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Common causes of congenital hip dislocation and effective treatments. How to establish the correct diagnosis? When to start treating hip dysplasia in newborns

Congenital hip dislocation is a fairly common disorder, which for a number of reasons is difficult to diagnose on early stages. However, the sooner it is determined, the sooner treatment is prescribed, the easier it will be to eliminate the pathology and reduce the risk of developing further changes. But violations in skeletal system– this is always very serious.

It is known that hip dislocation occurs up to ten times more often among girls than among boys. This may be due to differences in structure hip joint. The joints in the pelvic region in women are, by definition, more mobile. A hip dislocation can be unilateral or bilateral. In the second case, both joints will be affected. Fortunately, bilateral lesions are several times less common. However, the treatment in both cases is no different.

Causes of congenital hip dislocation

For a long time it was believed that congenital dislocation hip joint- a consequence of injuries in birth period, which means wrong actions doctor. They spoke less often about various inflammatory processes. However latest research pathologies have shown that its cause lies in a violation intrauterine development child - dysplasia.

Can provoke deviation various factors, For example, infectious diseases mother during pregnancy, abuse of medication, unfavorable environmental conditions in the place where the expectant mother lives or in her place of work. All this negatively affects the process of fetal development, in particular, it can cause developmental disorders musculoskeletal system.

Dysplasia is a primary developmental disorder that inevitably entails others. Underdevelopment of the pelvic bones leads to partial or complete separation of the joint surfaces, and the head gradually comes out of the glenoid cavity. In addition, dysplasia significantly affects the rate of ossification, reducing it.

There are three degrees of dysplasia:

Disturbances can only affect the glenoid cavity, while the neck and head of the femur are completely normal. In this case, it is too early to talk about dislocation.
Dysplasia plus congenital subluxation of the hip, when the head is slightly displaced relative to the glenoid cavity, but has not yet completely come out of it.
Congenital dislocation of the hip, when the articular surfaces are separated, and the head of the femur comes out of the articular cavity completely.

Possible complications

If congenital dislocation is not treated in time, then there is a risk of facing a very serious complications both in childhood and in adulthood. First of all, children with this pathology, as a rule, begin to walk much later. At the same time, their gait is changed. With a unilateral dislocation, the child limps on the affected leg, and with a bilateral dislocation, his gait begins to resemble that of a duck.

Due to constant lameness and body tilt to one side, the child may develop scoliosis - rachiocampsis.

Naturally, an untreated hip dislocation causes gradual deformation of bone tissue, flattening of the bones of the joint, a decrease in the joint space, and further displacement of the head of the joint. In adults, such disorders are treated only through surgery and complete replacement of the head of the joint with a metal analogue.

Symptoms and diagnosis of pathology

It is very important to diagnose congenital dislocation of the hip joint in a child in a timely manner. However, the diagnostic process is complicated by the fact that the hip joint lies deeper than any other. It is tightly covered with muscle and fat tissue. This means that it cannot be felt with your hands. You have to rely on not the best exact signs diseases.

There are several symptoms that may indicate the presence of a hip dislocation already in the maternity hospital, in the first days after birth. However, they are all very conditional, and, alas, not at all mandatory. Therefore, newborns are examined very carefully. The first time this is done in the maternity hospital, the second time - in the first days after the mother and child return to their home, then at preventive examinations every month, six months and a year.

Typically, once the child begins to walk, the presence of a hip dislocation becomes obvious. But, alas, it is already quite late. Bone changes have already begun, and it is problematic to straighten the hip without consequences; this process is long and complex.

The first thing the orthopedist does when examining a newborn is to lay him down on his back, bend his legs at the knee and hip joints and gently, effortlessly move them to the side. Normally, a child’s legs in this position are separated by 160–180 degrees. Significantly dislocated hip narrows this angle . Especially if the lesion is bilateral.

However, it is important to remember that this situation may be caused not only by hip dislocation, but also by temporary muscle tone in the child’s legs. During the examination, this is quite natural, because the child is tense.

Another symptom of congenital hip dislocation is called Marx's sign or click sign . The doctor’s actions will be similar to the previous option. However, in this case, more attention is paid not to exactly how the legs are spread, but to the sounds. A dry click will be heard from the side of the dislocation. It is usually quite quiet, but can sometimes be heard from a distance.

