Hip dysplasia in newborns

Hip dysplasia in the newborn (infants)

Disturbance of development and formation of hip joints - the main type of congenital anomalies of the musculoskeletal system in children younger than 1 year.

Hip dysplasia in newborns occurs at a frequency of 25 cases per 1000. In regions that have a negative ecological situation, the morbidity rate increases several times.

What is hip dysplasia?

Hip dysplasia (abbreviated: DTS) is a disease characterized by underdevelopment in the process of embryogenesis of all elements involved in joint formation:

• ligaments;
• cartilage;
• bone surfaces;
• muscles;
• neural structures.

In medical literature, you can find a synonym - congenital dislocation of the hip.
There are three degrees of severity of the disease:

• 1 degree (pre-exertion) - underdevelopment of bone-cartilaginous elements is observed; the musculoskeletal device is not changed. Deviation of the head of the femur is absent.
• 2 degree (subluxation) - against the background of the characteristic manifestations of prelighness, displacement (dislocation) of the head of the femur is observed upward and outward.
• 3 degree (dislocation) - severe form, the femur head does not contact the acetabulum, there is no contact of the articular surfaces.

The figure shows the types of dysplasia of the hip joints.

A - hip joint of the newborn in norm, B - dysplasia of 1 degree, C - dysplasia of 2 degrees, D - dysplasia of 3 degrees.

The causes of hip dysplasia in newborns

There are several theories explaining why there is congenital dysplasia of the hip joints.

• Hereditary theory ─ the onset of the disease is associated with a genetic predisposition.
• Hormonal theory - the basis for the development of dysplasia is the high level of progesterone at the end of pregnancy; at The result is a decrease in the tone of the musculoskeletal system, which causes instability in hip joint.
• Exogenous theory - exposure to toxic substances, including certain groups of medicinal products drugs, disrupts the development of bone tissue and leads to pathology of the musculoskeletal apparatus.
• Multifactorial theory - hip dysplasia in infants occurs as a result of the combined effects of the above factors.

Conditions that contribute to the development of congenital dislocation of the hip include:

• breech presentation of the fetus;
• lack of vitamins and trace elements (calcium, phosphorus, iodine, iron, vitamin E);
• underdevelopment of the acetabulum;
• restriction of mobility of the fetus in the uterine cavity.

Symptoms of dysplasia

When examining a child, pay attention to the following symptoms:

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

Dysplasia of the hip joint in infants is manifested by characteristic symptoms.

• Symptom of slipping (synonym: click symptom). The child is laid on his back, bending his legs in both knee and hip joints at an angle of 90 degrees (the thumbs of the investigator are placed on the inner surface of the thighs, the remaining fingers on the outer surface). When hips are guided, a large spit is pressed against the head of the femur. The process is accompanied by a characteristic click.
• Limitation of hip withdrawal. Pediatric dysplasia of the hip joint is manifested by the presence of an exclusion limit of up to 80 degrees or less. The symptom is most characteristic for unilateral defeat.
• Relative shortening of the limb. Symptom occurs in newborns rarely, observed with high dislocations.
• External rotation of the lower limb is a sign characterized by turning the hip on the side of the defeat outside. Can also occur in healthy children.
• Asymmetric position of the femoral and gluteal folds - is revealed during the external examination.

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

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

Rarely are asymptomatic cases of congenital dislocation of the hip.

Many mothers are interested in the question: how to determine hip dysplasia in newborns with absolute certainty? In order to clarify the diagnosis, it is necessary to perform the following diagnostic manipulations.

X-ray examination - Before you take a picture, you must observe the following conditions: symmetrical placement of the newborn, minimum time for the procedure, the use of protective gaskets. In the production of radiographs, it is obligatory to have assistants or parents who will help fix the baby in the right posture. Dysplasia of the hip joint has characteristic x-ray signs:

• slanting of the roof of the acetabulum;
• departure of the femoral head from the central axis;
• inconsistency of the size of the joint cavity in the size of the head;
• The hip is moved outward from the vertical line.

Arthrography allows us to judge the X-ray negative elements - ligaments, capsule. With this method, even hip dysplasia of the 1st degree can be established.

On the arthrogram it is possible to determine the position of the head and its shape, fibrosis of the capsule, the infiltration of the acetabulum. The procedure is performed under general anesthesia. A thin needle pierces the skin, subcutaneous fatty tissue, capsule, penetrate into the cavity of the hip joint.

Enter a contrast iodine-containing substance or an inert gas. Then X-rays are taken.

Ultrasound examination of the hip joint.

Advantages - possibility of repeated use for the purpose of treatment control, absence of radiation load in comparison with radiography. The method is non-invasive, safe for the child.

Using an ultrasonographic study, it is possible to identify congenital hip dislocation in the early stages. The ultrasound is performed according to the following indications:

• presence of clinical manifestations of DTS;
• severe course of pregnancy and childbirth;
• decrease in muscle tone in the lower limbs.

