments, capsule, articular surfaces) are unknown.
• The genetic predisposition to the development of congenital dislocation of the hip joint is assumed.
• It has been statistically revealed that cases of congenital dislocation of the hip joint are more frequent in girls and primiparous mothers (the effect of uterine muscle elasticity on the development of congenital hip dislocation).
• In addition, congenital hip dislocation occurs in newborns who were in the wrong position in the uterus or during labor (for example, pelvic presentation, when the child lies to the opening of the pelvis not with the head, but legs).

LookMedBook reminds: the sooner you seek help from a specialist, the more chances to keep health and reduce the risk of complications:

1. A pediatrician will help with the treatment of a disease

• Analysis of anamnesis and complaints of the disease:
  • the presence of hereditary diseases in the family (in the relatives of the patient, orthopedic pathology is revealed: curvature spine, excessive mobility in the joints of the limbs, sprain of the ankle joint, flattening of the arches Stop. This all speaks of the inheritance of the weakness of the musculoskeletal system);
  • presence of risk factors of hereditary and congenital diseases during mother's pregnancy;
  • the course of labor (whether there were birth trauma, false presentation of the fetus, etc.) in the mother;
  • complaints of parents about the asymmetry of the gluteal folds in the child, shortening of the limb, unnatural mobility of the leg and wrong position of the body when standing and walking (spinning outward, shifting up and down, clicks when moving in the hip joint, incorrect gait (limp, duck walk) and the position of the child's body when standing (with curvature of the spine, shortening of the lower extremities)).
• General examination: visual evaluation of the lower limbs (symmetry in length and position of the skin folds) and the position of the child's body when standing (wrong the position of the body, the curvature of the spine), the identification of characteristic symptoms of the dislocation of the head of the hip joint when bending, unbending, child.
• Radiographic and ultrasound examination of the hip joint of the child to confirm the diagnosis.
• It is also possible to consult a pediatric surgeon, an orthopedist.

• Treatment should be as early as possible (after the 2nd week of the child's life). The later treatment is started, the higher the probability of complications and disability of the child.
• From the moment of birth, a wide swaddling is used (between the legs of the child, bent at the knee and hip joints, and with the laying of legs at 60-80 °, two diapers are placed, and this position is fixed by the third diaper).
• Pillow of Freik, Pavlik's stirrups, medical tires - orthopedic methods of treatment of congenital dislocation of the hip.
• Physiotherapy (heat therapy with ozocerite), massage, physiotherapy exercises (leg extraction, rotational movements of the thigh and others).
• Operative treatment (the optimal age for surgical treatment of hip dysplasia is 2-3 years):
  • open repositioning operation with arthroplasty (hip joint plastic surgery);
  • reconstructive surgery on the iliac and femur without opening the capsule of the joint;
  • a combination of open repositioning and reconstructive operations;
  • alloarthroplasty (joint replacement). The method of operation is chosen by the physician on the basis of anatomical changes of the hip joint.

In the absence of timely treatment, the following complications are possible:

• incorrect gait (due to shortening, pathological rotation (rotation)), clubfoot, etc .;
• disorders of posture (scoliosis - curvature of the spine);
• development of coxarthrosis (calcification of the articular surfaces of the hip joint and bone tissue), arthritis (inflammation of the joint capsule);
• decreased mobility of the joint.

Prenatal and intravenous prophylaxis(before and during childbirth) - for the mother:

• regular observation by a doctor during pregnancy (timely research (eg, ultrasound examination of the fetus), the delivery of tests, the implementation of the doctor's recommendations) for the prevention and diagnosis of developmental abnormalities fetus;
• refusal from bad habits (smoking, alcohol).
• maintaining a healthy lifestyle (regular walks in the fresh air (at least 2 hours), exercise gymnastics, observance of the regime of day and night (night sleep not less than 8 hours));
• balanced and rational nutrition (eating foods high in fiber (vegetables, fruits, greens), refusal of canned, fried, hot, hot food);
• frequent fractional meals (5-6 times a day in small portions);
• timely access to a doctor if you have health problems;
• control of arterial (blood pressure) (for the timely detection of gestosis);
• careful management of childbirth (special attention is paid to children with pelvic presentation - the child is located with the buttocks or legs down during labor, and not with the head, as in the head presentation).