If you put the child on his tummy and stretch his legs, then in the event of a hip dislocation, you can see some asymmetry of skin folds on the buttocks. On the affected side, the fold may be located lower and have greater depth.

Another symptom - shortened legs . However, in the first days after birth it is quite difficult to notice this, since the difference in the length of the legs will be insignificant. In order to determine this symptom, the child is again placed on his back, the legs are bent at the knees and at the hip joint and looked at the knees. If they are on at different levels, then we can assume a dislocation.

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

Unfortunately, these symptoms may not appear. Or they may be talking about completely different diseases. Therefore, at the slightest suspicion of congenital hip dislocation, the child is referred to ultrasonography and x-ray. This is the only way to reliably make a diagnosis and start treatment on time.

As already mentioned, at an older age, hip dislocation can also be determined by an altered gait. In addition, the child may have several other characteristic symptoms, named after those researchers who identified the connection between the symptom and the disease. These include the symptom of gluteal muscle insufficiency (called the Duchenne-Trendelenburg symptom), the symptom of non-vanishing pulse and whole line others. And here pain It is not usually observed in children with hip dislocation.

How to help a child?

There are two possible methods Treatment of congenital dislocation of the hip joint - conservative and surgical. Fortunately, even in severe cases of bilateral dislocation, with timely diagnosis, as a rule, it is possible to manage with a conservative method.

That is why he is considered the leader and consists in individual selection special tire , which fixes the newborn’s legs in one position: bent at the knees and hip joints and slightly apart to the side.

In this way, the head of the femoral joint is gradually reduced into place. It is important that this happens slowly, without haste or abruptness. IN otherwise can be damaged bone tissue, which will lead to more big problems.

It is believed that at the age of one year the dislocation is already thoroughly advanced, but even in such a situation they try to correct it conservative methods. Only in very old cases do they resort to surgery.

What else can be advised to parents who are faced with the problem of congenital dislocation of the hip joint in their small child? First of all, be careful. Nowadays, various gymnastics and massages for children have become fashionable, but it is important to understand that not all exercises and massage techniques are suitable for children with congenital dislocations.

For massage in the case of such pathology, more thorough and intensive treatment of the lumbar and gluteal region. Attention is also paid to the hip joints. However, it is important not to make sudden, jerking movements.

It is worth mentioning separately swaddling children. For a long time, tight swaddling, when the baby's legs are pulled together, was encouraged. It was believed that in this case the legs would be straighter. In fact, this position of the legs is unnatural for newborns. Behind long months in the womb, babies get used to the position with legs bent. Tight swaddling is especially harmful for children with a dislocated hip joint, but also for healthy children positive influence it does not. Moreover, for development at such a young age, movements have great value. Therefore, the ideal option would be to dress the child in rompers. If you still prefer to swaddle, then do not try to twist the legs as tightly as possible, leave the child the opportunity to bend and move them at will. Tight swaddling will only aggravate the situation with dislocation of the hip joint, interfering with the process of repositioning the head into the socket.

Gymnastics for children with congenital hip dislocation

Gymnastics won’t hurt kids with this illness either. Below are some simple and effective exercises. Remember that all of them should be performed without any additional effort.

Exercise 1. Place the baby on his tummy. Lightly rub your buttocks and outer surface hips. Now carefully move the child’s bent leg to the side and fix it in this position.

Exercise 2. The child lies on his stomach. Take him by the ankles and bring his feet together, while his knees, on the contrary, should be apart. Press your pelvis against the support.

Exercise 3. Place the child with his tummy on the ball so that he has to support his legs.

Exercise 4. Place the baby on his back. Gently and slowly bend and straighten your legs at the hip joints, and also spread them to the sides. This must be done carefully, do not rush under any circumstances, do not jerk the child or put pressure on the legs with force. Movements should be natural.

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

Due to the deteriorating environmental situation and the negligent attitude of many women towards bearing a child, congenital dislocation of the hip is becoming more common. Doctors pay a lot of attention timely diagnosis this problem in children. However, parents must fully rely not only on the opinion of doctors, but also on their own discretion.

