What is hip dysplasia, causes, symptoms, treatment. Dysplasia - a disease of the hip joints in children What is congenital dysplasia

The birth of a baby always brings great joy to the mother. But sometimes a young mother notices some strange and disturbing signs, for example, the asymmetry of the baby's buttocks and femoral folds, or different lengths of the legs. It is necessary to do a simple test procedure by laying the baby on the table and bending its legs at the knees, and try to spread them apart, if significant difficulties arise, you need to urgently show the baby to a surgeon or orthopedist, since, most likely, the baby has hip dysplasia, in which underdevelopment of both one joint and both is noted. Only a doctor will be able to determine the condition of the baby and prescribe treatment, which cannot be postponed.

Hip dysplasia is a disorder in the development of the hip joint of the baby, in which the femoral component of the joint, the head of the femur, has an incorrect orientation relative to the space of the pelvic part of the joint - the acetabulum. The consequences of this condition lead to a violation of the further support function of the baby's legs.

Dysplasia is divided into 3 degrees:

• 1 degree − predislocation. The condition is characterized by underdevelopment of the hip joint, when the head of the femur is not displaced relative to the acetabulum.
• 2 degree − subluxation. In this case, a partial displacement of the constituent parts of the hip joint occurs.
• 3 degree − dislocation. It is characterized by a complete displacement of the articular bones.

In addition, dysplasia can also have an extreme manifestation, expressed in. Violation of one or both hip joints is often found in newborns and toddlers of the first year of life, most often in girls.

In fact, dysplasia is not a disease, it is only a functional disorder that is easily eliminated. But this condition in a child cannot be ignored, because without treatment, an injury can have serious consequences for the general health of the child, expressed in the appearance of lameness, constant pain in the joint, and can also lead to chronic dislocation.

Symptoms and signs of dysplasia in babies are conventionally divided into two categories:

• Those that even inexperienced young parents who do not have a medical education can notice.
• Those that only an experienced orthopedist can see.

Mom, when examining a baby, can see:

• Asymmetric arrangement of the femoral and inguinal folds of the skin of the child, as well as his buttocks. This is the first visual symptom of dysplasia. To check the symmetry, you need to put the baby on the tummy (and then on the back), straighten his legs and see exactly how the skin folds or buttocks are located. Paired folds (buttocks) should be located in the same way and have an identical angle.
• The knee joints have different heights. To determine this, the baby needs to be laid on the back, gently straighten the legs and see if his knees are at the same level. After that, the legs need to be bent at the knees (put a “house”) and look at the level of the joints. If there is a difference in height, you should immediately consult a doctor.
• The presence of a different amplitude of movements when breeding the legs to the sides. To determine the baby, they lay it on the table, on the back, bend the legs at the knees and spread them apart. In infants under the age of one year, the hip joints are highly flexible, therefore, in a healthy baby, it is possible to spread the knees, without applying any effort, so that they touch the table. The use of force is strictly prohibited. If it is difficult to spread the legs, this is a symptom of dysplasia.

Diagnosis of violation

Even in the maternity hospital, when a baby is born, doctors conduct an examination to assess the condition and health of the baby, including checking the possible pathology of the hip joints.

Also, the pediatrician monitors the condition and development of the baby's joints during a monthly examination. If the doctor suspects the presence of a pathology, the child will be assigned an ultrasound of the hip joints, as well as an examination by an orthopedist.

In addition, each infant undergoes a mandatory examination by a surgeon at the age of one month, then at 3 months, at six months and a year. The doctor conducts a complete examination of the crumbs and, if necessary, prescribes additional studies, such as ultrasound.

The procedure is harmless to the child's body, but it makes it possible to get a complete picture of the state of the hip joints, and during the treatment it allows you to monitor its effectiveness.

In the presence of high-grade dysplasia or congenital dislocation, a child may be prescribed an x-ray of the pelvic region to fully assess the condition and choose a method for correcting the disorder.

Treatment of the baby should not be postponed. If left untreated, the disorder begins to progress, gradually moving into a more severe stage that requires more serious therapy.

Treatment of any stage is always carried out in a complex manner, with the obligatory use of special massage and exercise therapy. But the parents of an infant should be prepared for the fact that correcting such a violation is a long and very painstaking task that requires a lot of patience, since at the initial stage all children perceive therapy very hard.

On average, the duration of treatment can be from one month to a year, but in some cases more.

In the first month of a baby with dysplasia, as a therapy, in addition to a special massage, a wide swaddling technique is used, the principle of which is that a rectangular spacer is folded from a warm soft flannel diaper, the width of which should be about 15 - 17 cm.

The device is laid between the divorced legs of the baby (abduction is carried out at about 60-80 °), while the knee joints should be bent. After that, the baby is swaddled, leaving the diaper on the legs slightly loose. Babies quickly get used to such swaddling and in the future they themselves keep their legs apart at the right angle.

Some young mothers do not swaddle newborns, considering this a kind of atavism. In this case, you can fasten the diaper over the diaper and sliders by attaching ties to the spacer to attach it to the crumbs' shoulders.