Postnatal prevention(after the birth of the child). The physiological posture for a newborn at birth is a pose with slightly bent and retracted hips. The translation of the hip from the bent position to the unfolded one is one of the main points that contribute to the development of the dislocation. Actions aimed at straightening the legs of a newborn are antiphysiological (unnatural). For the proper development of the hip joints, it is recommended:

• wide free swaddling (shown to all children from the first days of life);
• therapeutic gymnastics (aimed at breeding the legs): helps strengthen the ligaments and muscles of the hip joint, improve blood supply and nutrition;
• s, -2-month-old age with the same purpose it is recommended to carry the baby on the stomach or waist with the legs apart.

A source: https://lookmedbook.ru/disease/vyvih-bedra-vrozhdennyy

Congenital hip dislocation

Congenital hip dislocationare among the most frequently encountered malformations.

According to international researchers, this congenital pathology affects 1 in , 00 newborns.

The disease affects girls about 6 times more often than boys. Unilateral defeat occurs, -2 times more often than bilateral. Not diagnosed in infancy, dislocation of the hip is manifested by the lameness of the child at the first attempt to walk alone.

The most effective conservative treatment of congenital dislocation of the femur in children of the first 3-4 months of life. With its ineffectiveness or belated diagnosis of pathology, surgical treatment is performed.

The lack of timely treatment of congenital dislocation of the hip leads to a gradual development of coxarthrosis and disability of the patient.

Hip dysplasia andcongenital hip dislocation- different degrees of the same pathology, arising from the disruption of normal development of the hip joints.

Congenital hip dislocationare among the most frequently encountered malformations.

According to international researchers, this congenital pathology affects 1 in , 00 newborns. The disease affects girls about 6 times more often than boys.

Unilateral defeat occurs, -2 times more often than bilateral.

Hip dysplasia is a serious disease. Modern traumatology and orthopedics has accumulated a sufficiently large experience in the diagnosis and treatment of this pathology.

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The data obtained show that, in the absence of timely treatment, the disease can lead to early disability.

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The sooner they begin to treat, the better the result, therefore, at the slightest suspicion of a congenital dislocation of the hip, it is necessary to show the child to the orthopedic doctor as soon as possible.

Classification

There are three degrees of dysplasia:

• Hip dysplasia. The joint cavity, head and neck of the thigh are changed. The normal relationship of the joint surfaces is preserved.
• Congenital subluxation of the hip. The joint cavity, head and neck of the thigh are changed. The ratio of articular surfaces is disrupted. The head of the hip is displaced and is located near the outer edge of the hip joint.
• Congenital dislocation of the hip. The joint cavity, head and neck of the thigh are changed. Articular surfaces are disconnected. The head of the femur is located above the articular cavity and away from it.

The hip joints are located deep enough, covered with soft tissues and powerful muscles. Direct examination of joints is difficult, therefore pathology is revealed, mainly, on the basis of indirect signs.

• Symptom of clicking (symptom of Marx-Ortholani)

It is only found in children under 2-3 months of age. The kid is laid on his back, his legs are bent, and then carefully folded and bred. With an unstable hip joint, dislocation and hip adjustment occur, accompanied by a characteristic click.

It is found in children up to a year. The child is laid on his back, his legs are bent, and then without effort are bred to the sides. In a healthy child, the angle of the hip is 80-90 °. Limitation of lead can indicate hip dysplasia.

The child is laid on his back, his legs are bent and pressed against the stomach. With unilateral dysplasia of the hip joint, the asymmetry of the position of the knee joints is caused by the shortening of the thigh on the affected side.

• Skin fold asymmetry

The child is placed first on the back, and then on the abdomen to examine the inguinal, gluteal and popliteal folds. Normally, all folds are symmetrical. Asymmetry is evidence of congenital pathology.