Computer tomography allows you to evaluate additional radiographic indices - the degree of atrophy of the surrounding joints of soft tissues.

The main drawback of the method is a high dose of radiation even with a single examination.

Magnetic resonance imaging is used to determine indications for surgical treatment.

Differential diagnosis of hip dysplasia in children

There are diseases that can manifest themselves with the same symptoms as congenital hip dislocation. The doctor needs to make certain efforts to put the right diagnosis.
Dysplasia of hip joints in newborns should be distinguished from the diseases listed below:

Hip dysplasia in newborns in numbers

• If treatment is started before the age of 3 months, the positive result is 97%.
• Treatment prescribed in the second half of the year gives excellent results only in 30% of cases.
• Detection of the disease at the age of up to 6 months is only 40%.
• Treatment started at the age of 3 months, lasts 2 months, and started at the age of 12 months - more than 20 years.

There are many scientific papers, which contain information on how to treat hip dysplasia.

Most authors are guided by the following principles:

• treatment is prescribed when clinical signs of the disease are detected;
• treatment is prescribed in the presence of X-ray signs of the disease, even in the absence of clinical;
• the combination of asymmetry of the gluteal folds with a severe course of pregnancy is an indication for the treatment.

Conservative treatment includes:

• wide swaddling: carried out for 1 to 2 months, while active movement in joints, which contributes to spontaneous management of the dislocation, the correct formation of the acetabular hollows;
• the spacers for dysplasia of the hip joints make it possible to withdraw the legs when they bend, and freely access the body. The most commonly used tire for dysplasia is Pavlik's stirrups;
• application of functional gypsum dressings with a distraction system;
• physiotherapy techniques reduce the activity of the inflammatory process, improve trophic processes in tissues, prevent the appearance of contractures, reduce pain syndrome. Apply the following types of physiotherapy:
  • Electrophoresis in dysplasia allows the introduction of drugs into the hip joint region;
  • amplipulse therapy;
  • ultrasound;
  • mud treatment;
  • magnetic-laser therapy;
  • hyperbaric oxygenation;
  • massage;
  • acupuncture.

Operative treatment of DTS is indicated if conservative methods are ineffective. The following types of operations are used:

• open direction of congenital hip dislocation;
• endoscopic treatment of dysplasia.

Rehabilitation measures for hip dysplasia in newborns

Rehabilitation is aimed at:

• strengthening the muscles that form the hip joint;
• activation of reparative (recovery) processes;
• adaptation of the joint to the changed conditions of dynamics and statics.

For this purpose, therapeutic physical training, physiotherapy treatment, medicinal preparations are used.

How to prevent the development of hip dysplasia in a newborn?

For this purpose it is necessary:

• visit the neurologist and orthopedist regularly;
• perform ultrasound examination of the joints;
• engage in exercise therapy;
• exclude tight swaddling.

From the piggy bank of an orthopedic physician - a clinical example

Patient Ira K., age - 8 months. The diagnosis is made: "dysplasia of the right hip joint of the 2nd degree".

Periodically outpatient treatment courses were conducted without positive dynamics, which served as the basis for hospitalization in the trauma department of the children's city hospital.
Upon admission to the hospital, the physician identified:

• shortening of the left lower limb by 1 cm;
• limitation of lead in the hip joints to 70 degrees;
• asymmetrical position of the gluteal and femoral folds.

X-ray examination - absence of femoral head heads, hypoplasia (underdevelopment) of the leading elements of the hip joint on the right.
The following treatment was performed:

• operation under general anesthesia - lengthening of the adductor muscles of the thigh;
• adhesive plaque traction for 3 weeks, followed by a closed insertion of the head of the right femur and the application of a plaster bandage;
• In 3 months the plaster bandage was removed;
• carried out the imposition of the Vilenskii bus;
• dosed load on the affected lower limb.

After the treatment, the control radiograph was performed: the dislocation of the head of the right femur was inserted. From the age of 6 months, Ira is allowed to crawl.

The next stage - rehabilitation treatment (with a frequency of 1 every 3 months), which included:

• Gymnastic exercises aimed at developing the affected joint;
• physiotherapy (amplipulse therapy, electrophoresis, lower limb massage, mud cure);
• hyperbaric oxygenation;
• vitamins of group B;
• diet therapy;
• drugs aimed at restoring the cartilaginous structure.

At the age of 1 year 1 month, the Vilensk bus was removed, the static load was permitted. On the roentgenogram performed at this age, there is a complete absence of signs of DTS on the right.
The volume of movements in the affected joint was restored completely. The child has no pain syndrome.

Ira is recommended: regular visits to the orthopedist (1 every 3 months), exercise therapy, lower limb massage, dosed physical exercise.

From the above, we can conclude: hip dysplasia is a curable (curable) disease. A full recovery is possible provided that the orthopedist is treated promptly and the recommendations are fully implemented.

