All about the immaturity of the hip joint in newborns. Hip dysplasia in infants: first signs and treatment

Violation of the development and formation of the hip joints - the main type congenital anomalies musculoskeletal system in children under 1 year of age.

Dysplasia hip joint in newborns it occurs with a frequency of 25 cases per 1000. In regions with a negative environmental situation, the incidence rate increases several times.

What is dysplasia?

DTS is a disease characterized by underdevelopment during embryogenesis of all elements involved in the formation of the joint:

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

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

1st degree (pre-luxation) - underdevelopment of osteochondral elements is observed; the muscular-ligamentous apparatus is not changed. Head deflection femur absent.
2nd degree (subluxation) - against the background characteristic manifestations pre-dislocation there is a displacement (dislocation) of the head of the femur upward and outward.
3rd degree (dislocation) - severe form, the femoral head does not contact the acetabulum, contact articular surfaces absent.

The figure shows the types of DTS.

A - normal hip joint of a newborn, B - 1st degree dysplasia, C - 2nd degree dysplasia, D - 3rd degree dysplasia.

Historical background - Hippocrates described the first symptoms of the disease in newborns. He used traction with heavy loads. Only at the beginning of the twentieth century did serious work appear on the timely diagnosis and treatment of pathology. The term “dysplasia” was first introduced by Hilgenreiner in 1925.

Reasons for the formation of DTS in newborns

There are several theories to explain why congenital hip dysplasia occurs.

Hereditary theory ─ the occurrence of the disease is associated with genetic predisposition.
Hormonal theory - the development of dysplasia is based on a high level at the end of pregnancy; as a result, there is a decrease in the tone of the muscular-ligamentous apparatus, which is the cause of instability in the vehicle.
Exogenous theory - exposure to toxic substances, including certain groups medicines, disrupts the development of bone tissue and leads to pathology of the musculoskeletal system.
Multifactorial theory - hip dysplasia in infants occurs as a result of the combined influence of the above factors.

To conditions that promote development congenital dislocation hips include:

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

A directly proportional dependence of the increased incidence of DTS on the characteristics of swaddling a child has been established. In many countries in Africa and Asia, the incidence is lower because newborns are not swaddled; they prefer to be carried on the back, thereby ensuring freedom of movement for the child. In this regard, in the early 70s of the last century, the Japanese, in accordance with the national program, abandoned the ancient tradition: tight and durable swaddling was prohibited for hip dysplasia in newborns. The result surprised even skeptics: the number of children with TS pathology decreased by approximately 10 times.

Symptoms of dysplasia

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

position and size of the lower extremities;
position of skin folds in the thigh area (symmetrical or asymmetrical);
muscle tone;
volume of active and passive movements.

DTS in infants manifests itself with characteristic symptoms.

Slipping symptom (synonym: clicking symptom). The child is placed on his back, bending his legs at both the knees and the knees at an angle of 90 degrees ( thumbs The examiner is placed on the inner surface of the thighs, the remaining fingers are on the outer surface). When the hips are abducted, pressure is applied to the greater trochanter, resulting in the reduction of the femoral head. The process is accompanied by a characteristic click.
Limitation of hip abduction. Childhood hip dysplasia is manifested by limited abduction to 80 degrees or less. The symptom is most typical for unilateral lesions.
Relative shortening of the limb. The symptom is rare in newborns and is observed with high dislocations.
External rotation of the lower limb is a sign characterized by outward rotation of the hip on the affected side. May also occur in healthy children.
The asymmetrical position of the femoral and gluteal folds is revealed during an external examination.

Secondary (auxiliary) signs of DTS in a newborn:

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

Asymptomatic cases of congenital hip dislocation are rare.

Instrumental diagnostic methods

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

X-ray examination - Before taking a photo, you must comply following conditions: symmetrical positioning of a newborn, minimum time performing the procedure, using protective pads. When producing radiographs, it is necessary to have assistants or parents involved to help fix the baby in the desired position. TS dysplasia has characteristic X-ray signs:

obliquity of the roof of the acetabulum;
departure of the femoral head from the central axis;
discrepancy between the size of the glenoid cavity and the size of the head;
displacement of the thigh outward from the vertical line.

Arthrography allows us to judge the X-ray negative elements - ligaments, capsule. Using this method, even grade 1 hip dysplasia can be established. On an arthrogram it is possible to determine the position of the head and its shape, fibrosis of the capsule, fusion of the acetabulum. The procedure is performed under general anesthesia. The skin is pierced with a thin needle, subcutaneous fat, capsule, penetrate into the cavity of the vehicle. A contrast agent containing iodine or an inert gas is injected. X-rays are then taken.

Arthroscopy - A conductor with a camera is inserted into the joint cavity, and an image of all elements is displayed on the TV screen - bone surfaces, ligaments, cartilage.

Ultrasound examination of the vehicle. Advantages - the possibility of repeated use to monitor treatment, no radiation exposure compared to radiography. The method is non-invasive, safe for the child. Ultrasonography can detect congenital hip dislocation in the early stages. Ultrasound is performed for the following indications:

presence of clinical manifestations of DTS;
severe pregnancy and childbirth;
decreased muscle tone in the lower extremities.

CT scan allows you to evaluate additional radiological indicators - the degree of atrophy of the soft tissues surrounding the joint. The main disadvantage of the method is the high radiation dose, even with a single examination.
Magnetic resonance imaging used to determine indications for surgical treatment.