With each diaper change, it is necessary to massage the muscles and carry out exercise therapy exercises, which consist in reducing and diluting the legs to develop the hip joints.

If exercise therapy, massage and wide swaddling are not enough to treat the disorder, the doctor may prescribe one of the special orthopedic remedies, which include:

• Pavlik's stirrups. The device is considered the most gentle, as well as the most convenient for the child. The device can be given to a child between the ages of 1 and 9 months.
• Freyka pillow. The device is a panty made of plastic, the purpose of which is to support the baby's legs in the desired position, called the "frog" position. The device can be given to a child from 1 to 9 months old, but as the child grows, a larger device will be needed.
• Tire spacers. The device is presented in three versions: splints for walking, splints with femoral splints and splints with popliteal splints.

Any treatment method, except for special massage and exercise therapy, is aimed at fixing the hip joints in the correct position, functionally beneficial for eliminating the existing disorder, while the joint must be bent and retracted.

A splint with popliteal splints, like Pavlik's stirrups, is most often prescribed for babies from 1-8 months, after which the device is changed to a splint with femoral splints. After the child begins to walk, a special walking splint becomes an orthopedic device.

In addition to fixing the joints in the correct position, physiotherapy procedures are also used, for example, electrophoresis on the area of ​​the damaged joint with calcium. An obligatory element of therapy is a therapeutic massage aimed at strengthening the muscles.

Exercise therapy exercises, as well as therapeutic massage, should be carried out only by a specialist in order for the effect of therapy to be positive.

It is important to observe all the features of therapy, the main of which is the continuity of treatment, that is, all procedures and massage should be carried out daily and at a strictly defined time. The massage technique that the baby needs to do at each diaper change should be mastered by the mother, but this does not mean that the baby will not need massage by a specialist.

Some parents, believing that the therapy has been delayed and the baby is healthy, begin to remove orthopedic devices on their own, but this should not be done in any case. Only a doctor can correctly determine whether the violation has been eliminated and whether treatment can be stopped.

Undertreated dysplasia can lead to the onset and rapid development of dysplastic asarthrosis, as a result of which the child may become disabled. The disease is accompanied by impaired gait, lameness, severe pain and can be eliminated exclusively by surgery.

In the presence of congenital dislocation of the hip and ongoing conservative treatment, children begin to walk late, since it is strictly forbidden to put such a child on his feet without the permission of a doctor.

If conservative treatment did not give the necessary results, the baby will have an operation, the essence of which is to reduce the head of the femur, and put all the components of the joint in the correct position. The plan of the operation, as well as its volume, in each case will be completely individual and depend on the scale of the violation and the degree of dysplasia.

Prevention of dysplasia

For the proper development of the hip joints of a newborn, doctors recommend swaddling the baby according to the principle of wide swaddling or not using diapers at all. In no case should you swaddle the baby tightly, forcibly straightening his legs and pulling the diaper. According to statistics, in countries where it is not customary to swaddle newborns, hip dislocation is very rare.

In order for the joints to develop correctly, it is necessary to provide them with natural movement, while at rest the legs of the crumbs should be in their physiological position, that is, spread apart and bent at the knee joint.

It is important for parents to understand that treatment will last a long time. Of course, it will not be pleasant for any mother to constantly put special orthopedic devices on the baby and swaddle him with a spacer bumper between her legs, this is sad and does not allow you to fully communicate with the baby, play with him.

But all restrictions, efforts and procedures will certainly bring results, which means that it is worth being patient, because we are talking about the health of the child and his future full life.

Useful video about hip dysplasia

The birth of a child is a holiday for the family. The sadder becomes the illness of a small newborn. Often among babies there is a disease known as hip dysplasia 2a.

The best weapon against disease is information. Consider the concept of the disease, the signs, causes of occurrence and control measures.

Recently, hip dysplasia has become more common in newborn babies under the age of one year. Reasons established:

• Unfavorable atmosphere for fetal development (environmental);
• Violations during pregnancy (malposition of the fetus, irresponsible attitude of the mother);
• Hereditary tendency to disorders of the musculoskeletal system.

The doctor will not be able to accurately determine the cause of the development of the disease.

What is hip dysplasia

Dysplasia is a violation of the structure of the joints of the pelvis and hip. If the age of the hip joints has not reached maturity, the disease is classified as type 2a. More often, dysplasia appears already at birth, judging by the latest estimates, too often. Interestingly, more often dysplasia occurs in young girls.

Type 2a - the initial stage. At the first stage, the hip joint is in a relatively free, healthy position, but some shifts in the negative direction are already outlined. At the mentioned stage, the ligaments and articular tissues do not adhere to the joint, do not hold, because of this, the connection begins to “wobble”, loosens like a flimsy bolt.

Elected people believe that the birth of a baby with incorrect joints in the joint means a lifelong defect. The opinion is wrong. The truth is more complicated: it will continue to expand, turning into other types, leading to serious diseases. Here are some examples:

• Predislocation (types 3a and 3b). At this stage, the head of the femoral bone protrudes slightly from the acetabulum;
• Dislocation of the femoral head (type 4). The head comes out completely, the joint begins to deform. Mobility is impaired: the baby is able to limp or not step on his foot.