A source: http://zdravotvet.ru/displaziya-tazobedrennogo-sustava-u-novorozhdennogo-grudnichka/

Hip dysplasia in infants

At the first reception at the orthopedist the mother of the newborn can hear an alarming diagnosis: dysplasia of the hip joint. To it it is impossible to concern lightly, after all in the future of the child strong pains along with inflammatory processes can excruciate.

But do not panic either. The earlier parents begin to act, the more effective and faster they can help the baby. How does this most frequent orthopedic pathology of the infantile period manifest itself and what to do with it? Let's discuss.

A little anatomy

Hip dysplasia in newborns is a condition in which the joint is underdeveloped. Normally, it is formed by the head of the femur and the acetabulum of the hip bone.

The acetabular hollow looks like a semicircular bowl, framed on the edge by a cartilaginous rim, which limits movement in the joint.

The hollow itself is filled with synovial fluid (sticky liquid, performs the function of joint lubrication).

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The head of the thigh is spherical, so it exactly enters the acetabulum. With the body of the bone, it is combined with a small so-called neck of the hip.

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The cervix and the head of the thigh are covered by the joint capsule. Inside, the joint is held on the ligaments, thanks to which the cushioning occurs during power loads.

In the main ligament there passes a vessel carrying nutrients for the head of the femur.

In the figure you can see what the norm and pathology of the placement of joints looks like

The hip joint, resembling a ball-shaped hinge, is much more stable, in comparison with other joints of the body, and is very mobile.

Of course, the ligaments and muscles make its mobility non-limiting.

Dysplasia in newborns is determined when there is underdevelopment of the joint, its inferior development, or ligaments are excessively elastic. There are following forms of dysplasia:

1. Precipitations. Occurs when the joint capsule is stretched, due to which the head of the femur is slightly shifted, but it easily returns to the desired position.
2. Subluxation of the hip. The head of the femur is partially displaced relative to the acetabulum, and the ligament is stretched and tense.
3. Hip Dislocation. Full displacement of the head (it extends beyond the basin).

Whatever the situation, remember that the immaturity of the articular sac is to some extent explained by physiological causes.

On the one hand, this means that all newborns have a risk of developing pathology; on the other hand, the condition does not is a disease as such, especially since it is successfully treated in infancy, thanks to an active process formation.

However, if irresponsibility and negligence in relation to the health of the baby by parents or doctors and the child "were decided" save when he limped limp independently, you can help, but it is possible that the baby will feel the consequences throughout his life dysplasia.

Factors contributing to the development of dysplasia

Why do some children develop hip dysplasia, while others do not? Physicians identify a risk group, supported by statistical data and a well-founded theory.

It is believed that the main reason for the development of dyslasia is the hormone relaxin. It is produced by a woman during childbirth.

Under its influence, the pelvic ligaments relax, and the pelvic bones "soften becoming as flexible and soft as possible.

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All this in the complex allows the newborn to pass through the birth canal.

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But the hormone affects not only the mother, it also softens the bones and ligaments of the infants, and the girls, whose bones are initially more plastic than the males, are more powerful. If a woman gives birth for the first time, the body, experiencing stress, produces relaxin more than usual. Thus it becomes clear why in the risk group are:

• first-born,
• female infants.

Other factors are:

• Pelvic presentation. When the baby is born ass the way forward, it's not entirely physiological, and there is a risk of dislocating the hip joint.
• Hereditary predisposition. If there were problems with the hip joint in the family, it is possible that the child "inherits" such a gift from the mother.
• A large fruit. A baby with a weight over 4 kg does not always easily overcome the birth canal. The increased pressure goes both to the pelvic bones of the mother, and to the child himself, and the risk of trauma increases. According to statistics, the left hip joint is damaged in 60% of cases, which is due to the forced position of the fetus in the womb.
• Malodode. A small amount of amniotic fluid (less than 1 liter) complicates the mobility of the fetus, this situation is fraught with trauma and pathology.
• Tight swaddling. It was noted that in African countries, where children are not swaddled, but worn on the back, the incidence of dysplasia is minimal. And when in Japan in the 70's began to abandon the traditional for their nation's tight swaddling, congenital dislocation of the hip began to occur not in 3% of babies, but only in%. So the relationship is obvious.

Why did we consider all these factors? To know how to reduce the risk of developing dysplasia to a minimum.

For example, if a woman has first childbirth as a large girl, and besides breech presentation, there is every reason to conduct a Caesarean section operation.

And this is not because the aunt's midwives are so much easier and more money-efficient. First of all, it is caring for the child, because the risk in this case is great.