Differential diagnosis

There are diseases that can present with the same symptoms as congenital hip dislocation. The doctor needs to make some efforts to make the correct diagnosis.
TS dysplasia in newborns must be distinguished from the diseases listed below:

pathological hip dislocation;
paralytic dislocation;
metaphyseal fractures;
arthrogryposis;
epiphyseal osteodysplasia.

DTS in newborns in numbers

If treatment is started before the age of 3 months, the cure rate is 97%.
Treatment prescribed in the second half of the year gives excellent results only in 30% of cases.
The detection rate of the disease before the age of 6 months is only 40%.
Treatment started before the age of 3 months lasts 2 months, and treatment started at the age of 12 months lasts more than 20 years.

Main types of treatment

There are many scientific papers that contain information on how to treat TC dysplasia. Most authors are guided by the following principles:

treatment is prescribed when clinical signs of the disease are detected;
treatment is prescribed if available radiological signs diseases, even in the absence of clinical ones;
combination of asymmetry of the gluteal folds with severe course pregnancy is an indication for treatment.

Conservative treatment includes:

wide swaddling: carried out for 1 - 2 months, while active movements in the joints are maintained, which contributes to the spontaneous reduction of the dislocation and the correct formation of the acetabulum;
spacers for DTS make it possible to abduct the legs when they are bent, free access to the body. The most commonly used splint for dysplasia is Pavlik stirrups;
use of functional plaster casts with a distraction system;
physiotherapeutic techniques reduce activity inflammatory process, improve trophic processes in tissues, prevent the occurrence of contractures, and reduce pain. The following types of physiotherapy are used:
- for dysplasia, it allows the administration of medications into the hip joint area;
- amplipulse therapy;
- ultrasound;
- magnetic laser therapy;
- hyperbaric oxygen therapy;
- massage;
- acupuncture.

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

open reduction of congenital hip dislocation;
endoscopic treatment of dysplasia.

Memo for parents

Children who have completed treatment for hip dysplasia need to adhere to a certain regimen.

It is recommended to continue performing gymnastic exercises.

Prohibited early learning walking.

Walkers and other devices that force walking are not used.

Boots are used that fix the ankle joints.

Rehabilitation measures for dysplasia

Rehabilitation is aimed at:

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

For this purpose, physical therapy, physiotherapeutic treatment, and medications are used.

How to prevent the development of dysplasia in a newborn?

For this purpose it is necessary:

regularly visit a neurologist and orthopedist;
perform ultrasound examination of joints;
engage in physical therapy;
Avoid tight swaddling.

From the collection of an orthopedic surgeon - a clinical example

Patient Ira K., age - 8 months. A diagnosis was made: “grade 2 dysplasia of the right hip joint.” She periodically underwent courses of outpatient treatment 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 doctor revealed:

shortening of the left lower limb by 1 cm;
limiting abduction in joints to 70 degrees;
asymmetrical position of the gluteal and femoral folds.

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

surgery under general anesthesia - lengthening of the adductor muscles of the thigh;
adhesive traction for 3 weeks, followed by closed reduction of the head of the right femur and application of a plaster cast;
after 3 months the plaster cast is removed;
a Vilensky splint was applied;
dosed load on the affected lower limb.

After treatment, a control radiograph was taken: the dislocation of the head of the right femur was reduced.
From the age of 6 months, Ira is allowed to crawl.
Next stage - rehabilitation treatment(with a frequency of 1 time in 3 months), which included:

gymnastic exercises aimed at developing the affected joint;
physiotherapeutic treatment (amplipulse therapy, electrophoresis, massage of the lower extremities, mud therapy);
hyperbaric oxygenation;
B vitamins;
diet therapy;
drugs aimed at restoring cartilage structure.

At the age of 1 year 1 month, the Vilensky splint was removed, and dosed static loads were allowed. An x-ray taken at this age shows a complete absence of signs of DTS on the right.
The range of motion in the affected joint was completely restored. Pain syndrome the child does not.

From the above we can conclude: hip dysplasia is a curable (curable) disease. Full recovery is possible provided timely appeal see an orthopedist and fully follow all recommendations.

Abnormal structure and malfunction pelvic bones are the first signs of hip dysplasia in an infant. This is the most common type of musculoskeletal pathology in children in early childhood.

Statistics show that this disease develops in 2.5% of newborns. In regions where there are poor environmental conditions, the indicator can increase significantly. In addition, experts note that the disease more often affects girls than boys.

Joint dysplasia - what is it?

According to medical terminology, hip dysplasia is a pathology in which unformed parts of the joint are observed:

ligaments;
cartilage tissue;
bones;
muscle tissue;
nerves.

Some experts call this disease congenital hip dislocation. Doctors distinguish three stages of development of pathology in children:

Stage 1 - osteochondral tissues are not formed, muscles and ligaments are developed normally. There is no deviation of the femoral head;
Stage 2 - against the background of the abnormal structure of the osteochondral segments, a displacement of the bone head to the top and outward is formed.
Stage 3 is the most severe type of pathology. There is no contact of the femoral head with the acetabulum.

Depending on the clinical picture diseases, experts identify several forms of pathology in newborns:

acetabular - there is an irregular structure of the acetabulum. The head of the femur puts pressure on the cartilage and deforms it. Ossification of the cartilage tissue and displacement of the femoral head occurs;
epiphyseal - diagnosed when the mobility of the pelvic joints is impaired and pain appears;
rotational - there is an incorrect location of the pelvic bones. The child has clubfoot.