There are unilateral and bilateral hip dysplasia. The point is the involvement of the legs: either the only leg becomes a victim of dysplasia, or both at the same time. In newborns, unfortunately, bilateral dysplasia is more common.

Distinguishing pathology is difficult, the disease does not show presence. The baby does not get sick, convulsions and other vivid symptoms of the disorder do not develop. An attentive parent will notice the disease in speaking manifestations:

• Different length of legs;
• Buttocks are asymmetrical;
• Characteristic clicks are emitted from the hip joint: the head of the femur pops out of the acetabulum.

If the child is one year old, the time has come for active walking, dysplasia 2a is manifested by signs:

• The kid loves to walk on tiptoes;
• "Duck" waddle gait.

If a doctor notices a symptom, so much the better. If the factor alerted the parents, seek advice as soon as possible.

How is dysplasia diagnosed?

Self-diagnosis and prescription of treatment are prohibited for the benefit of the child. Diagnosis is pending, without clear evidence of the appearance of dysplasia, treatment will not begin. A common procedure for detection is the passage of an ultrasound.

The procedure shows clear benefits. Firstly, it does not cause discomfort to children (and adults). Secondly, to make an ultrasound, you do not need to pay a lot of money, the procedure is quite affordable.

An ultrasound is performed on a baby, starting at 4 months and ending at 6. The study will reveal the degree of the disease, confirm or refute the presence of the disease. Treatment will begin. Upon reaching the age of 6 months, you will have to go for an x-ray.

How is the treatment

The success of treatment of newborns with hip dysplasia (initial type) depends on the month when the disease is noticed. Statistics show: in 90% of cases, children remain healthy and continue to grow without insurmountable obstacles. More often, doctors achieve results by the age of one and a half years.

If the child is already six months old, you will have to wait with lightning-fast treatment: sometimes up to five years or more. There is no guarantee that the result will be the best. More often the opposite happens. Sometimes surgery is required.

If the baby walks with might and main and dysplasia of the next degree is diagnosed, the result of treatment is unpredictable. To be honest, treatment is unlikely to bring a complete recovery. Parents are required to follow the rules:

1. Do not put the baby on its legs until the doctor writes out the appropriate permission;
2. It is required to help the baby to do special preventive exercises. For example, lie on your back, spread your legs and rotate your hip joint. Exercise helps the bones become more flexible, stretches them;
3. Ensure the child is in a position where the hips are constantly apart. If you fix the correct position in the joint, the bones will get used to the accepted position and grow together correctly.

Fortunately, treatment is available and quite feasible with positive results. The main thing is to visit the doctor on time, without starting the disease.

How to help a child before a diagnosis is made

If the baby was born healthy, hip dysplasia is not terrible.

For newborns, a monthly examination by a pediatrician becomes mandatory. Three times a year, parents bring their child to an orthopedist. If doctors do not notice warning signs, do not worry.

An interesting preventive method is known -. It is impossible to swaddle a child so that the legs of a wrapped baby remain straightened, like those of a tin soldier. Recent studies show that there is a relationship between the two methods - swaddling with a "tin soldier" and pathology of the hip joint. Such swaddling was accepted in the time of great-grandmothers, do not let the representatives of the older generation swaddle the baby in the wrong way.

It is better if the little one is wrapped up in the likeness of the children of ancient tribes: the baby simply "sits" in a diaper hung around his mother's neck. Mom supports the child, and the baby's legs hang freely above the ground. If the baby is behind his back - the method is correct, the child wraps his legs around his mother's back, the femurs are constantly in a divorced, fixed state. The Japanese noticed that when the swaddling method became widely used in families with newborn children, the percentage of dysplasia decreased significantly!

Hip dysplasia, type 2a, is more common in newborns. It is better for expectant mothers to closely monitor their health during pregnancy, without stopping caring for the baby after his birth.

Hip dysplasia in children is quite common. According to official statistics, this pathology is diagnosed in 3-4% of newborn babies. One or both hip joints can suffer. The prognosis and consequences of such a congenital disease depend on how timely the problem was identified, as well as on the degree of underdevelopment of the articulation components and on compliance with all medical recommendations regarding treatment. Therefore, every parent should be aware of the existence of such an ailment, since it is mom or dad who can be the first to notice that something is wrong with the child.

What it is?

Hip dysplasia in children is a congenital inferiority of the components of the hip joint, its underdevelopment, which can lead or has already led to congenital dislocation of the hip in a newborn.

The hip joint consists of 2 main components: the acetabulum of the pelvic bone and the head of the femur. The acetabulum has the appearance of a half-shape, along its contour there is a rim of their cartilaginous tissue, which complements the shape and helps to keep the femoral head inside. Also, this cartilaginous lip performs a protective function: it limits the amplitude of unnecessary and damaging movements.