Unbalanced creases suggest problems with joints

Symptoms

There are signs that should alert the mother and encourage her to visit the orthopedist unscheduled. They include:

1. Asymmetry of folds. Babies are put on their tummies and their legs are straightened. Normally, all wrinkles (gluteal, inguinal, popliteal) should be mirrored. Estimate the depth of folds. However, in itself this method is not very reliable, because with bilateral dysplasia, asymmetry will not be noticeable. In addition, up to 3 months different creases may be normal.
2. Thigh breeding incomplete. In practice, it looks like this: an infant is put on the table on his back and, holding his knees, hears his legs to the sides. Normally, the exercise is done without much effort, so that the knees touch the table. But if you feel resistance in your legs when you try to dilute them, or one leg lies well, and the other one does not, this is an alarming signal.
3. Clicking while raising the legs to the sides(a symptom of slipping). It is also checked when the hips are dilated to the sides. At some point, the doctor feels that the hip is not removed further, after which the hand "hears" a characteristic click. This is a reliable diagnostic method, but only in the first three weeks.
4. The situation whenone leg shorter than the other. The extremities of the baby are stretched out and they look, at the same level are the kneecaps. The shortening indicates a severe form of dysplasia when a hip dislocation is formed.

Diagnostics

Dysplasia in newborns, as well as subluxation, is determined on a routine examination of the orthopedist. Such a survey is carried out at birth, per month, at 3 months, at six months and a year. Then, as a preventive measure, it is recommended to visit the doctor annually.

On the right on an x-ray you can see a dislocation

The trouble is that about 18% of diseases occur without any visible symptoms. Therefore, for accurate diagnosis, ultrasound and X-ray methods are used.

And if you do not heal?

If the immaturity or underdevelopment of the joint is small, they speak of mild dysplasia. In half the cases it will pass by itself. But only in half!

When the children are diagnosed with a dislocation, subluxation of the hip or expressed dysplasia of the hip joints, treatment is necessary, otherwise, as it was said earlier, the baby will complain of pain in the limbs, quick fatigue while walking, and the gait will resemble duck.

Methods of treatment

Gypsum

The essence of therapeutic measures to adjust the condition is to fix the joint in the correct position.

It takes enough time for the ligaments to grow stronger and securely hold the joint.

For this purpose, gypsum is used when the legs are fixed in a dilute, semi-bent position with a plaster bandage. Minus gypsum - its hygroscopicity and very heavy weight.

Orthopedic devices

There is a mass of orthopedic devices that allow to correct the deviations that have arisen.

The stirrup of Pavlik

Unlike rigid structures that led to complications (in particular, to necrosis), Pavlik's stirrups allow the baby to move more or less freely.

The design includes a chest bandage and linings on the bootlegs, combined with each other by strips. A pair of strips in front helps to bend the legs in the knees, and the pair behind the back of the shin shakes apart.

Are made stirrups from soft fabrics.

The stirrup of Pavlik

Pillow of Freik

It looks like a panties made of dense material, which helps to support the legs in the state of dilution by 90 OC. Wear a bandage if a subluxation or dysplasia is diagnosed without dislocation.

The bus of Vilnius

The device consists of two leather straps with laces, connected by a metal spacer. They are of three kinds, oriented to the age of the baby. The length of the strut is regulated by an orthopedist, he also shows his parents how to properly wear it.

To the child, when playing, accidentally did not move the adjusting wheel, it is fixed with an insulating tape. Straps lace more tightly, otherwise they will slip. The tire wears up to six months. You can remove it only in order to be bought.

A variation of this design is the tire CITO.

Tübinger Bus

It consists of saddle leg spacers with a metal rod inserted between them, shoulder pads, strings connecting spacers and adjusting the length of the product, and Velcro fixing the orthosis.

Tübinger Bus

Shina Volkova

Now almost is not used, because it practically immobilizes the child, it is difficult to fit in size and quite expensive.

Gymnastic and massage techniques

Massage and gymnastics - another tool that accelerates the development of joints. All manipulations are carried out only on the instructions of the doctor and only a good specialist.

Usually the course is divided into 10 sessions with repetition in a month.

In addition to therapeutic massage, parents at home can daily do relaxing exercises, including stroking and rubbing.

With the help of medical gymnastics it is possible:

• strengthen the thigh muscles;
• return the original configuration of the joint;
• maintain good blood circulation and trophic of articular tissues, prevent complications like necrosis;
• to develop the physical activity of the baby.

For children up to a year passive gymnastics is shown as elements of complex massage.

Physiotherapy

We advise you to read: what size of a foot does the newborn have?

1. Electrophoresis with calcium and phosphorus. Electrodes with a solution are placed on the joint area.

   Thus, the elements, getting into the body, strengthen the joints.

2. Warm bath. Water with sea salt acts relaxing on the body, improving blood circulation and speeding up regeneration processes.
3. Applied with ozocerite. Also affect the nutrition of tissues, contributing to early recovery.
4. UFO. A treatment regimen using ultraviolet rays is selected individually.

   Its purpose is to stimulate immunity and accelerate regeneration.