Monitor your baby carefully and, at the slightest suspicion of congenital hip dislocation, immediately contact your pediatrician. The doctor will examine the child and, if necessary, refer him for examination to an orthopedist. Only attentive attitude towards the child from the first days of life guarantees timely determination problems and cure the baby before serious complications develop.

Fortunately, congenital dislocation of the hip, although a common disorder, is quite easily corrected. Therefore, do not panic when you hear this diagnosis. Just strictly follow the doctor’s instructions, and everything will be fine with your child very soon.

Consultation with a specialist about the signs of congenital hip dislocation in children

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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 head connection femur with the acetabulum pelvic cavity 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) manifests itself incorrect formation one of its sections, 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%.
The relationship between the traditions of tight swaddling and increased performance morbidity. 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 during 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 subject 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're talking about 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 poor 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 grades II and III 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. Such a sign is reliable symptom deviations 2–3 weeks after the birth of the child. When examining children of other ages, this method is not informative.
Shortening one leg is reliable sign dysplasia and is detected when combining kneecaps in a lying 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 femoral artery from the side of the changed joint;
signs of torticollis.

DIAGNOSTICS

In a baby, signs of hip dysplasia in the form of dislocation can be diagnosed as early as 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 aggravated this characteristic heredity. In addition, attention is paid to pregnancy toxicosis 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 an effective method for 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. Hip joint in children under seven months of age it 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 a complete 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 dysplasia. These invasive methods require general anesthesia to receive 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 to normalize the anatomical shape of the 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 comfortable to use.
Freyk'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, providing therapeutic effect on desired zone and does not restrict the child’s movements.
Reduction of the dislocation with further immobilization of the limb in severe cases diseases 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. It is performed in case of obvious ineffectiveness of 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 in 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 refers to curable diseases. Given that early start therapy under the supervision of an orthopedist and following his recommendations, a complete recovery is possible.

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For a long time, congenital dislocation of the hip in an infant was perceived as an acquired problem and was mistakenly attributed to errors in obstetric activities.

However, today it is known that such a pathology is congenital, and there are few cases of acquired dislocation of the wrist.

It is necessary to understand that changes occur in the child’s joints while still in the womb, when the child’s hip joint begins to develop and form incorrectly.

As a result of this development, an incorrect femur is obtained, and as a result it is not able to occupy its proper place.

Unfortunately, it is simply impossible to immediately detect a dislocation in a newborn baby. So it is not shown on ultrasound, and the defect remains unnoticed.

As a rule, the problem can be noticed only with a thorough examination, and if it is visually clear that one of the child’s legs is longer than the other, and the baby spreads them asymmetrically.

Symptoms

Hip dislocation is one of the types of diseases such as hip dysplasia. The connection of the femur bones is incorrect, or rather, the baby's bone is located outside the acetabulum, as in the photo.

Because of this situation, children develop dislocations, and if we talk about predisposition to such a pathology, it is more common in girls.

Damage may also be:

Unilateral, in this case the dislocation is recorded in only one joint.
Double-sided.

It is possible to accurately determine congenital hip dislocation only some time after the birth of the child.

It is worth paying attention to this symptom - the child cannot move the hip to the side normally, and if he does this, it is not completely.

To check whether this is a symptom, you need to put the child on his back and bend his knees.

Bent legs should form an angle of 90 degrees relative to the horizontal surface. Next, the legs are spread to the side. If everything is normal with the joints, then the legs should be spread to an angle of at least 160 degrees.

Less than this number indicates a problem, including congenital dislocation of the hip.

Besides:

When performing the leg spread exercise, there should be no clicking in the joints.
If there is asymmetry of the legs, this is a symptom of dislocation.
The baby's legs cannot be bent and pulled towards the stomach.

Anatomy of a problem

Congenital dislocation of the hip is formed in the womb; this is the process of formation of the hip joint, only with a defect.

Note that this area of the body continues to change for another two years after the birth of the child.

However, it is in the womb that the main formation takes place, where cartilage and tissue, bones and joints are formed.

Huge role in correct formation The joint is given to the acetabulum and the proximal femur. It is these departments that are responsible for the timely replacement of cartilage with bone tissue.

Besides, important role allocated to muscle tone, which, in a weakened state, is also a prerequisite for the formation of dislocation.