• External rotation of the limb

The child's foot on the side of the defeat is turned outwards. The symptom is more noticeable when the baby is sleeping. It should be borne in mind that external rotation of the limb can also be detected in healthy children.

In children over the age of 1 year, there is a gait disturbance ("duck walk lameness), insufficiency of the gluteal muscles (Duchesne-Trendelenburg symptom) and a higher location of the large trochanter.

The diagnosis of this congenital pathology is made on the basis of radiography, ultrasound and MRI of the hip joint.

Consequences of dysplasia and congenital hip dislocation

If pathology is not treated at an early age, the outcome of dysplasia will be an early dysplastic coxarthrosis (aged 25-30 years), accompanied by pain, limited mobility of the joint and gradually leading to disability patient.

With untreated subluxation of the thigh, lameness and pain in the joint appear at the age of 3-5 years, with congenital dislocation of the hip pain and lameness appear immediately after the start of walking.

Treatment of dysplasia and congenital hip dislocation

With the timely start of treatment conservative therapy is used.

A special individually selected tire is used, which allows you to keep the legs of the child withdrawn and bent in the hip and knee joints.

Timely comparison of the femoral head with the acetabulum creates normal conditions for the correct development of the joint. The earlier treatment begins, the better the results can be achieved.

It is best if the treatment starts in the first days of the baby's life. The beginning of treatment for hip dysplasia is considered timely if the child is not yet 3 months old.

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In all other cases, treatment is considered belated. Nevertheless, in certain situations, conservative therapy is quite effective in treating children older than 1 year.

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The best results for surgical treatment of this pathology are achieved if the child was operated under the age of 5 years. Later, the older the child, the lesser effect is expected from the operation.

Operations with congenital hip dislocation can be intraarticular and extra-articular. Children who have not reached adolescence are given intra-articular interventions. During the operation, the acetabulum is deepened.

Adolescents and adults are shown extraarticular operations, the essence of which is to create the roof of the acetabulum.

A source: http://www.krasotaimedicina.ru/diseases/traumatology/hip-dislocation-congenital

Congenital hip dislocation in children - diagnosis and treatment

One of a whole set of anomalies, denoted by the general term "hip dysplasia is from mobility of the hip joint to the present dislocation of the globular hip joint is a congenital dislocation hips. In this article, we will tell you about the main symptoms of congenital dislocation of the hip in a child, as well as how to treat congenital dislocation of the hip in children.

Congenital dislocation of the femur is more common in girls than in boys, in a ratio of approximately and for an unknown reason more often affects the left side.

Congenital dislocation of the hip does not cause pain and does not prevent children from crawling or walking.

The child develops normally, going through the usual stages of development, begins to crawl and walk at a certain age.

However, the network defect remains undetected or untreated, it can lead to limp or unequal length of the legs, which will become apparent when the baby starts walking.

Clinical tests to detect congenital hip defects are usually performed at birth and again at the first examination at the age of 6 to 8 weeks.

Diagnosis of congenital hip dislocation

Ultrasound examination of congenital hip dislocation

Ultrasound is used because in young children, fluoroscopy does not show a developing bone that has not yet undergone ossification.

Earlier, when the development of the bone can be checked by an X-ray, it is after 4 to 6 months. By this time, the bone contains enough calcium to make it possible to see the difference between the head and the hollow of the joint.

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Ultrasound examination will show the cartilage parts earlier, if all children were checked using ultrasound, the frequency of the defect would increase to 60 to 70 cases at that due to the high sensitivity of this species research.

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However, if these children are re-checked after 8 to 9 weeks, it turns out that 90% of them are perfectly normal.

Treatment of congenital hip dislocation

If you treat everyone who has a defect in the first ultrasound study, it turns out that they treat those who do not need it. Therefore, doctors concentrate their efforts on certain "risk groups". They include children:

• With a congenital hip dislocation in a family history. About 10% of children with congenital hip dislocation have a close relative with this defect. Given the genetic factor, doctors carefully examining children who have one of the parents has this defect,
• With breech presentation at delivery (t. e. the baby in the uterus lies down the buttocks, not the head, as in most cases). For this reason, in many cases of breech presentation, a cesarean section of the genus with a gluteal Only 4% of all births are represented, but they account for about 17% of children with congenital dislocation thighs,
• Having other physical defects associated with congenital hip dislocation, such as defects in the spine, foot, or skeleton.