Congenital dislocation - how to recover

If the x-ray or ultrasound indicates a hip dislocation in a child aged 1 to 5 years, the closed direction is shown, unless the displacement is strongly pronounced (otherwise an operation is needed). What is this method?

Under anesthesia on the basis of ultrasound data, the physician returns the thigh head to the correct position, after which a plaster bandage is applied for half a year, fixing the legs in a diluted state. When the bandage is removed, the rehabilitation period begins, which includes massages, physiotherapy procedures, etc.

Operative intervention

Sometimes the displacement is so strong that it can not be eliminated by a closed method. The situation can be complicated by infringement of the joint capsule, underdevelopment of the femur or late diagnosis. Then resort to open surgery.

The minus of surgical interventions is that they are fraught with complications: large blood loss, inflammatory processes, suppuration or necrosis of tissues. Therefore, it is important to pass the recommended examinations in time and observe all the prescriptions of the doctor.

In a timely manner, check the child with an orthopedic surgeon

Prevention

To minimize the possibility of developing such a problem, observe the following recommendations:

1. Do not practice tight swaddling. Instead, fix the knobs with the diaper, and let the legs stay free. If the crumb is at risk, master the technique of wide swaddling: Lay the baby on your back, lay two diapers between your legs and fix them third on the baby's belt.
2. Slings. In accordance with age, use slings, carrying and backpacks of the kangaroo type. In African countries, where such a method of transporting children is a tradition, the problem under discussion practically does not exist.
3. Use diapers for a larger size. In addition, that it's just convenient, filled diapers plant legs in the sides - excellent prevention.
4. Massage and gymnastics. Physical exercises strengthen the muscles, so a general massage for prevention is done daily.

Summarize.We examined the causes of dysplasia of the hip joints and the ways of its treatment. Wearing fixing devices seems an exhausting affair.

Of course, it is very pitiful for a kid, especially when his peers begin to stamp.

But in this situation, as they say, time heals, and treatment can not be interrupted, otherwise all your efforts will be brought to nothing.

An untreated subluxation of the hip leads to severe chronic diseases. Therefore, follow all the recommendations of the doctor and do not try to put the child on the legs, if the orthopedist has not given the go-ahead.

A source: http://mladeni.ru/zdorovye/displaziya-tazobedrennyh-sustavov-mladencev

All methods of treatment of hip dysplasia of a newborn baby

Pediatric dysplasia is not as dangerous as the immaturity of the hip joints, two of these states need to be able to distinguish.

With the similarity of symptoms, only a doctor can distinguish one disease from another, so a newborn should be necessarily shown to the orthopedist in order to exclude pathology.

Timely treatment allows you to completely get rid of the disease.

Causes of the disease

The very concept of "dysplasia" means a violation of the development of any part of the body. If this ailment has struck precisely the hip joints, then this is often manifested in:

• abnormal development of the articular cavity;
• immaturity of the head of the femur;
• violation of mobility of the hip joint.

The consequence of these conditions may be pre-severity (predisposition to dislocations), subluxation and dislocation in newborns.

The reasons why the hip joints do not develop normally have not yet been clarified. But some characteristic features of the disease are found.

Firstly, such a disease often occurs in girls, but not in boys. Secondly, the propensity to this pathology is genetically conditioned and transmitted from generation to generation.

So, in which cases are babies more vulnerable to dysplasia:

• if the family already had cases of congenital subluxation of the femoral joints;
• if children are born in a pelvic presentation;
• in the presence of deformed feet;
• with too much weight at birth;
• at pathologies of pregnancy.

Clinical symptoms

Symptoms of subluxation or dislocation of the femur in infants are visible during visual examination. It:

• asymmetrically located skin folds in the groin area, but the buttocks and knees;
• short hip;
• limited mobility of the thigh.

The signs of the disease are best seen in children aged 3 months. In any case, if you notice symptoms of the disease, do not panic, see a doctor and begin timely therapy.

Examining the baby, the doctor pays special attention to the folds of the skin in the groin, buttock zone and under the knees - in the affected areas they are bigger and deeper than usual.

However, with bilateral dysplasia, the asymmetry can be seen not so clearly.

However, wrinkles on hips can be asymmetric in healthy children, so you need to pay attention to a few more indicators.

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Lay the baby on the back and gently bend his legs in the knees and in the hips.

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If you notice that the knees are on different levels, this is already quite a serious reason to show the newborn to the doctor.

The orthopedist on examination should check the symptoms of slipping and the limitation of mobility of the hip joints. The presence of the last sign is most important when establishing the correct diagnosis.

Diagnosis of the disease

For early detection of dysplasia, it is necessary to show the baby to the orthopedic surgeon almost immediately after birth - at 1 month. and at the age of slightly older - at 3 months.

Diagnosis is carried out using ultrasound and X-rays. X-ray is used for children of older age - from 6 months.

On how early the disease is discovered, the treatment itself, its methods and speed depends.