It is necessary to be aware that even a completely healthy hip joint in a newborn is still not a fully formed structure. Articular ligaments in infancy too soft and extremely easily susceptible to various defects.

The following points may also be noted:

The joint gap of a child is directed in a different direction, different from what is observed in an adult.
Joint stability depends on childhood depending on the position of the joint box.
If there is a dislocation, then the baby may have a slightly sloping glenoid cavity, as in the photo.

Thus, soft ligaments The joint and articular box cannot provide the head of the femur with normal and strong fixation in its proper place. The bone begins to systematically slip out of the joint space and a defect develops

When the head of the femur completely leaves the joint space, an extremely severe form of hip dislocation is diagnosed. In this case, fluid and fatty matter begin to penetrate deep into the joint, and this leads to difficulty in reducing the dislocation.

In addition, if the dislocation is not detected in time, the process of deformation of the child’s leg begins, the femur finally adjusts to a new, incorrect position, and the deformation of the limb begins to spread to the pelvic bones.

Classification

First of all, a congenital type of dislocation may indicate an inferior joint in a child. There are several options here, it could be:

Subject to displacement.
Initially it is wrong to develop.
Deformed.

In addition, you can clarify that there is both dislocation and subluxation of the hip. In any case, such defects in a newborn lead to damage to the hip.

Let us also note that with dysplasia of the joint, a violation of its basic functions occurs, but there is no displacement.

On the other hand, in medicine, orthopedists believe that the term can generally include almost all disorders that are associated with hip pathologies. If you accept this principle, then you can determine the diagnosis using x-rays.

From this perspective, it is proposed to divide all pathologies into three types:

Subluxation of the hip joint. Such a defect should not lead to confusion of the hip, and it can be determined on x-ray. Often found in newborns.
Subluxation of the femoral head. Here the subluxation can be primary or residual. Observed if present slight displacement in the joint capsule.
Congenital hip dislocation in children.

The third type is our congenital dislocation, which happens:

tall,
Bokov,
In front of him,
Acetabular.

Principles of treatment

As we wrote above, if you don’t start timely treatment, then congenital dislocation in a newborn can lead to complications and disastrous consequences, including disability.

One of the most obvious and severe complications is cosarthrosis of the hip joint, which develops precisely as a response to congenital dislocation, as in the photo.

From a treatment point of view, proper swaddling and exercises, which should be carried out by a doctor, are important for newborns.

One of the most effective methods To eliminate the problem, a special fixation is used. Injured leg in newborns, they are clamped in such a way that the head of the femur fits clearly and accurately into the hole from which it slips out.

This fixation allows the ligaments to heal properly, as well as the joint itself. In addition, this will be a kind of stimulation for the body, which will continue to produce special substances and build up the missing parts of the articular cavity.

To ensure that newborns' feet are properly secured, proper swaddling alone will simply not be enough.

Therefore, an additional splint, pillow, and stirrups are used for fixation. By the way, splints are best suited when congenital hip dislocation is corrected. The uniqueness of the method is that. That the location of the splint makes it possible not only to press the bone and fix it, but also not to interfere with motor functions.

The use of fixation continues until the socket cap is built up and the hip stops slipping.

During treatment, you will have to take an x-ray of the child’s leg, thus monitoring the entire process.

If the treatment concerns not newborns, but a child over a year old, then traction is prescribed using a special patch.

IN extreme cases When conservative treatment is unable to solve the problem, surgery is prescribed to help restore the proper functioning of the joint.

The most common cause of hip dislocation is birth injuries. Perhaps the doctor acted somehow wrong, did not perform the birth correctly.

However, there are other causes of hip dislocation in a newborn:

Intrauterine changes in the baby, developmental disorders. As well as the position of the child and his weight in the womb before the start labor activity is also one of the important factors of manifestation;
Various past infectious diseases and acute respiratory viral infections expectant mother during the period of bearing your child
Something negative drug treatment the expectant mother, which has a detrimental effect on the health of the baby
Poor lifestyle of the expectant mother, unfavorable environmental conditions, frequent stress.