Incorrect formation of the hip joints in infants occurs against the background of disturbances in the intrauterine development of the embryo. Most often, the development of this pathology begins at 4-5 weeks of pregnancy. Experts identify several factors that have a negative impact on the development of the musculoskeletal system in the fetus:

a genetic mutation caused by a disorder in the primary formation of pelvic joints;
exposure to negative substances on the embryo (chemicals, poisons, toxins, some groups medications etc.);
large size of the fruit;
breech presentation, which causes damage to the pelvic bones during delivery.
intrauterine infections or renal failure in the fetus. Against the background of such deviations, a violation of water-salt metabolism is observed.

Factors for the development of dysplasia on the part of the expectant mother are:

chronic pathologies in which dysfunction is observed internal organs women (heart, kidneys, liver, stomach, etc.);
lack of vitamins;
nervous shocks 1-2 weeks before birth;
taking hormonal medications;
sedentary and inactive lifestyle;
metabolic disease;
first birth;
narrow pelvis of a woman;
premature birth;
risk of miscarriage;
development of infectious pathologies during pregnancy;
toxicosis and gestosis;
unhealthy lifestyle (use of alcohol, cigarettes and drugs);
unbalanced diet.

In addition, experts note the relationship between the development of pathology and tight swaddling. In those regions where doctors recommend not restricting the child’s movement, this disease is less common.

As a rule, this pathology can be noticed by a specialist (neonatologist, surgeon, pediatrician) during the initial examination of the newborn. But many parents are interested in: “how to diagnose the disease yourself and what to do if the development of the pathology is confirmed?” Most often, the disease is latent for the first 2-3 weeks, and then may manifest itself with one or more symptoms:

asymmetrical arrangement of folds in the gluteal area, they can be noticed if you turn the baby onto his stomach;
difference in the length of the lower limbs, usually the leg on the side of the unformed joint is shorter than in the healthy area;
stiffness of movement when spreading the child’s legs, this can be noticed in the process of performing gymnastics for the baby;
incorrect posture;
constant tilt of the head to one side;
asymmetrical arrangement of the feet, they can be turned in different directions;
the appearance of a click when spreading the child’s hips.

In the absence of proper treatment, the disease progresses to a more severe stage and is accompanied by more severe symptoms:

pain when moving;
increased tone or complete atrophy pelvic muscles;
thinning muscle tissue in the zone of development of the pathological process;
frequent falls when trying to step;
swaying when walking;
stiffness of joint mobility.

If you don't start timely treatment dysplasia, this can lead to the development various complications, starting with incorrect posture and ending with disability.

According to statistics, children suffering from this disease begin to walk much later than healthy ones. They have an unsteady gait, accompanied by swaying. This becomes especially noticeable in children aged 1.5-2 years. In addition, other abnormalities are observed in children:

the occurrence of arthrosis of the hip joint at an older age;
poor posture;
flat feet;
disturbances in the mobility of joints and the spine;
death of joint tissues;
osteochondrosis.

Diagnostic measures

Many parents are interested in: “how to treat dysplasia in children?” To select a treatment method, it is necessary to accurate diagnosis and establish the stage of the pathology. To do this, the doctor will examine the baby and prescribe additional examinations, based on the results of which he will decide how to cure the pathology and avoid the consequences.

X-ray examination.
Arthrography.
Arthroscopy.
UAC and OAM.
Blood chemistry.

In order to have an idea of what dysplasia looks like in infants, you can look at the photo that shows the diseased joint.

Treatment

The choice of treatment method for this pathology directly depends on the stage of the inflammatory process. If the baby is diagnosed with pre-luxation, then it is enough to massage the joint. At more advanced stages, the child requires complex treatment, which includes the use of several techniques:

orthopedic;
physiotherapy;
surgical.

In order to get rid of dysplasia in early age, it is necessary to fix the hip joint in the correct position. For this purpose, specialists prescribe the wearing of special devices. The duration of such treatment depends on the degree of deformation of the hip joint.

Pavlik stirrups. This is a special device that was invented in the last century by a Czech scientist. It is made from soft fabric, which does not irritate the baby’s skin and is a device made of straps and a chest bandage. Thanks to him, it is possible to record normal position the femoral head and gradually the hip joint takes on the correct shape. It does not limit the baby’s movements at all and the child can take a position that is comfortable for him.
Freyka's pillow. This is a special device that is placed between the baby’s legs and secured with special belts. In this case, the child’s legs are fixed in a spread state and are in a bent state.
Vilensky tire. Another name for this device is a spacer. It consists of a pipe and a special cuff with lacing. This device is worn daily for 4-6 months and is removed only before taking water procedures.
Tire Volkova. This design is made of plastic and has several parts. The child's legs are fixed in a stationary position using a special corset.

Physiotherapeutic treatment

If the baby is diagnosed with acetabular dysplasia, then the baby is prescribed physiotherapy:

therapeutic gymnastics - consists of a set of exercises that parents can carry out for the child even on their own;
massage - to carry out the procedure, the child is first laid on his stomach, and then on his back, and not only the hip joint, but also other parts of the body (stomach, back, arms, etc.) are kneaded;
thermal procedures - the inflamed joint is treated with ozokerite or paraffin;
electrophoresis - a solution with calcium and chlorine is used for the procedure.

You should not try to carry out these procedures at home, as this may worsen the child’s condition. The procedure must be performed by a highly qualified specialist, taking into account the form of the disease and all possible contraindications.