Scheme of the formation of congenital dislocation of the hip in hip dysplasia

The head of the femur is spherical in shape. It connects to the rest of the thigh with the neck. The head is normally located inside the acetabulum and is securely fixed there. A ligament extends from the top of the head, which connects the head and the acetabulum, in addition, in its thickness there are blood vessels that feed the bone tissue of the femoral head. The inner surface of the articulation is covered with hyaline cartilage, its cavity is filled with fatty tissue. Outside, the joint is additionally reinforced with extra-articular ligaments and muscles.

With dysplasia in a child, one or more of the structures described are underdeveloped due to certain circumstances. This contributes to the fact that the femoral head is not fixed inside the acetabulum, resulting in its displacement, subluxation or dislocation.

In most cases, dysplasia in infants has one of these anatomical birth defects:

• Pathological shape of the acetabulum (too flat), violation of its normal size (too large or, conversely, small). Such circumstances do not make it possible to securely hold the femoral head inside, which is why it is displaced.
• Underdevelopment of the cartilaginous ridge along the perimeter of the acetabulum, too long ligament of the femoral head, lack of fatty tissue inside the joint.
• Pathological angle between the neck and head of the femur.

Any of these defects, along with weakness of the muscles and intraarticular ligaments in infants, leads to hip dysplasia or congenital dislocation of the hip.

Breech presentation of the fetus - a risk factor for the development of hip dysplasia

Causes

Unfortunately, the true cause of the development of such a pathology has not yet been established. But experts have found a number of factors that increase the risk of hip dysplasia in newborns:

• incorrect position of the fetus inside the uterus during pregnancy, especially for pelvic presentations;
• too large size of the child at birth;
• the presence of the same disease in close relatives (genetic predisposition);
• pregnancy at a very young age;
• toxicosis in the mother during childbearing;
• hormonal disruptions in the female body during pregnancy.

If at least one of the above risk factors is present, then such a child automatically falls into the risk group for hip dysplasia, even if there are no signs of a violation at birth, and during the first months of life should be regularly examined by a pediatric orthopedic doctor.

How to suspect a problem?

Symptoms of dysplasia are not always possible to identify in time, as they are often barely noticeable or completely absent. Among the signs that can be seen during an external examination of the child, it is worth highlighting:

1. Violation of the location of skin folds on the legs, the appearance of their asymmetry. You should carefully examine the folds under the buttocks, under the knees, inguinal. In the case of their unevenness (both in location and in depth), children's hip dysplasia can be suspected. But this is not a completely reliable sign, since up to 2-3 months the folds can be asymmetrical and normal due to the uneven development of the subcutaneous fatty tissue in the baby.
2. Various leg lengths child. This is a more reliable symptom, but it occurs already at the stage of hip dislocation, and may be absent with dysplasia. To check the length of the legs in an infant, you need to stretch them and compare them by the location of the kneecaps. There is a second way: we bend the legs at the knees of the baby, who lies on his back and pull the heels to the buttocks. Moreover, if the legs have different lengths, then one knee will be higher than the second. The leg is shortened on the side where the dislocation is located.
3. "click" symptom. To check it, the newborn needs to be laid on his back, legs bent at the knees and spread at the hip joints. In this case, a characteristic click occurs on the side of dysplasia, which corresponds to the reduction of the femoral head. This sign is informative only up to 2-3 weeks of age of the baby.
4. hip abduction restriction. This feature is checked in the same way as the previous one. Informative after 2-3 weeks of life. Normally, the baby's legs can be parted by 80-90º or laid on the surface. If there is dysplasia, then this cannot be done.

It is important to know! In children up to 3-4 months, there is an increased muscle tone, which sometimes leads to difficulty in breeding the legs in the hip joints and creates a false positive picture of the disease.

Unfortunately, there are no other symptoms until the child starts walking. At an older age, attention is drawn to the different lengths of the legs, gait disturbance, asymmetry of anatomical landmarks, the development of duck walking with bilateral dysplasia. Treatment at a later age is difficult and the situation can be corrected, but not always, it is possible only with the help of surgery. Therefore, it is important to identify pathology from the first months of a child's life, when conservative therapy is effective.

This is how you need to check the symptom of a click and the amount of dilution of the legs in the hip joints

Degrees of dysplasia

There are 4 degrees of this congenital disease:

1. Actually dysplasia- congenital underdevelopment of some structures of the joint, but there is no displacement of the femoral head. Previously, such a diagnosis did not exist, since it was impossible to diagnose it. Today, thanks to modern techniques, dysplasia is often diagnosed and is an indication for conservative treatment in order to prevent possible congenital dislocation of the femur.
2. Predislocation. It is diagnosed in the case when the femoral head is slightly displaced, but does not go beyond the acetabulum; when moving, it easily takes its normal position. If no measures are taken, then the disease progresses and transforms into a dislocation.
3. Incomplete dislocation of the hip. It is installed in the case when the femoral head is displaced, but does not completely come out of the acetabulum. In this case, the ligament of the head is strongly stretched, which negatively affects its blood supply. When moving, it does not fall into place.
4. Congenital dislocation of the hip. This is an extreme degree of dysplasia, when the femoral head completely extends beyond the acetabulum. The joint capsule is tense, the ligament inside is strongly stretched.