Use of a tire to treat congenital hip dislocation

If the child has a mobile hip joint from birth, the standard method of treatment is used - stabilization of the joint in comfortable position with the help of Pavlik's stirrups Baby buckets are bent under the 90 ° angle and spread out to the sides, forming an angle of 40 - 50. This provision will give the child some freedom of movement. Pavlik's stirrups keep the joint in optimal positions so that the head is always in the acetabulum. Although the device looks uncomfortable, the child quickly gets used to it. If necessary, a pediatric surgeon can place a child in these stirrups soon after birth.

Stirrups should be adjusted every week so that they do not become too tight as the child grows. Usually the device wears 6 to 12 weeks. The child can be freed from it during bathing, but the clothes should be worn over the stirrups.

In the early diagnosis most children can be treated with a tire, the effectiveness of this method is more than 70%. Tires can cause temporary damage to the globular joint, but this risk is minimal.

If the violation is detected later (after 6 months, but before 2 years) or the use of a spine has been unsuccessful, other measures may be required. It is often possible to correct the joint with a closed reposition, performed under anesthesia.

Reposition means the restoration of the normal position of the displaced femur in the acetabulum. Sometimes, before the closed reposition, stretching is performed.

This helps to hold the child's body in an extended position, with the bed tilted, the head retracted.

The purpose of the procedure is to overcome the contracture of the muscles, ease their tension and return the head of the hip to the acetabulum.

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Before applying gypsum, the doctor examines the thigh under anesthesia. If it is difficult to control, soft tissue can be released through a small incision in the groin, this will facilitate the reposition of the joint.

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The task of the procedure is to keep the head of the hip in the acetabular depth. When this goal is achieved, the doctor "zakovyvaet" the child in plaster in the so-called humane position (legs bent and divorced).

After 6 weeks, the doctor again examines the thigh.

If the joint is firm and begins to recover a stable condition, the child remains in the plaster for another 3 months, until the elements of the globose joint begin to form. After this, the gypsum is removed, and the child gets the opportunity to move and train the joint.

Now you know everything about the diagnosis and symptoms of congenital hip dislocation in children, as well as how the congenital dislocation of the hip is treated in a child. Health to your children!

A source: http://www.medmoon.ru/rebenok/vrozhdennyy_vyvih_bedra.html

Congenital hip dislocation: symptoms and treatment

Category: Joints, bones, muscles 1523

• Rachiocampsis
• Lameness
• Slouch
• Shortening of one leg
• Duck's gait
• Hypertonus of back muscles
• Limited leg movement
• Compression of one hand into a fist
• Crunch when bending the leg
• Asymmetry of buttocks
• X shaped foot installation
• Walking on the fingers
• Excess fold on buttock
• C-shaped position of the trunk

Congenital dislocation of the hip - is one of the most common anomalies of development. Underdevelopment or dysplasia of the hip joint is both unilateral and bilateral.

The reasons for the development of pathology are not fully understood, but clinicians are aware of a wide range of predisposing factors that can act as a provocateur of ailment, starting from a genetic predisposition and ending with an inadequate course pregnancy.

With the establishment of a correct diagnosis, there are often no problems - the basis for diagnosis is a physical examination, and confirmation of the presence of this disease in a child can be achieved after studying the data of instrumental surveys.

Treatment of hip dislocation in the vast majority of cases is surgical, however in some situations enough conservative therapy methods are sufficient to eliminate the disease.

In the International Classification of Diseases of the Tenth Revision of Hip Dysplasia, an individual cipher has been identified. Thus, the code for the ICD-10 will be Q 65.0.