If the child was born healthy, and the dislocation of the hip joint manifested itself later, then most likely the parents who swaddled the child incorrectly are to blame for this illness. After all, if you squeeze the baby’s joints too tightly, then various disorders in the development of its joints and bones.

Symptoms

There are several various symptoms, which indicate a dislocation of the hip joint in an infant. The very first symptoms are already noticed by the neonatologist at the maternity hospital, when the baby is just born. Therefore, doctors very carefully examine the newborn for various pathologies and changes. If the neonatologist did not notice anything suspicious, then the mother herself is unlikely to suspect something was wrong. Therefore, only during subsequent preventive examinations can doctors diagnose a dislocated hip joint. To summarize, the following symptoms can be noted:

asymmetry of skin folds on the buttocks
shortened baby legs
foot that turns out

But sometimes all these symptoms may not appear or may indicate some other disease.

Diagnosis of hip dislocation in a newborn

Diagnosis of hip dislocation is complicated by its deep location, unlike all other joints. Unfortunately, it cannot be felt by palpation, since it is very tightly covered with fat and muscle tissue. The very first test that doctors perform is ultrasound. Also, during the examination, the orthopedist carefully places the baby on his back, bends his legs at the knees and gently spreads them apart. If the separation is not very wide, then this may indicate that the child has a dislocated hip joint. Another alarming fact during this manipulation is a click. A dry click will be heard from the side of the dislocation. It is usually quite quiet, but can sometimes be heard from a distance.

Complications

Hip dislocation in a newborn is very common occurrence, but it can be fixed quite easily with timely application to the doctor. If you do not delay treatment, there will be no consequences. However, otherwise, problems may arise with the growth of leg bones and subsequently with walking. Also flat feet and the development of arthritis.

Treatment

What can you do

It is better to never resort to amateur activities and not self-medicate. Therefore, you should not do anything yourself without consulting a doctor. The first thing parents can do if they discover something wrong is to contact the medical institution. After examination and doctor’s recommendations, parents can independently do massage or some procedures to eliminate this ailment:

wide swaddling, which allows you to hold the baby’s legs in a wide apart position
gymnastics and massage,
exercises on a ball, lying on your stomach and back.
Various exercises aimed at developing leg joints.

What does a doctor do

When visiting an orthopedist, he will conduct full examination which includes ultrasound. After making a diagnosis, the doctor can apply a special splint to the baby’s legs to keep them in the widest possible position. After this, the head of the femoral joint returns to its correct place. The main thing is that the doctor does this slowly and carefully. Otherwise, this can lead to even greater problems and also damage bone tissue. If the condition is already advanced, then doctors can resort to various operations aimed at eliminating this disease.

Prevention

There are several options for preventing dislocation in a newborn. These are perinatal and postnatal.

Perinatal prevention includes:

constant monitoring by a doctor during pregnancy with the implementation of prescribed procedures (ultrasound examination of the fetus, taking tests, following the doctor’s recommendations);
regular exercise, maintaining a sleep schedule in compliance with all the rules;
Right balanced diet, which should consist of fresh fruits and vegetables. Products must contain a large number of vitamins and minerals;
fractional and balanced meals with an interval of 1.5-2 hours;
timely consultation with a doctor if health problems arise;
refusal of such bad habits like smoking and drinking alcohol.
careful monitoring of blood pressure expectant mother

Postnatal prevention is as follows:

wide, loose swaddling;
performance therapeutic exercises with baby;
carrying a child on the stomach or back with legs spread apart.

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Congenital dislocation of the hip joint is a serious pathology that often leads to disability.

IN in this case the child may become chained to wheelchair. To prevent this from happening it is necessary early detection of this disease.

This dislocation is characterized by complete separation of the surfaces of the joint, and with subluxation, the total area of contact remains. This pathology is more often detected in newborn girls than in boys.

In the article you will learn everything about subluxation and dislocation of the hip joint in newborns, as well as about treatment of injury and rehabilitation after surgery.

Causes of congenital dislocation

Orthopedists and traumatologists today cannot clearly identify the main cause of development. However, they all claim that this pathology develops in the presence of hip dysplasia.