In degrees, the disease is divided into:

• light, when the muscles and ligaments do not fit well to the joint, because of this the hip bone is incorrectly located in the joint fossa;
• pre-acute - borderline condition, in which the femoral head is partially located in the articular cavity, and partly extends outwards;
• dislocation - in this state the head of the bone is outside the articular cavity, in this position, not only does the gradual deformation of the joint occur, but also the mobility of the leg in the thigh is disturbed.

The form of the disease can be one-sided and two-sided. The second option is hip dysplasia in the newborn.

After ultrasound, it is necessary to conduct an X-ray examination, this is done at an older age, when the baby is at least six months old.

Treatment of the disease

Dysplasia is treated quite a long time, so do not expect the first results immediately after the start of treatment.The disease is treated not medication.

First, the legs of the child should be permanently fixed in a divorced position with bent knees, and secondly - the child must necessarily move in this position.

In order to keep the feet of the baby in the right position, there are various devices - tires, bandages, a pillow of Freik, Pavlik stirrups, etc. The first time in the period of treatment of the illness the baby should be in them constantly.

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In orthopedic adaptations the child must stay at least 3 months, but the exact period is established only by the orthopedist. On the basis of how early treatment began, the future forecasts largely depend.

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Diagnosis and treatment of the disease at the earliest possible time gives a 90-95% chance of recovery.

If the subluxations and dislocations of the hip joints are not treated in time, the baby can remain lame.

For very young children use soft pads and wide swaddling, while rigid orthopedic structures are used to treat older babies. Only in extreme cases it is possible to treat by operative methods, usually the above mentioned adaptations can be achieved.

In addition to various devices for the treatment of the disease, massage and medical gymnastics are shown. The doctor can also direct to physiotherapy, for example, electrophoresis or paraffin therapy.

How to do massage and exercise

Treatment, which advises Dr. Komarovsky, is very simple.

This massage, which greatly improves the effectiveness of therapy, is also useful for healthy babies, and in case of pathological development of the hip joints it is shown to be 100% complete. You can conduct the procedure as a professional masseur, and parents themselves.

Step 1

Put the newborn on your back and start the massage with a light stroking of the hands, feet and abdomen, and then turn the baby face down. Make sure that the legs are turned to the sides in this position.

Carefully stroke and rub the hips of the baby from the inside, then with similar movements work the lower back of the newborn. After this, you can go to the buttocks, massage is done with light tapping movements and neat tingle.

Step 2

After you have massaged the back and buttocks, turn the baby over and continue the massage, develop the front surface of the hips, gently bending and unbending the legs of the baby. Do not make sharp movements and watch the reaction of the newborn - it should not be painful. Otherwise, the baby will begin to be capricious during subsequent massage procedures.

Step 3

Then start rotating the baby's thigh in the inside.

Do this alternately with each leg - with one hand, hold the baby's pelvis, and the other hand slowly bring the knee closer to the body and gently rotate the thigh inward.

Such a massage will contribute to the proper formation of the hip joint cavities. Give the child a rest, gently stroking all of his body.

At the end, take care of your feet - put a small ball under them and roll it.

The final stage is chest massage.

Wellness gymnastics

Exercises are extremely simple and do not require any adaptations.Gymnastics should be held often - at least 5 times a day before feeding.Within 3-4 months you must do the exercises 15-20 times.

1. The first exercise: rotate the leg of the newborn in the hip and knee along the axis of the thigh.
2. The second exercise: bend and unbend the legs in the hips and knees towards the stomach, while the hips should be in a horizontal position.

Together with physiotherapy, massage, gymnastics and orthopedic appliances will give excellent results.

Prevention of disease

All newborns for early detection of the pathology of hip joint development in the maternity hospital or in the polyclinic in 1 month. spend ultrasound of the pelvis.

One of the preventive actions, according to Dr. Komarovsky, is wearing a baby in a sling face to the mother.

It was believed that it is this swaddling that straightens the legs, but in fact it only harms the baby and, as it turns out, significantly increases the risk of developing hip joint dysplasia in the newborn.

For a wide swaddling use a soft, but dense fabric.

Fold it in several layers and lay between the diluted legs of the baby so that the side edges are in the area of ​​the knees, and the upper ones completely cover the pelvis. It turns out something like a diaper, but much wider and more stable form.

A source: http://ogrudnichke.ru/lechenie/displaziya-u-novorozhdennogo-vse-sposoby-lecheniya.html

Hip dysplasia in newborns

The hip joint provides the connection of the largest bones of the human body, so it has mobility and is able to withstand increased loads.

This is achieved by combining the head of the femur with the acetabular pelvic cavity using four ligaments.

Their strands are permeated with nerve endings and vessels, so their damage or pinching provokes degenerative phenomena in the head of the bone.