Etiology

Despite the existence of a wide range of predisposing factors, the causes of congenital dislocation of the hip in children remain unknown. Nevertheless, experts in the field of orthopedics and pediatrics as provocateurs distinguish:

• the wrong position of the fetus in the womb of matter, namely his pelvic presentation;
• severe toxemia during pregnancy;
• nurturing of a large fetus;
• the young age category of the mother is less than 18 years old;
• a wide range of infectious diseases transferred by the future mother;
• delay in the development of the baby;
• an unfavorable ecological situation;
• specific working conditions;
• influence on an organism of a pregnant exhaust gas or ionizing radiation;
• addiction to bad habits - here also it is necessary to include passive smoking;
• presence of female gynecological pathologies, for example, uterine fibroids or the development of an adhesion process. Such ailments adversely affect the intrauterine movement of the child;
• excessively short umbilical cord;
• the appearance of an infant before the preset period;
• fetal cord embryos;
• trauma of the newborn in the course of labor or after childbirth.

In addition, the cause of dislocation of the femur in infants can be a genetic predisposition.

Moreover, congenital dislocation of the hip is inherited by an autosomal dominant type.

This means that a child with a similar diagnosis should be born, a similar pathology should be diagnosed at least one of the parents.

Comparison of the normal and displaced hip

Classification

To date, there are several stages of the severity of congenital dislocation of the hip, why the ailment is divided into:

• dysplasia- Modified are the articular cavity, head and neck of the thigh. In addition, there is a normal preservation of the relationship between articular surfaces;
• pre-exertion- there is a free mobility of the head of the femur, which moves freely inside the joint;
• subluxation- the main difference from the previous form is that there is a violation of the ratio of articular surfaces;
• congenital hip dislocation- In such situations, the joint surfaces are disconnected, and the head of the bone lies outside the joint.

Due to the presence of such changes it is possible to put the correct diagnosis in newborns in the second week after the appearance of the baby.

Depending on the site of localization, the pathology may occur:

• one-sided- this variant of the course of the disease is revealed twice as often as bilateral;
• bilateral- occurs less frequently, while pathology involves both the left and right legs.

Symptomatology

With a congenital dislocation of the femur, there is a presence of rather pronounced clinical signs, which parents pay attention to. However, sometimes the diagnosis of pathology in infancy does not occur, why adults have irreparable consequences.

Thus, the symptoms of congenital dislocation are:

• high tonus of the back muscles;
• visual shortening of the affected limb;
• the presence of an extra fold on the buttock;
• asymmetry of the buttocks;
• C-shaped position of the torso of the newborn;
• the compression of one hand into the cam, often from the side of the diseased leg;
• appearance in the process of bending the legs of a characteristic crunch;
• X-shaped installation of the foot;
• the habit of the baby to stand and walk, leaning only on the fingers;
• pronounced curvature of the spine in the lumbar region - thus there is a "duck" gait;
• stoop;
• restriction of movements of the affected limb.

In those situations when the pathology was not cured in childhood, in adults the signs of congenital dislocation of the hip will be lameness, overtaking from side to side during walking and shortening of the patient legs.

Diagnostics

Due to the fact that the disease has a characteristic clinical manifestations, the presence of congenital dislocation of the hip newborns, the clinician may be suspected at the stage of primary diagnosis, which consists of manipulations:

• the study of the medical history of close relatives of a small patient - such a necessity is conditioned by the fact that the pathology has an autosomal dominant inheritance;
• collection and analysis of a life history - this includes information about the course of pregnancy and labor;
• careful physical examination of the patient;
• a detailed interview with the patient's parents - to establish the first time of onset of symptoms, which may indicate the severity of the course of the disease.

With a congenital dislocation, the passage of such instrumental procedures is indicated:

• radiography of lower limbs;
• Ultrasound and MRI of the affected joint - is shown to infants from 3 months of age, and if necessary also to adults;
• ultrasonography - will show the presence of such a deviation in toddlers who are 2 weeks old.

Laboratory diagnostic methods have no value in confirming dysplasia or underdevelopment of the hip joint.