Degrees of hip dysplasia

Diagnostics

There are 2 methods that allow you to confirm or refute the diagnosis of hip dysplasia:

• radiography,

X-ray examination is very informative, but is carried out only from 3 months of age. The reason is that newborns do not yet have complete ossification of the structures of the hip joints, which can cause false positive or false negative results. Up to 3 months it is recommended to conduct an ultrasound of the hip joints. This is an absolutely safe and highly informative research method, which allows diagnosing dysplasia in infants with great accuracy.

Radiography can accurately confirm the diagnosis of dysplasia in a child

Treatment

The main key to the success of the treatment of hip dysplasia is timely diagnosis. Therapy is always started with conservative methods that are successful in most babies. Surgical treatment may be needed if the diagnosis is late or complications develop.

Conservative therapy

Includes several groups of therapeutic measures:

• physiotherapy;
• massage;
• wide swaddling;
• wearing special orthopedic structures;
• physiotherapy procedures;
• closed reduction of hip dislocation.

Exercise therapy is prescribed in each case of hip dysplasia, not only as a therapeutic measure, but also as a preventive measure. This very simple method, which all parents can master, has absolutely no contraindications and is painless. A pediatrician or pediatric orthopedist should teach how to perform exercises for the legs. You need to do 3-4 times daily for 5-6 months. Only in this case, exercise therapy will bring a positive result.

A few simple exercises to treat hip dysplasia:

Massage for dysplasia should be prescribed and performed only by a specialist. It allows you to achieve process stabilization, strengthen muscles and ligaments, reduce dislocation, improve the general condition of the child. But there is also a general massage that parents can use. It should be done in the evening after swimming before going to bed.

Important to remember! In infants, not all massage techniques are used, but only stroking and light rubbing. Tapping, vibration is prohibited.

Wide swaddling is most likely a preventive rather than a curative measure. It is indicated in the case of the birth of a child from the risk group, in the presence of the 1st stage of pathology, with the immaturity of the structures of the joint according to ultrasound.

If it is not possible to correct the dislocation with the help of massage and exercise therapy, then they resort to the use of special orthopedic structures that allow you to fix the legs in a position divorced in the hip joints. Such designs are worn for a long time without removing. As the child grows, the structures of the joint mature and securely fix the femoral head inside, which does not pop out from there, thanks to various stirrups and splints.

The main orthopedic structures that are used to treat dysplasia:

• stirrups Pavlik,
• tire CITO,
• tire Volkov,
• Vilensky tire,
• Frejka tire,
• Tyubenger tire.

All of these devices are put on and adjusted by an orthopedic doctor. Parents cannot remove or change parameters on their own. Modern stirrups and splints are made from natural, soft and hypoallergenic fabrics. They absolutely do not affect the condition of the child and the ability to care for him.

The complex of therapeutic and rehabilitation measures is always supplemented with physiotherapy procedures. Particularly effective: UVR, warm baths, applications with ozocerite, electrophoresis.

With a dislocation formed and the absence of the effect of conservative therapy, they can resort to closed bloodless reduction, which is carried out under anesthesia in a child aged 1 to 5 years. The doctor returns the femoral head to the acetabulum, after which a coxite plaster cast is applied to the child for 6 months. Further rehabilitation continues. It is important to emphasize that the child does not tolerate such treatment well.

Surgery

Surgery is resorted to in the case when the disease is diagnosed late, with the ineffectiveness of all previous therapeutic measures, as well as in the presence of complications. There are several options for surgical intervention, among which there are palliative ones.

Forecast

As a rule, with timely diagnosis and adequate conservative therapy, the prognosis is favorable. By the age of 6-8 months, all components of the joint mature, and dysplasia disappears. If the disease is not eliminated in time, then an operation and a long rehabilitation period may be necessary, and some children may develop a relapse after surgery. If the pathology has not been completely eliminated, then the following complications may occur with age: dysplastic coxarthrosis, impaired walking and gait, the formation of neoarthrosis, aseptic necrosis of the femoral head, etc.

Prevention of congenital hip dysplasia, first of all, consists in avoiding the risk factors described above. If this fails, then it is necessary to proceed to secondary measures, among which daily therapeutic exercises and massage are especially effective.

One of the serious congenital diseases in children is such an orthopedic problem as hip dysplasia (abbreviation - DTS), which occurs in 1-3 cases per 1000 births and is an underdevelopment of the structures and elements of the joint. In girls, DTS is more common than in boys (approximately 4-7 times). The pathology of the left joint is more often diagnosed, less often - both or only the right joint.

Conducting a diagnostic examination by an orthopedist of newborns allows you to identify the problem in a timely manner and begin treatment. The lack of adequate therapy can lead to a number of complications, and ultimately disability. However, the excessive alertness of doctors in this matter often becomes the reason for overdiagnosis - the diagnosis of healthy children.