Surgery

This method of therapy is used only in extreme cases, if diagnosed advanced stage pathology (dislocation) or in the case when the treatment did not bring the desired result. There are several ways to perform surgery in young children:

osteotomy of the hip joint - the femur is divided into two parts and its correct fusion is ensured;
palliative surgery - with the help of surgery, specialists align the child’s asymmetrical limbs;
endoprosthetics - the inflamed joint is replaced with a plastic implant.

After operation, lower limbs the child is fixed in a stationary position using a splint. This equipment will cause discomfort to the baby, but it is necessary to ensure proper fusion of the joint. After some time, the splint can be replaced with more comfortable devices: stirrups or Freik’s orthopedic pillow. The duration of wearing these devices is determined by the attending physician.

Preventive actions

If diagnosed easy stage pathology, then in order to get rid of hip dysplasia, it is enough to do regular massage. In addition, Dr. Komarovsky advises following some recommendations that will be useful for caring for children with any stage of dysplasia.

It is not recommended to use tight swaddling of a child's lower extremities. It is better if the baby's legs are free.
The transfer of the child must be carried out according to a certain rule. Give the baby a vertical position and press him to your body, while spreading his legs.
Carry out lower limb exercises daily. Very good exercise is considered a “bicycle”, since during the process the baby’s legs are in motion.
It is better to lay the baby so that his lower limbs partially hang down. This will reduce the load on the area of inflammation and give the sore joint some rest.
You should not place a child with dysplasia on his legs, since even minimal load can cause curvature of the joint.
When transporting a baby in a car, you must have a special seat. It will not only protect the child in the event of a collision, but will also prevent the legs from twisting.
If a child eats in a special highchair, then he should place a roll made of a towel between his legs.

At late diagnosis pathologies, the duration of treatment is prolonged, and the risk of complications increases significantly. If therapy was started in the 2nd week of life, then the chance of complete recovery is 100%. In the treatment of dysplasia in children under one year old, it is sufficient to use conservative methods therapy: orthopedic, physiotherapeutic. At an older age, more serious treatment is required and surgical intervention is possible.

The literal meaning of dysplasia is abnormal growth. The cause of the disease is inadequate development of muscle, bone, cartilage, nerve tissue, connectives and assumes compulsory treatment. In newborns and babies up to one year old, in most cases, hip dysplasia is diagnosed. It manifests itself in incorrect position femur at the point of attachment to the pelvic ring. In most cases, the disease is congenital, less often - acquired.

Why is it important to diagnose immediately?

Deviations in the development of the musculoskeletal system in a newborn are the cause of impaired musculoskeletal function. Successful treatment possible if the diagnosis is made in the early stages of the disease. In this case, adverse consequences for the future development of the child can be avoided. Untimely treatment and severe progression of hip dysplasia can lead to lameness and disability.

Signs of the disease

In the neonatal hospital to identify hip dysplasia. Dr. Komarovsky notes the importance of examination in the first days of a baby’s life and subsequent mandatory examinations. Particular attention is paid to children at risk:

premature;
large;
during difficult pregnancy;
pelvic position of the fetus before birth.

Parents need to pay close attention to the condition of the newborn and contact a pediatrician if the following symptoms are detected.

Asymmetrical inguinal and gluteal folds

If you put the baby on his tummy, three folds are visible under the buttocks on both straightened legs, which healthy child continue each other. With dysplasia on the side of the affected joint, the folds are located higher, and sometimes an additional fold is formed on the thigh.

Komarovsky notes that asymmetry also occurs in healthy children, so it cannot be included in the symptoms required for the disease. The folds will be symmetrical in a newborn and with bilateral hip dysplasia.

Limited leg movement

The baby needs to be placed on his back, his legs bent at the knees and spread in different directions as in the photo to create a “frog” pose. U healthy baby this will not cause any discomfort; the knees almost touch the surface on which he lies. If a joint is damaged, it is difficult for him to take such a position: the incorrect joint location prevents him from straightening or spreading his legs strongly.

This method of identifying abnormalities in the development of the hip joints in a baby gives more accurate results and is an important reason to see a doctor.

Clicking sound when moving

Bending the baby's leg or abducting it to the side causes a clicking sound, which is caused by the reduction of the dislocated joint. When moving back, the click is repeated.

This method is the most reliable for diagnosing hip dysplasia in children under one year of age. It allows you to identify the disease in a baby at the earliest early stage, but with a mild disease, the signs disappear on the 8th day after birth. Availability extraneous sounds, a crunching sound when flexing and extending the joint should alert parents.

One leg is longer than the other, which is noticeable externally

If you bend your legs and place your feet on the surface where the baby is lying, your knees should be at the same level. On the side of the affected joint, one knee will be lower than the other. Based on this feature, it is difficult to identify bilateral dysplasia.

At the slightest suspicion, you should consult a doctor to rule out symptoms of the disease, or start urgent treatment upon confirmation of the disease. To diagnose the disease, X-ray or ultrasound examination is often used.

X-ray

X-rays are ineffective in identifying the presence and extent of the disease in an infant. In a newborn, the areas under study—the femoral head and the pelvic ring—consist of cartilaginous tissue, deviations in which are x-ray are not viewed. This does not give a complete picture and requires additional calculations.

Ultrasound

Ultrasound helps to accurately establish or exclude a diagnosis, which is harmless to the child and does not cause any harm. pain. It allows you to detect the disease in newborns and children under 3 months.