Treatment

Often, surgical intervention is necessary to eliminate the disease, but sometimes conservative therapies are sufficient.

An inoperable method of therapy can be performed only with early diagnosis, namely in those situations when the patient was 4 months old. At the same time, it is possible to treat the disease with the help of:

• the use of an individual tire, which makes it possible to keep the legs of the baby withdrawn and bent simultaneously in the hip and knee joint;
• exercise exercises of medical gymnastics or exercise therapy;
• exercise physiotherapy.

Methods for treating congenital hip dislocation

As for surgical treatment of congenital dislocation of the hip, it is best if it is carried out before the child turns 5 years old. Clinicians argue that the older the patient, the less effective the operation will be, therefore, getting rid of the pathology in adults is extremely difficult.

Two most effective methods of operative therapy are known:

• intra-articular operations - only for children. In such situations, the intervention is aimed at deepening the acetabulum;
• extra-articular operations - are conducted for adolescents and adult patients, while creating the roof of the acetabulum.

If the above treatment methods are ineffective, the only method of therapy is endoprosthetics of the hip joint.

In any case, after the operation, patients need physiotherapy and exercise therapy.

Possible complications

The absence of treatment of such a disease in infancy increases the likelihood of the child's acquisition of consequences.

As the most frequent complication is dysplastic coxarthrosis - this is a serious illness leading to disability of the patient, accompanied by:

• intensive pain syndrome;
• incorrect gait;
• a violation of the motor function of the joint.

Treatment of such ailment is only surgical, and patients often require nursing care.

Prophylaxis and prognosis

In order for newborns and adults not to have problems with the formation of congenital dislocation of the hip, it is necessary to follow such rules:

• in cases with a genetic predisposition, every 3 months from the moment of the baby's appearance, ultrasound of the hip joints on both legs should be examined;
• To be examined at a pediatric orthopedist every 3 months after birth;
• complete exclusion of vertical load on the legs of the baby without the approval of the clinician;
• to supervise adequate course of pregnancy and to visit in time the obstetrician-gynecologist;
• exercise from the first days of life of the baby.

A favorable prognosis of such a disease is possible only with early diagnosis and timely treatment. The presence of untreated disease in adults and the development of consequences threaten disability.

Diseases with similar symptoms:

Osteochondropathy (coinciding symptoms: 3 of 14)

Osteochondropathy is a collective concept that includes diseases that affect the musculoskeletal system, deformation and necrosis of the affected segment occurs against the background. It is noteworthy that such pathologies are most common in children and adolescents.

... Sheyerman-Mau's disease (coinciding symptoms: 3 of 14)

The disease of Sheyerman-Mau (syn. kyphosis of Sheyerman, dorsal (dorsal) juvenile kyphosis) is a progressive deformation of the spinal column that develops during active growth of the body. Without timely therapy can lead to serious consequences.

... Osteoarthritis of the hip joint (coinciding symptoms: 2 of 14)

Osteoarthritis of the hip joint is a disease that also occurs under the name of coxarthrosis, and usually affects people after forty years. Its cause is a decrease in the volume of allocation of synovial fluid in the joint.

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According to medical statistics, women tend to suffer from coxarthrosis more often than men. It affects one or two hip joints. This disease disrupts the nutrition of the cartilaginous tissue, which causes its subsequent destruction and limits the mobility of the joint.

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The main sign of ailment is pain in the groin.

... Tuberculosis of bones (coinciding symptoms: 2 of 14)

Tuberculosis of bones is a disease that develops due to the active activity of tubercle bacillus mycobacteria, which in medicine are also known as Koch's rods.

As a result of their penetration into the joint, fistulas are formed, which do not heal for a long time, its mobility is disrupted, and in more severe cases it completely collapses.

With the development and progression of tuberculosis of the spine, a hump and a spin may develop. Without proper treatment, limb paralysis occurs.

... Osteomalacia (coinciding symptoms: 2 of 14)

As a result, pathological softening of the bones occurs.

The ailment of its etiology and clinic resembles a disease such as rickets in children, which occurs due to hypovitaminosis D3.

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