The structure of the hip joint and its dysplasia

The hip joint is formed by the cup-shaped acetabulum, which is formed by the pelvic bones, and the head of the femur. It also includes ligaments, nerves and blood vessels.

With dysplasia, the development of the constituent elements is disturbed (although some immaturity of the joint in newborns is quite common and normal and, as a rule, is partially eliminated by the end of the first year). The cavity becomes flatter, the ossification of the head slows down, and its dimensions become larger or smaller than normal. As a result, such a mismatch of surfaces leads to a number of problems: the neck of the femur is shortened, its direction changes, and pathological changes in the ligamentous apparatus and muscle tissues develop. If appropriate measures are not taken in time, then gross violations of the joint begin to negatively affect the formation of nearby structures (internal organs, spine, pelvis, and other joints).

Causes of pathology

Currently, the following main groups of causes are distinguished:

1. Violation of the development of tissues at the earliest stage of their formation (deterioration of the environmental situation increased the proportion of this cause to 12%).
2. Genetic predisposition - the disease is transmitted through the mother (up to 30% of all cases of DTS).
3. Myelodysplasia is a congenital underdevelopment of the spine and spinal cord (up to 30%, often accompanied by other disorders of the musculoskeletal system (clubfoot, torticollis, etc.)).
4. The impact of hormones - progesterone, produced in large quantities by the mother's body shortly before childbirth, can cause weakening of the articular ligamentous apparatus (up to 40% of episodes of pathology). As the effect of the hormone is eliminated after the birth of the child, the problem often resolves itself.

Factors that contribute to the appearance of DTS are:

• restriction of the mobility of the joint of the unborn child during its intrauterine development due to increased tone of the uterus, oligohydramnios, large sizes of the fetus itself, with breech presentation (usually the left joint is pressed against the wall of the uterus, which is why it is more often affected);
• the female gender of the child;
• insufficient intake by the mother during pregnancy of iron, iodine, calcium, phosphorus, vitamins B and E.

Signs and degrees of DTS

The main signs of hip dysplasia in children, which can often only be identified by a specialist, are:

Based on the severity of the pathology, the following classification of DTS is proposed:

Diagnostics

Diagnostic measures include the following points:

• collection of anamnesis and identification of risk factors (presence of infections, intoxications, exposure to radiation or adverse environmental conditions during the mother's pregnancy, aggravated heredity, etc.);
• examination and identification of signs of DTS (before the onset of the stage of physiological muscle hypertonicity);
• Ultrasound - is prescribed without fail when signs of DTS are detected in children under three months of age;
• x-ray examination - carried out from the 7th month of life.

Complications of DTS

• Dysplastic - a progressive degenerative pathology of the hip joint, which develops in patients with dysplasia 25-50 years old.
• Violation of posture, osteochondrosis, scoliosis, flat feet and other problems of the musculoskeletal system.
• Neoarthrosis - restructuring of the joint, flattening of the femoral head and reduction of the acetabulum with the formation of a new joint (occurs quite rarely, can be considered some kind of self-healing).
• Aseptic necrosis of the femoral head is caused by damage to the blood vessels in its ligament (more often it is a complication of surgical intervention for hip dysplasia in children).

Treatment of DTS

When the diagnosis of hip dysplasia is confirmed, treatment begins without delay, since it is its early start that allows you to achieve the greatest efficiency and avoid serious consequences.

Conservative treatment

Basic principles:

• Ensuring the ideal position of the limb to achieve reduction (Frajk pillow, wide swaddling, Pavlik's stirrups, etc.).
• Preservation of mobility (rigid fixing structures are not used in babies under 6 months of age!).
• Continuity of therapy and its early initiation.
• Additional methods of influence (massage, therapeutic exercises, physiotherapy - have their own characteristics depending on the stage of treatment and are carried out strictly for the intended purpose, as well as under the supervision of a doctor).
• Carrying out therapy under the control of x-ray or ultrasound.

Surgical treatment

With a gross violation of the structure of the joint, the absence of effect or the impossibility of applying conservative measures, surgical treatment is performed.

Types of surgical interventions:

• myotomy (a cut in the muscles that caused the restriction of movement in the joint of the joint, the so-called “minor intervention”);
• open reduction of dislocation (tissues are dissected and the head returns to the desired position, may require deepening of the acetabulum, usually performed at the age of six months - 2 years);
• osteotomy (dissection of the bone to give the correct configuration);
• operations on the pelvic bones (allow you to create an obstacle to the upward displacement of the femoral head);
• endoprosthetics (replacement with an artificial prosthesis of the affected joint);
• palliative operations (aimed at alleviating the condition and restoring the patient's performance, applicable when it is impossible to correct the configuration of the joint).

In the pre- and postoperative period, physiotherapeutic procedures, massage, exercise therapy, prescription of medicines are carried out.

Prevention of hip dysplasia is:

• prevention of pathologies of pregnancy (exclusion of the effects of negative factors, proper nutrition, therapy of pathologies of the second half of pregnancy, etc.);
• ensuring timely diagnosis (in the very first days of a child’s life).