Other signs

If a diagnosis is not made at an early stage and treatment is not prescribed, other signs appear:

Limping. Before one year of age, most babies begin to walk; due to lameness, a “duck walk” is formed.
Pain in a deformed joint, especially when moving, which may be accompanied by crying, whims, and a clear reluctance of the child to move.
Deformation of the pelvic bones, which severe cases leads to problems with internal organs.

Forms of the disease

Dysplasia is also called joint dislocation and has several stages.

Immaturity of the hip joints

A slight deviation from the norm, which is characterized by some thickening in the recess pelvic bone. Due to the formations, the head of the femur is partially covered. This deviation is common in premature babies. If over time the joint develops fully and the disease does not progress to another stage, then treatment is not required.

Pre-luxation

It consists of an incorrect relationship between the sizes of the acetabulum and femoral head, which may be slightly larger or smaller and goes up and to the side.

Subluxation

Accompanied by a shift of the head of the femur and its partial exit from the recess of the acetabulum. At the same time, their contact is maintained.

Dislocation

It is characterized by complete displacement of the femoral head in relation to the recess of the pelvic bone. This severe degree of hip dysplasia leads to the inability to fully function the limb, sometimes to rupture of the joint. When it is detected, urgent treatment is necessary to avoid the persistent formation of pathology and possible disability.

Causes of the disease

There are several factors that cause dysplasia in children under one year of age:

The longitudinal position of the fetus and complications during childbirth cause hip dysplasia in children. Features of the intrauterine position of the child often cause signs of joint deformation on the left side;
The disease can be transmitted hereditarily through the maternal line in almost a third of cases. In newborn girls it occurs several times more often;
A child's lack of B vitamins, calcium minerals, iodine, iron, phosphorus, and vitamin E provokes the development of dysplasia. The formation of musculoskeletal tissue in children begins after a month of intrauterine development. A significant proportion of babies with joint damage are born in winter time, which is caused by a spring deficiency of vitamins in the diet of a pregnant woman and vitamin deficiency in a child;
Metabolic disorders and water-salt balance interferes with normal tissue formation;
Diseases endocrine system and infectious nature during pregnancy, the use of medications can cause complications in the child;
Hormonal disorders. Before birth female body produces more progesterone to relax the ligaments, muscles for the baby to pass through birth canal. In excess, the hormone enters the baby’s body, contributing to weakness and deformation of the ligaments. In a newborn, the level of progesterone normalizes in the first days of life, the elasticity of the ligaments is restored and the dislocation can straighten itself;
Developmental disorder spinal cord– one of the common reasons for diagnosing dysplasia in children under one year of age;
Restriction of fetal movement during pregnancy due to increased muscle tone of the uterus or small quantity amniotic fluid. Lack of activity prevents the normal formation of the musculoskeletal system;
The unfavorable environmental situation in some areas causes an increase in the incidence of newborns by 3-4 times compared to those who live in favorable conditions;
Tight swaddling for up to a year contributes to the development of acquired dysplasia, especially in children with weak ligaments. As a result of a study of morbidity in African countries, where children are almost never swaddled, Japan switched to loose swaddling or abandoned it. This made it possible to reduce the level of the disease by almost 10 times.

Treatment of the disease at an early stage gives good results, so it is important to contact your pediatrician promptly if your child suspects signs of the disease. At the same time, complex therapy, if necessary, surgical treatment.

The hip joint connects the largest bones human body, so it has mobility and is able to withstand increased loads. This is ensured by the connection of the head of the femur with the acetabulum of the pelvis using four ligaments. Their cords are pierced nerve endings and vessels, so their damage or pinching provokes degenerative phenomena in the head of the bone.

In newborns, hip dysplasia (HJD) is manifested by the incorrect formation of one of its parts, and the ability to hold the femoral head in a physiological position is lost. This condition, depending on the characteristics of the displacement of the structures, is characterized as subluxation or dislocation.

Disease statistics:

Deviations in the development of this area are recorded in infants quite often. On average, these figures reach 2–3% among children. In Scandinavian countries, hip dysplasia is recorded somewhat more often, while in southern Chinese and Africans it is rare.
The pathology most often affects girls. They make up 80% of patients diagnosed with hip dysplasia.
On the facts hereditary predisposition indicates that familial cases of the disease are recorded in a third of patients.
In 60% of cases, dysplasia of the left hip joint is diagnosed; damage to the right joint or both simultaneously accounts for 20%.
A relationship has been noted between tight swaddling traditions and increased morbidity rates. In countries where it is not customary to artificially limit the mobility of children, cases of hip dysplasia are rare.

CAUSES

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

Most common cause disorders that occur with intrauterine development, are genetic abnormalities (25–30% of cases) that are transmitted through the maternal line. But other factors can also negatively influence these processes.

Causes of hip dysplasia in newborns:

A large fetus is susceptible to anatomical displacement of bones when abnormal location inside the uterus.
Effect on the fetus physical factors And chemical substances(radiation, pesticides, drugs).
Not correct position fetus First of all, we are talking about breech presentation, in which the fetus rests against bottom part the uterus not with the head, as it should be normally, but with the pelvis.
Kidney disease in the unborn child.
Genetic predisposition if parents have the same problems in childhood.
Severe toxicosis on initial stage gestation.
Uterine tone during pregnancy.
Maternal diseases - diseases of the heart and blood vessels, liver, kidneys, as well as vitamin deficiencies, anemia and metabolic disorders.
Viral infections suffered during pregnancy.
Influence increased concentration progesterone on last weeks pregnancy can weaken the ligaments of the unborn child.
Bad habits and Not proper nutrition expectant mother, in which there is a deficiency of microelements, vitamins B and E.
Dysfunctional environment in the region where parents live, it causes frequent (6 times more) cases of hip dysplasia.
Traditions of tight swaddling.