In newborns, dysplasia of the hip joint (DTS) is manifested by the incorrect formation of one from his departments, at the same time the possibility of holding the femoral head in the physiological position. Such a state, depending on the features of the displacement of structures, is characterized as a subluxation or dislocation.

Statistics of the disease:

• Deviations in the development of this area are registered in infants quite often. On average, these indicators reach 2-3% among children.

  In the Scandinavian countries, dysplasia of the hip joints is fixed somewhat more often, while southern Chinese and Africans rarely.

• Pathology affects girls more often.

  They account for 80% of patients with a diagnosis of hip dysplasia.

• The facts of hereditary predisposition are indicated by the fact that family cases of the disease are fixed in a third of patients.
• In 60% of cases, dysplasia of the left hip joint is diagnosed, a fracture of the right joint or both simultaneously accounts for 20%.
• The relationship between the traditions of tight swaddling and increased incidence rates was noted. In countries where it is not customary to artificially limit the mobility of children, cases of dysplasia of the hip joints are rare.

CAUSES

Elements of the musculoskeletal system are laid at 4-6 weeks of pregnancy. The final formation of joints is completed after the child begins to walk independently.

The most common cause of disorders arising from intrauterine development are genetic abnormalities (25-30% of cases) that are transmitted on the maternal line. But other factors are also capable of adversely affecting these processes.

The causes of hip dysplasia in newborns:

• A large fetus is prone to anatomical displacement of bones with its abnormal location inside the uterus.
• Influence on the fetus of physical factors and chemicals (radiation, pesticides, drugs).
• Malposition.

  First of all, we are talking about the breech presentation, in which the fetus rests against the lower part of the uterus not with the head, as it should be in the norm, but with the pelvis.

• Kidney disease in a child.
• Genetic predisposition in case of presence of the same problems in parents in childhood.
• Significant toxicosis at the initial stage of gestation.
• Tonus of the uterus during the gestation of the child.
• Diseases of the mother - heart disease and blood vessels, liver, kidneys, as well as beriberi, anemia and metabolic disorders.
• Viral infections carried during pregnancy.
• The influence of increased concentration of progesterone in the last weeks of pregnancy can weaken the ligaments of the unborn child.
• Harmful habits and improper nutrition of the future mother, in which there is a deficiency of trace elements, vitamins of group B and E.
• An unsuitable environment in the region of residence of parents causes frequent (with excess of 6 times) cases of dysplasia of the hip joints.
• Traditions of tight swaddling.

CLASSIFICATION

Types of anatomical disorders in DTS:

• Acetabular dysplasia - abnormalities in the structure of the acetabulum. The limbus cartilage located at its edges is touched. The pressure of the head of the thigh causes its deformation, displacement and twisting inside the joint.

  There is a stretching of the capsule, ossification of cartilage and movement of the femoral head.

• Epiphyseal.

  Such dysplasia of hip joints in newborns is determined with stiffness of joints, deformation of limbs and the appearance of pain. It is possible to change the diaphase angle up or down.

• Rotational dysplasia. Placement of bones when viewed in the horizontal plane is incorrect, manifested by clubfoot.

Degrees of severity DTS:

• I degree - pre-acute. The deviation of development, in which the muscles and ligaments are not changed, the head is located inside the canted joint of the joint.
• II degree - subluxation.

  Inside the joint cavity, only a part of the femoral head is located, since its upward movement is observed. The ligaments are stretched and lose tension.

• III degree - dislocation. The head of the thigh completely leaves the cavity and is located higher.

  Bundles in tension and stretched, and the cartilaginous rim enters the inside of the joint.

SYMPTOMS

The first signs of dysplasia of the hip joints in infants can appear when they reach the age of 2-3 months, but they need to be diagnosed in the conditions of the maternity home.

The main symptoms are:

• The restriction during the withdrawal of the unhealthy thigh is characteristic of the II and III degree of dysplasia. In healthy children, knees bent at the knees easily divorced in the sides at an angle of 80-90 degrees. Pathological changes prevent this, and dilute them can not more than 60 degrees.
• Asymmetry of folds under the knees, buttocks and groin. Normally they are symmetrical and of equal depth. Attention should be paid in the case when the lying on the abdomen folds on one side deeper and are located higher.

  This sign is not considered objective, as it can not indicate a problem with bilateral dysplasia. In many children, the picture of the folds is aligned to three months.

• Symptom of slipping, or clicking.

  The head of the femur slides when moving, this is accompanied by a characteristic click when breeding or bringing the legs. This sign is a reliable symptom of abnormalities 2-3 weeks after the birth of the child.

  When examining children of another age, this method is not informative.

• The shortening of one leg is a reliable sign of dysplasia and is detected when the kneecaps are in a prone position. This symptom may indicate a formed hip dislocation.
• Later, getting up on the feet, wrong walking can be noted already at the last stages of dysplasia of the hip joints.

Identification of at least one of the listed signs is the reason for resorting to a pediatric orthopedist.