Modern pediatricians and pediatric orthopedists strongly recommend that parents:

• avoid tight swaddling of babies, since such a procedure contributes to the aggravation of a pathology that was not detected in time;
• use wide swaddling;
• do not swaddle the baby at all, dressing him in loose clothes and a larger diaper.

Prevention of complications in the presence of pathology at an older age includes:

• dispensary observation;
• exclusion of increased loads on the joint;
• engaging in sports that help strengthen and stabilize the joint and muscles, such as skiing or swimming.

Forecast

With the detection of pathology at an early age and adequate treatment, the problem can be completely eliminated. At an older age, the detection of hip dysplasia, for example, accidentally during an x-ray, which does not manifest itself in any way, requires constant monitoring by an orthopedist.

Dr. Komarovsky - Hip Dysplasia

The development of a child up to a year is rapid: every day brings something new. The kid sits down, starts to crawl, stands on his legs ... finally, takes the first step. There is no limit to the delight and tenderness of parents. However, sometimes soon after this joyful event, it becomes clear that not everything is in order with the gait: the child strangely puts his legs, or limps, or rolls over when walking. What is this? And this is most likely a manifestation of hip dysplasia.

Hip dysplasia (DTS), or congenital subluxation of the hip joint, is the underdevelopment (or abnormal development) of the joint itself or its components: the acetabulum of the pelvic bone, cartilage, ligaments and muscles that hold the femur in the correct position.

With underdevelopment of the joint, the correct contact between the head of the femur and the recess for it (the acetabulum in the pelvic bone) is disturbed or absent. Manifestations of such a pathology are sometimes difficult to identify by parents at an early age of the child. The initial diagnosis of this congenital pathology is carried out immediately after the birth of the baby, which makes it possible to prevent its serious consequences that develop with late detection.

In the absence of contact between the femur and pelvic bones, the femur can move freely outside the joint. This condition is called joint dislocation, or dislocation. There are 2 subspecies of dislocation: teratological and typical.

Teratological develops in utero due to genetic diseases or anomalies in the development of muscle tissue. She is rare. A typical dislocation is characterized by an existing contact between two bones, but it is incomplete, unstable. This developmental pathology is most common and can occur both in utero and after birth in healthy newborns.

Subluxation is a less severe condition: the contact between the bones is within the normal range, but the joint is unstable and the femur is easily separated from the acetabulum.

Causes

The true cause of the pathological development or underdevelopment of the joint is not fully known.

Predisposing factors are:

• genetic predisposition (often along the female line);
• female infant (80% of all cases of dysplasia);
• hormonal background: an excess of progesterone in a woman before childbirth can contribute to the underdevelopment of the ligamentous-muscular system;
• incorrect position of the fetus in the uterine cavity, limiting the normal mobility of the child;
• the large size of the fetus, which restrict its movement and prevent the development of the joint;
• harmful factors, especially in the early stages of pregnancy (ecology, toxicosis, maternal illness, etc.);
• prematurity: fetal tissues do not have time to mature.

Symptoms

The pathology of the development of the joints in the normal position of the legs does not cause any discomfort or pain in the baby. Because of this, it is difficult for parents to notice the underdevelopment of the joints in the early stages.

The first manifestations of pathology may appear when the child begins to walk. With DTS, swaying when walking or the so-called "duck gait" is noted on both sides. With underdevelopment of one or both joints, the child may limp, walk "on tiptoe" (do not step on his heels).

At the slightest suspicion, you should consult a doctor who can determine the diagnosis not only through examination, but also through special manipulations. With DTS, the following symptoms are detected:

• different lengths of the lower extremities, shortening of the thigh;
• asymmetry of folds on the inner surface of the thighs (non-specific symptom, can also be observed in healthy children);
• pain (the child reacts by crying) or restriction of movement when trying to spread half-bent legs to the sides (normally, in infants, the legs are bred up to 90 °);
• the head of the femur easily (with a click) moves forward from the acetabulum and returns to it: this indicates an increased elasticity of the joint;
• excessive mobility in the hip joints: the baby may unnaturally turn the legs outward or inward.

Diagnostics

To confirm the diagnosis suspected by the doctor when examining the child, the following are used:

• Ultrasound (in the first half of the baby's life);
• x-ray examination (after 6 months, since at an earlier age the skeletal system is underdeveloped, it consists of cartilage, which is difficult to fix on a radiograph).

An additional examination is necessary to detect DTS, since sometimes even an experienced doctor can make a mistake. So, according to statistics, pediatricians suspect this pathology of the joints in 8.6 cases out of 1000, orthopedists - in 11.6 cases, and ultrasound reveals violations of the structure of the joints in 25 children out of 1000.

Ultrasound is the prevailing method for diagnosing the pathology of the hip joint in the first months of a baby's life: it is more informative than a simple medical examination, painless, and does not give radiation. The study makes it possible to see a clear shape of the cavity of the pelvic bone, which is of great importance in the development of dysplasia.

It makes no sense to conduct an ultrasound scan before 4 weeks of a newborn's life, because some changes in the structure of the hip joint disappear on their own, without treatment, during the first month of life.