CLASSIFICATION

Types of anatomical disorders in DTS:

Acetabular dysplasia is a deviation in the structure of the acetabulum. The limbus cartilage, located along its edges, is affected. Pressure from the femoral head causes its deformation, displacement and inversion into the joint. The capsule is stretched, cartilage ossifies, and the femoral head moves.
Epiphyseal. Such dysplasia of the hip joints in newborns is determined by stiffness of the joints, deformation of the limbs and the occurrence of pain. It is possible to change the diaphyseal angle towards increasing or decreasing.
Rotational dysplasia. The placement of the bones when viewed in the horizontal plane is incorrect, resulting in clubfoot.

DTS severity:

I degree – pre-dislocation. A developmental deviation in which the muscles and ligaments are not changed, the head is located inside the beveled cavity of the joint.
II degree – subluxation. Only part of the femoral head is located inside the articulation cavity, as it moves upward. The ligaments are stretched and lose tension.
III degree – dislocation. The head of the femur comes completely out of the socket and is located higher. The ligaments are tense and stretched, and the cartilaginous rim fits inside the joint.

SYMPTOMS

The first signs of hip dysplasia in infants may appear when they reach the age of 2–3 months, but they need to be diagnosed in the maternity hospital.

Main symptoms:

Restriction during abduction of the unhealthy hip is typical for II and III degree dysplasia. In healthy children, the legs are bent at the knees and easily spread apart at an angle of 80–90 degrees. Pathological changes prevent this, and they can be separated by no more than 60 degrees.
Asymmetry of folds under the knees, buttocks and groin. Normally they are symmetrical and of the same depth. Attention should be paid if, when lying on your stomach, the folds on one side are deeper and located higher. This sign is not considered objective, since it cannot indicate a problem with bilateral dysplasia. For many children, the pattern of folds evens out by three months.
Symptom of sliding, or clicking. The head of the femur slips during movement, this is accompanied by a characteristic click when the legs are extended or adducted. This sign is a reliable symptom of abnormalities 2-3 weeks after the birth of the child. When examining children of other ages, this method is not informative.
Shortening of one leg is a reliable sign of dysplasia and is detected when the kneecaps are aligned in the supine position. This symptom may indicate a mature hip dislocation.
Late standing on your feet and improper walking can be observed already in the last stages of hip dysplasia.

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

The main symptoms of hip dysplasia in newborns can be identified simultaneously with associated symptoms.

Secondary symptoms of the disease:

violation of the searching and sucking reflex;
Muscle atrophy in the affected area;
reduced pulsation of the femoral artery from the side of the changed joint;
signs of torticollis.

DIAGNOSTICS

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

The risk group includes children who belong to the category of large children, children with deformed feet and those with heredity burdened by this characteristic. In addition, attention is paid to toxicosis of pregnancy in the mother and the gender of the child. Newborn girls are subject to mandatory examination.

Examination methods:

External examination and palpation are carried out to identify characteristic symptoms of the disease. In infants, hip dysplasia has signs of both dislocation and subluxation, which are difficult to identify clinically. Any symptoms of abnormalities require a more detailed instrumental examination.
Ultrasound diagnostics is effective method identifying abnormalities in the structure of joints in children in the first three months of life. Ultrasound can be performed multiple times and is acceptable when examining newborns. The specialist pays attention to the condition of the cartilage, bones, joints, and calculates the angle of the hip joint.
The X-ray image is not inferior in reliability ultrasound diagnostics, but has a number of significant limitations. The hip joint in children under seven months is poorly visible due to low level ossification of these tissues. Radiation is not recommended for children in their first year of life. In addition, placing an active baby under the device while maintaining symmetry is problematic.
CT and MRI provide full picture pathological changes in joints in various projections. The need for such an examination appears when planning surgical intervention.
Arthroscopy and arthrography are performed in severe, advanced cases of dysplasia. These invasive methods require general anesthesia for getting detailed information about the joint.

TREATMENT

Pediatric orthopedists should treat hip dysplasia in infants. The treatment method is determined by the severity of the dysplastic process. The main principle of therapy is early initiation functional treatment which helps normalize anatomical shape hip joint and maintain its motor function.

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

Methods for treating dysplasia:

Wide swaddling is recommended when treating very young patients. A folded diaper 15–20 cm wide is placed between the legs, bent at a right angle.
Becker pants have the same principle as a wide swaddle, but are more convenient to use.
Freik's pillow resembles Becker's pants with sewn-in stiffening ribs.
Fixing spacer splints - elastic Vilensky and Volkov splints, as well as fixing gypsum splints.
Pavlik stirrups are a bandage made of soft fabric that provides a therapeutic effect on the desired area and does not limit the child’s movements.
Reduction of dislocation with further immobilization of the limb in severe cases of the disease in children under 5–6 years of age. This procedure is contraindicated for older patients.
Skeletal traction is performed in difficult cases dysplasia in the treatment of children under 8 years of age.
Corrective surgery, in which the dislocation is reduced during open or endoscopic surgery. Performed in case of obvious ineffectiveness conservative treatment or if it is impossible to reduce the dislocation using gentle methods.
Physiotherapy. The exercises are aimed at bending, straightening the legs, bringing them together and spreading them apart.
Physiotherapy - massage, electrophoresis, paraffin baths, mud therapy, ozokerite and warm baths.