It is characterized by inferiority of the articular apparatus, that is, it has not developed correctly. There are several predisposing factors that contribute to the occurrence of dysplasia, dislocation and subluxation of the hip:

If during the period of intrauterine development of the fetus a woman suffered various infections, then this may affect the formation of the musculoskeletal system. It should be borne in mind that it begins to develop already in the first trimester of pregnancy (at 6 weeks), so from the very beginning it is necessary to monitor your health and, if necessary, undergo appropriate treatment;
Pathology endocrine system from the expectant mother;
Flaw nutrients in the diet of a pregnant woman, this leads to disruption of the formation of the fetus or its individual systems;
Severe early toxicosis, which leads to impairment metabolic processes and primarily protein;
Pelvic proposal of the fetus, it can also provoke difficult labor;
Risk of miscarriage, late pregnancy, uterine hypertonicity and oligohydramnios;
Increased levels of the hormone progesterone at the end of the third trimester. This mechanism promotes muscle relaxation pelvic floor in a woman. However, its excess can also affect the child, his ligaments and muscle also relax;
Poor environmental conditions prevent normal development fetus on early stages gestation;
Hereditary predisposition (if there have been cases of birth of children with this pathology in the family).

Degrees of dislocation and symptoms of congenital dislocation

It is customary to distinguish several degrees of this pathology:

Immaturity of the joint (grade 0). This condition is neither normal nor pathological. It lies between them and can be detected in premature infants. In this case, the head of the joint is not completely covered by the glenoid cavity;
Grade 1 hip dysplasia or pre-luxation. The structure of the articular apparatus is not disturbed, but there is some discrepancy in the shapes and sizes of the articular head and cavity. This, in turn, can lead to the development of dislocation;
Grade 2 joint dysplasia or subluxation of the hip joint in newborns. A shift occurs articular surfaces, but they continue to touch each other;
Grade 3 joint dysplasia or dislocation. The head of the joint comes completely out of the socket, and the articular surfaces lose common points of contact. The integrity of the articular apparatus is most often violated.

Based x-ray examination There are 5 degrees of dislocation, which are based on the location of the femoral head relative to the acetabulum.

Congenital hip dislocation in newborns is manifested by the following symptoms:

Higher listed signs typical for children under 1 year of age. When a child begins to walk, he has a gait disorder:

Limping;
Falling over onto the healthy leg;
A duck walk is characteristic of dislocations of both legs. The child waddles from one leg to the other like a duck.

Diagnostics

Newborn babies are examined by a neonatologist (a doctor who monitors and treats babies) immediately after birth. The specialist identifies the presence congenital pathologies. Hip dislocation can be diagnosed at this stage. Also, all babies are examined by an orthopedist in the first month of life.

To put accurate diagnosis, it is necessary to carry out certain diagnostic measures:

Collection of anamnesis of the disease. Parents are interviewed in detail about complaints and signs of pathology that they identified independently. The doctor identifies predisposing factors:
- How was the pregnancy?
- The presence of hereditary pathology of the musculoskeletal system;
- Social and living conditions of a pregnant woman and a newborn.

After diagnosis, treatment is prescribed for the child, which can be either conservative or surgical.

Conservative treatment

If the pathology is detected in the first month of life, then it is advisable to conservative therapy, which is as follows:

Reduction of the joint;
Fixation;
Gymnastics;
Massage.

The treatment process is quite long and, first of all, depends on the severity of the pathology. It can last up to 12 months.

Surgery

Experts prefer to treat the child using conservative methods. But there are cases when you have to resort to surgical treatment. Reduction operations congenital dislocation carried out in children over 2 years of age. If the dislocation is irreducible, then the child is operated on after 1 year.

Indications for surgical treatment:

If the pathology is detected in a child over 2 years of age;
Habitual dislocation, that is, after closed reduction (conservative therapy), the dislocation forms again;
If conservative treatment of congenital hip dislocation in newborns does not give positive dynamics. As a rule, in this case there are anatomical changes in the articular apparatus;
Severe pathology.

Surgical intervention is carried out after a thorough examination under general anesthesia. There are 4 types of operations that are performed to treat the diagnosis of “congenital dislocation of the hip joint in a newborn”:

The operation performed on ilium;
Open reduction of dislocation;
Open reduction of dislocation with reconstruction of the articular apparatus;
Palliative surgical treatment:
- Osteotomy of the femur according to Shants;
- Lorentz bifurcation;
- Operation Vo-Lami.