Symptoms of DTS, which can be detected using additional examination methods:

• flattening or deformation of the acetabulum of the pelvic bone;
• underdevelopment of the femoral head or cartilage;
• excessive stretching of the joint capsule or ligamentous apparatus;
• incorrect angle of the femur;
• partial (or complete) protrusion of the femur from the acetabulum.

Treatment

The goals of therapeutic measures for DTS:

• ensure a fixed position of the femoral head in the acetabulum;
• strengthening of cartilaginous tissue and the ligamentous-muscular apparatus of the joint in order to exclude excessive mobility of bones and ligaments.

Treatment after examination and diagnosis should be carried out immediately. The duration and complexity of therapeutic measures depends on the severity of dysplasia, on the age of the child. A pediatric orthopedic doctor prescribes treatment.

Depending on the severity and timing of diagnosis, DTS can be treated conservatively or surgically.

Conservative treatment includes the following types of treatments:

• orthopedic means;
• physiotherapy procedures;
• physiotherapy;
• massage;
• closed reduction of dislocation.

There is a wide range orthopedic aids , the main purpose of which is to maintain the baby's legs in a divorced and bent position without restricting the child's movements (which is very important). Orthopedics keep the femoral head in the correct position, which ensures the normal formation of the joint.

The most popular of these is Pavlik's stirrups . They are usually used in children under 6 months of age. The effectiveness of the remedy is about 85%, therefore, during their use, medical supervision is necessary.

Orthopedic splinter fixes the baby's legs in a divorced position with the help of metal devices, which contributes to the proper development of the joint.

However, there is no convincing data on the effectiveness of such swaddling. Some doctors still recommend it today.

Under no circumstances should you swaddle your baby tightly! With this fixation of the legs, the underdeveloped mobile and elastic joint turns inward and fuses in this unnatural position. It is better not to swaddle children at all, but to put them on small sliders.

From physiotherapy methods treatments are used: electrophoresis with calcium chloride, applications of ozocerite, mud therapy. Procedures help strengthen underdeveloped joints.

Physiotherapy used in the form of complexes of special exercises in accordance with the stage of treatment and the age of the child. Good effect gives swimming on the stomach. Exercise therapy helps to strengthen the muscular apparatus and restore range of motion.

The muscles of the thigh and gluteal region are well strengthened by a properly performed massage.

If the use of these methods of treatment from 3 months of age to 2 years did not give a result, then rigid fixation can be used to completely immobilize the hip joint in the form of a coxite bandage after reduction of dislocation in a closed way . Gypsum can be applied depending on the complexity of the case in one of 3 options: on the leg and half of the other leg, on two legs or on one leg.

Surgery It is usually used for advanced dysplasia and the ineffectiveness of previous treatments. More often this happens in those cases when DTS is detected in a child older than a year already at the stage of a formed dislocation of the hip. Although in some cases, even timely detection and treatment of the disease is ineffective.

Surgical intervention is achieved by the reconstruction of the hip joint. Operations can be carried out by different methods and are selected individually in each case. Sometimes only one operation is performed, and in another, more complex case, it may be necessary to carry out a multi-stage surgical intervention.

The following methods of surgical treatment are used:

• Reduction of dislocation in an open way and gypsum fixation. The surgeon inserts the head of the femur into the socket of the pelvic bone during surgery. It is used in cases where reduction by a closed route was ineffective. The operation is possible when the bone nucleus has appeared, that is, the head of the femur has already turned from cartilage into bone.
• Tenotomy, or surgical lengthening of the tendon to ensure proper insertion of the femoral head into the socket. After the operation, a plaster cast is also applied for 6 weeks. After that, an examination is carried out under anesthesia (to achieve complete relaxation), and an x-ray of the joint is taken. If it is unstable, reapply a plaster cast.

Such an examination (under anesthesia) can also be carried out after the ineffective use of the splinter method to decide on further treatment tactics (for example, to carry out reduction in a closed or open way).

• Osteotomy of the pelvic or femur: an artificial fracture of the femur below its head is performed and the hip is rotated to the optimal position; or deepen the acetabulum in the pelvic bone. Bone fragments are fixed in the correct position using metal osteosynthesis (metal plates and bolts). A year later, when the bone grows together, an operation is performed to remove the metal plates. Such operations reduce pain in the joint when walking and improve joint function.
• Palliative surgery: do not eliminate the defect in the joint, but improve the quality of life. One of the options for such an operation is to equalize the length of the legs using the Ilizarov apparatus.
• Endoprosthetics: the affected joint is replaced with an artificial prosthesis.

After the operation, the child is in the hospital for several days. After surgery, it is necessary to carry out rehabilitation treatment for a long time, during which massage, physiotherapy exercises, and physiotherapy are used.

Forecast

With timely detection of pathology and treatment from the first month of a baby's life, the prognosis is quite favorable: conservative treatment is effective, and in 95% of children the diagnosis is removed by the year.

In case of ineffectiveness of the treatment or late diagnosis of DTS, the consequences can be very serious, and the child is likely to become disabled.