Treatment of hip dysplasia in a newborn can be a long and painstaking process. Despite this, you cannot arbitrarily adjust or cancel doctor’s prescriptions, since incorrect treatment can lead to serious consequences.

COMPLICATIONS

The disease requires early diagnosis and start therapy as soon as possible. In infants, the consequences of hip dysplasia can provoke severe abnormalities leading to disability.

Complications of DTS:

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

PREVENTION

In infants, treatment of hip dysplasia is a mandatory preventive measure. severe complications. The development of dysplasia can be prevented by following preventive measures.

Measures to prevent dysplasia:

warning of any negative influences to the fruit;
thorough examination of children at risk in the first 3 months after birth;
nutritious nutrition for a nursing mother or the use of adapted formulas for feeding the baby;
free swaddling of a newborn;
diapers that do not put pressure on the pelvis.
strict adherence to the doctor’s recommendations when identifying any stages of dysplasia.

PROGNOSIS FOR RECOVERY

Hip dysplasia is a treatable disease. Given that early start therapy under the supervision of an orthopedist and following his recommendations is possible full recovery.

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A diagnosis such as hip dysplasia in infants is often given to newborn children. Although diagnosing the pathology is often difficult, initial symptoms can be detected already in the 1st year of a child’s life. If therapy is not started in a timely manner, the disease may be accompanied by negative consequences that worsen the quality of life.

This pathology of the musculoskeletal system develops due to the impact on the body of one of many factors, causing disruption intrauterine organ laying. These factors cause underdevelopment of the hip joints and all their elements that form the joints.

Severe pathology occurs with a violation of the articulation between the acetabulum and the head of the femur. Disorders of the musculoskeletal system cause unpleasant consequences for the child. clinical manifestations, including pain and complications if it is not treated in a timely manner. Congenital underdevelopment is often diagnosed: 3 out of 100 newborns have this pathology. Girls are more susceptible to the disease than boys.

In addition, underdevelopment most often affects the left side, while the right side undergoes changes less often. Bilateral pathology is also rare.

Causes and factors contributing to the development of pathology

What is hip dysplasia and what are the causes of the pathology? An incorrectly formed hip joint is a consequence of impaired development of the fetus during the intrauterine period, the formation of the musculoskeletal system starting from the 4-5th week of its stay in this environment.

Dysplasia causes the femoral head and acetabulum to misalign

Sources that can negatively affect the fetus include:

gene mutations, which contribute to the development of orthopedic abnormalities with disruption of the primary anlage and the formation of a defect in the pelvis femoral area embryo;
negative physical and chemical agents that affect the fetus: ionization, chemicals, poisons, medicines which are abused by a woman during pregnancy;
breech presentation or large size the fetus, which can cause displacement of the joints due to a violation of the anatomical localization of the fetus in the uterine environment;
disturbed water-salt metabolism in the fetus during development intrauterine infection or renal pathology.

Premature babies are at risk for developing hip dysplasia

Among the factors that apply to a pregnant woman are:

development of severe somatic disease: heart dysfunction, vascular pathology, severe renal or liver pathology, heart disease;
development of vitamin deficiency, anemia;
disturbed metabolic processes in a woman's body;
development of severe infectious and viral disease;
leading an unhealthy lifestyle (excessive smoking or drugs, alcohol), failure to maintain proper nutrition;
early or late toxicosis.

There is a risk group for the development of this pathological condition, taking into account which a doctor can promptly identify hip dysplasia in children under one year of age. This group includes premature babies, large children, as well as children who were in the breech position in the womb. They take into account how complicated the medical history is and how the pregnancy proceeded.

Please note: if a child has too weak muscle tone, this may indicate. This disease manifests itself in the inability of muscles to function normally.

Symptoms and severity

The first examination is carried out within the walls of the maternity hospital, immediately after birth.. If dysplasia was diagnosed during this period, it will be easier to cope with underdevelopment of the femoral area. Sometimes symptoms of hip dysplasia in children can be noticed already at home, after discharge from the hospital (read about). Parents should be alert to the following manifestations:

asymmetrical folds (gluteal, inguinal, femoral): if you put the baby on a flat surface, for example on a changing table, and legs at the knees, all the inguinal, femoral and buttock folds will not be at the same level;
different amplitude: if you put the baby on his back, bend his knees, and then straighten them to the sides, the knees will not touch the surface or will have a different angle of inclination.

All symptoms of a condition such as hip dysplasia in infants can be classified according to severity:

1st degree (pre-dislocation): the femoral part is underdeveloped, but there is no displacement of the femoral head;
2nd degree (subluxation): the head of the hip bone is partially displaced;
3rd degree (dislocation): the head is completely displaced.

According to the severity of the pathology, preluxation, subluxation and dislocation are distinguished

Go to to find out whether a hematoma on the head of a newborn is dangerous and how to determine its presence.

Types of dysplasia

Pathology can be unilateral or bilateral. The latter type is rarely diagnosed. also in medical practice There is a division of pathology into the following types:

acetabular displacement: non-standard size of the acetabulum, mostly reduced, the cartilaginous dome is underdeveloped;
hip dislocation: with normal development the femoral neck and its body, the angle connecting them is 40° (if the angle is violated, dislocation occurs);
rotational displacement: the anatomical structure and placement of bones is disrupted (symptoms: clubfoot, shortening of the limb).