The main symptoms of hip dysplasia in newborns can be detected simultaneously with concomitant symptoms.

Secondary symptoms of the disease:

• violation of the search and sucking reflex;
• Atrophy of muscles in the lesion;
• reduced throbbing of the femoral artery by the modified joint;
• signs of torticollis.

DIAGNOSTICS

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

Children who belong to the category of large, children with deformed feet and with heredity that is burdened by this feature fall into the risk group. In addition, attention is paid to the toxicosis of pregnancy in the mother and the sex of the child. Newborn girls are subject to mandatory examination.

Methods of examination:

• External examination and palpation is performed to identify the characteristic symptoms of the disease. In infants, dysplasia of the hip joints has signs of both dislocation and subluxation, which it is difficult to clinically identify.

  Any symptoms of abnormalities require a more detailed instrumental examination.

• Ultrasound diagnosis is an effective method of detecting abnormalities in the structure of joints in children of the first three months of life.

  USD can be performed many times and is allowed in the examination of newborns. The specialist pays attention to the state of the cartilage, bones, articulations, calculates the angle of the deepening of the hip joint.

• The X-ray diffraction pattern is not inferior in reliability to ultrasound diagnosis, but has a number of significant limitations. The hip joint in children under seven months is poorly seen due to the low level of ossification of these tissues.

  Children of the first year of life are not recommended to have irradiation. In addition, it is problematic to lay a mobile kid under the machine in compliance with the norms of symmetry.

• CT and MRI provides a complete picture of the pathological changes in the joints in various projections.

  The need for such a survey appears in the planning of surgical intervention.

• Arthroscopy, arthrography are performed in severe, neglected cases of dysplasia. These invasive methods require general anesthesia to obtain detailed information about the joint.

TREATMENT

To treat dysplasia of hip joints in infants should children's orthopedists. The method of treatment is determined by the severity of the dysplastic process.

The main principle of therapy is the early onset of functional treatment, which helps to normalize the anatomical shape of the hip joint and maintain its motor function.

It is noticed that when the hip is withdrawn, the bones acquire the correct position, and self-correction of the dislocation takes place. This position helps to improve the blood supply to the muscles of the limb and prevents their dystrophy.

Methods for treating dysplasia:

• Wide swaddling is recommended for the treatment of the youngest patients. Between the legs, bent at right angles, lay a folded diaper 15-20 cm wide.
• Becker's pants have the same principle as wide swaddling, but are more convenient to use.
• The pillow of Freik reminds Becker pants with stitched ribs.
• Fixing tire-struts - elastic tires Vilensky and Volkov, as well as fixing gypsum tires.
• Pavlik's stirrups are a bandage made of soft tissue, which provides a curative effect on the desired area and does not limit the movements of the child.
• Dislocation of the dislocation with further immobilization of the limb in severe cases of illness in children under the age of 5-6 years. For older patients this procedure is contraindicated.
• Skeletal traction is performed in complex cases of dysplasia in the treatment of children under 8 years of age.
• Corrective surgical intervention, in which the dislocation is corrected during an open or endoscopic operation.

  Is performed in case of deliberate inefficiency of conservative treatment or if it is impossible to correct dislocation by sparing methods.

• Physiotherapy. Exercises are aimed at flexing, unbending legs, mixing them and diluting them to the sides.
• Physiotherapy - massage, electrophoresis, paraffin applications, mud treatment, ozocerite and warm baths.

Treatment of dysplasia and hip joint in a newborn can be a long and painstaking process. Despite this, one can not arbitrarily adjust or cancel the appointment of a doctor, since incorrect treatment can lead to serious consequences.

COMPLICATIONS

The disease requires early diagnosis and the beginning of therapy in the shortest possible time. In the infant, the consequences of hip dysplasia can provoke severe abnormalities that lead to disability.

Complications of DTS:

• dysplastic coxarthrosis in adulthood;
• impaired mobility of the spine, legs and pelvic girdle;
• scoliosis;
• flat feet;
• neoarthrosis;
• change of posture;
• osteochondrosis;
• death of the tissues of the femoral head.

PREVENTION

In infants, the treatment of hip dysplasia is a mandatory measure of preventing severe complications. To prevent the development of dysplasia can be by following preventive measures.

Measures to prevent dysplasia:

• prevention of any negative effects on the fetus;
• careful examination of children at risk in the first 3 months after birth;
• full nutrition of the nursing mother or use of adapted formulas for feeding the child;
• free swaddling of the newborn;
• diapers that do not exert pressure on the pelvis.
• strict adherence to the doctor's recommendations in identifying any stages of dysplasia.

Prognosis for recovery

Hip dysplasia refers to curable diseases. Under the condition of early initiation of therapy under the control of an orthopedist and the implementation of his recommendations, complete recovery is possible.

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A source: http://pillsman.org/22374-displaziya-tazobedrennyh-sustavov-u-novorozhdennyh.html