Open reduction of a dislocated hip joint can be performed in two ways:

If the articular surfaces are well developed, then simple reduction is performed;
In the event that the articular (acetabular) cavity is shallow, it is slightly deepened before comparing the articular surfaces.

In the postoperative period, a plaster cast is indicated for a period of 2 weeks or more. The duration of immobilization will depend on the severity of the pathology and the complexity of the procedure. surgical intervention.

Open reduction with joint reconstruction. This method is suitable for treating children and young people who have not yet developed structural changes cartilage tissue. Most often, a so-called canopy is installed at the upper edge of the glenoid cavity. It helps keep your head hip bone in a physiological position and prevents the occurrence of repeated and habitual dislocations.

Surgery on the ilium. This method is most often used when treating children.

Palliative operations are performed in the following cases:

Untreated, chronic injury;
Severe dysplasia, in which conservative therapy has not given satisfactory results;
Complications after conservative treatment;
Patients over 30 years of age.

Rehabilitation after treatment

The rehabilitation period is quite long and depends on the type of dislocation and the method of treatment performed.

Rehabilitation after conservative therapy is aimed at strengthening muscles and ligaments and improving the functioning of the joint. It consists of the following methods:

Medical Physical Culture. It is necessary to develop the joint correctly to avoid possible complications;
Massage will improve nutrition and blood flow to affected tissues.

More long recovery required in patients undergoing surgery. In this case, the following tasks are posed:

Restoration of functions of the lower limb;
Increased muscle tone;
Establishing the correct gait.

IN postoperative rehabilitation There are 3 consecutive periods:

Limb immobilization;
Recovery;
Teaching the patient the correct gait.

The first period (immobilization) lasts for about 1 – 1.5 months. Superimposed gypsum bandage, with the legs bent at an angle of 30 degrees. This period ends the moment the patient’s bandage is removed, and the second period begins – the recovery period.

Functional restoration is carried out starting on average from 6-7 weeks postoperative period. This period consists of 2 stages:

Restoration of passive motor activity;
Restoration of passive and active motor skills.

At this time, exercise therapy is carried out. At the initial stage, the exercises are light, but the load and activity of the movements performed gradually increases.

The longest recovery period is teaching the patient to walk correctly. It may take from 1 to 2 years. In order for the gait to be correct, it is necessary to perform certain exercises on a specialized path. The duration of classes increases gradually to 30 minutes. Thanks to this, the gait becomes smooth and confident.

Consequences and complications

If there is no treatment, or it is not carried out in a timely manner, complications such as:

However unpleasant consequences and complications can be observed after treatment. What they will be depends on the type of therapy:

Complications after conservative treatment:

Poor circulation;
Dystrophic changes in the head of the joint;
Injury to major nerves, which manifests itself severe pain, impaired movement in the injured limb.

Complications after surgery:

Local: development of a purulent-necrotic process in the femur and its head; inflammation of a postoperative wound; postoperative bleeding;
Are common: massive blood loss during surgery, which leads to a decrease in hemodynamic parameters; state of shock; pneumonia, which develops due to congestion in the body (person long time is without active movements).

Dislocations and subluxations in older children

Dislocations and subluxations of the hip joint in older children are most often traumatic in nature. The causes of the pathology may be:

Injury received while playing sports, this especially often occurs in school-age children;
Various types of accidents (car accident);
A direct blow to the thigh with great force.

Symptoms of traumatic subluxations and dislocations:

Sharp pain that arose at the time of injury. As a rule, it is permanent and intensifies with palpation (feeling the damaged limb) and with passive movements;
Active movements are severely limited or impossible;
With subluxation, there is a noticeable lameness;
Swelling of the hip joint area;
Presence of hematomas different sizes(single or multiple);
The skin in the joint area is hyperemic (reddened) and hot to the touch.

In this case, the victim must be given first aid and hospitalized:

Call an ambulance;
It is strictly forbidden to adjust the joint yourself;
Lay the victim down;
Apply cold to the sprained area;
Painkillers can be given;
Wait for the doctors to arrive, do not leave the person alone.

Reduction of dislocation is carried out only in a hospital setting.