Diagnostics

A specialist examines the baby’s hips while still in the maternity hospital.

To make a correct diagnosis, the doctor finds out whether the newborn is at risk: whether the pregnant woman suffered an infectious disease or intoxication, what environmental situation she lived in, whether there is a family history, etc.

To confirm the diagnosis, instrumental diagnostic measures are prescribed.

Ultrasound examination of the hip is a mandatory method to help identify dysplasia. Ultrasound is mandatory for children under 3 months of age who show signs of pathology. The manipulation is completely safe and quite informative. Examining the deformed area, the doctor checks the condition of the bone as a whole, the cartilaginous protrusion, and the angle of inclination of the acetabulum.

X-rays will be informative in identifying pathology in babies over 7 months of age. Until 7 months, most of the acetabulum and the head of the bone are covered with cartilage tissue, and it will not be visible on an x-ray.

Therapy methods

Experts divide treatment of hip dysplasia in newborns into several groups:

orthopedic;
physiotherapy;
surgical.

The choice of treatment method depends on the characteristics of the development of the pathology and the degree of its severity. In any case, it is necessary to carry out physical therapy and massage for hip dysplasia in newborns. Follow the link to learn about treatment and how this disease is diagnosed.

Orthopedic therapy

The main goal of orthopedic therapy for the disease in infants is to center the femur in the joint and “build up” its roof. The hips are given a “forced” position using devices:

Freik's pads;
diverting pants;
Vilensky outlet bus;
Koshlya outlet bus;
Mirzoev outlet bus;
Volkov outlet bus;
Pavlik stirrups;
Gnevsky's apparatus.

The choice of device and its fitting are entrusted to the orthopedic surgeon. It is strictly forbidden to select and select a device on your own, because you can not only slow down recovery, but also cause additional harm to the baby’s health. The doctor will provide a consultation on how to care for the child in the device and how to remove it.

Orthopedic devices must be worn around the clock. Its removal is possible only during water procedures, massage and physical therapy. For mild dysplasia or during the final period of therapy, the device is worn only at night.

Physiotherapeutic treatment

Dysplasia in a newborn responds well to physiotherapeutic methods. One of the main ones is. Wet plates - electrodes with Eufillin solution (most often) are applied to the diseased area. Electrophoresis for hip dysplasia in children has a minimum of contraindications.

Another method of physiotherapy is heat therapy, or rather paraffin therapy. Exposing the affected areas to white paraffin helps warm them up. For newborns, it is the white type of paraffin that is used., since it does not contain any harmful substances or impurities.

Magnetic therapy is also often prescribed. The affected area is affected magnetic field, which helps speed up metabolic processes and blood microcirculation. Such processes help accelerate the development of tissues (muscle, cartilage, connective tissue).

Increased excitability, nervousness and hyperactivity in infants can be reduced using hydrotherapy. The main advantage of the method is the ability to use it at home. For example, decoctions from medicinal herbs or sea salt.

Physiotherapy can be supplemented with gymnastics, which for hip dysplasia in newborns gives good results. Exercise therapy for hip dysplasia in children is prescribed by a doctor, taking into account the characteristics of the development of the pathology.

Surgery

Surgeon intervention is necessary only for hip dysplasia in children after 1 year of age. Direct indications for surgery are true congenital dislocation and impossibility of reduction conservative methods. The operation is performed if after closed reduction re-dislocation occurred.

Common operative technique– open reduction of the femur bone (osteotomy). Despite its effectiveness, the risk of re-dislocation still remains. Another disadvantage is the long rehabilitation period.

Complications if measures are not taken in a timely manner

Delayed initiation of therapy may cause severe dangerous consequences. When your baby starts walking, he may limp. Lameness manifests itself either barely noticeable or pronounced (depending on the severity of dysplasia). It will be difficult for him to move his leg to the side, he will be bothered constant pain in the knees and pelvic area. There may even be bone distortion and muscle atrophy.

With age, such unpleasant symptoms only increase in intensity. Among the consequences of hip dysplasia in children is a “duck” gait, with waddling from one leg to the other. Restriction of motor activity is dangerous due to underdevelopment of not only the hip, but also bone elements in other areas, as well as disruption of the functioning of all internal organs.

Prevention

Daily exercise is a good prevention of hip joint pathology

You can avoid such complications and the development of pathology if you follow simple recommendations:

daily physical activity (for example, rotational movements of the legs, spreading them to the sides, etc.);
bringing the legs to a moderate spread (loose swaddling);
preventive massage;
correct holding of the child in your arms: facing the mother, so that the legs cover her body.

Prevention also applies to pregnant women. Future mom must lead healthy image life, maintain proper nutrition, eliminate exposure to harmful factors.

Forecast

If you start taking it in a timely manner curative measures, we can hope for favorable prognosis and complete recovery. In the absence of proper therapy, the outcome depends on the severity of the pathology.

conclusions

A child who has been diagnosed with this condition is registered with an orthopedic doctor until the age of 16. Even in infancy, pathology cannot be eliminated by short term, and if you start treating it at the wrong time, the correction will take even more effort and time.

In conclusion, take a look next video. In it, Dr. Komarovsky will talk about what hip dysplasia is and how to identify it in a baby.