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 the structure of the 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 during the birth period, and therefore, incorrect actions of the doctor. Less frequently discussed were various inflammatory processes. However, recent pathological studies have shown that its cause lies in a violation intrauterine development child - dysplasia.

Can provoke deviation various factors, For example, infectious diseases mothers during pregnancy, abuse drug treatment, unfavorable environmental conditions in the place where they live future mom or at her place of work. All this negatively affects the development of the fetus, in particular, it can cause disturbances in the development of the 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, reduction of the joint space, and further displacement of the head of the joint. In adults, such disorders can only be treated by surgical intervention and complete replacement of the joint head 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 most accurate signs of the disease.

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 per month, six months and 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 knees and pelvis. hip joints and gently, effortlessly, moves it 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 of the lower extremities: 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 symptoms of deficiency gluteal muscles(it is called the Duchenne-Trendelenburg symptom), the symptom of a non-disappearing pulse and a number of 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 Bilateral dislocation with timely diagnosis, as a rule, can be treated 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 set slightly 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. Otherwise it may be damaged bone tissue, which will lead to even bigger 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 is typical. 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 their 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 careful attention to the child from the first days of life guarantees timely identification of the problem and treatment of 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.

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Page editor: Oksana Aleksandrovna Kryuchkova - orthopedic traumatologist

Congenital hip dislocation - concept, clinic, diagnosis, treatment.

What is congenital hip dislocation?

Congenital hip dislocation (one of the degrees of congenital hip dysplasia) is a congenital anomaly that impairs the development of the hip joints in children. In terms of frequency of occurrence, it is one of the most common. According to statistics, today, out of 7,000 newborn babies, 1 of them has this pathology. By gender: girls are at risk 6-7 times higher than boys. Bilateral damage to the hip joints occurs 1.5-2 times less often than unilateral damage.
Hip dysplasia (or congenital hip dislocation) is very serious illness, requiring examination by a traumatologist-orthopedist. Today, traumatology and orthopedics have accumulated quite a lot of experience in treating these patients. Unfortunately, in the absence of control of this pathology and incorrect treatment tactics, congenital hip dislocation leads to early disability of young patients, which, of course, negatively affects people’s quality of life. In the development of hip dysplasia, the leading role is played by the time of detection of this pathology. The sooner it can be detected and diagnosed, the sooner treatment can begin and possible complications can be avoided.

Congenital hip dislocation: classification.

Currently, there are three stages of development in traumatology and orthopedics congenital dislocation hips.
- first stage: hip dysplasia. There is no change at this stage yet normal ratio articular surfaces, but the glenoid cavity, head and neck femur have already been changed.
- second stage: congenital subluxation of the hip. At this stage, disturbances in the relationship of the articular surfaces of the hip joint are already observed, coupled with disturbances of the glenoid cavity, neck and head of the femur. The head of the femur emerges from the acetabulum and moves to the outer edge of the glenoid cavity.
- third stage: congenital dislocation of the hip. At this stage, the changed glenoid cavity, neck and head of the femur also remain. The difference from the previous stage is that the joint is completely disconnected and the head is located away from the glenoid cavity, namely above it and slightly to the side.

Congenital hip dislocation - symptoms and diagnosis.

Anatomically, the hip joints are located very deep, have a very powerful articular capsule and muscular apparatus. That is why the study of the hip joints involves external observation, a series of tests and indirect signs. So, let's look at the main signs of hip dysplasia.

Marx–Ortolani sign (clicking sign).
This symptom appears only in children under 2-3 months of age. Technique: the baby is placed on his back, legs up. Then its legs are carefully bent at the knee joint and then a test is carried out using movements of bringing together and spreading. When carrying out such movements, the hip joints dislocate and realign, which are accompanied by characteristic clicks.

Symptom of restricted movement.
This symptom is considered in children under one year of age. When bringing the legs together - spreading the legs, the angle of movement in the hip joints should be at least 80-90 degrees, which corresponds to physiological norm for this age. The test is carried out similarly to the test for the clicking symptom - the child is placed on his back and the legs bent at the knees are moved away - spread apart. If the angle of movement is less than 80-90 degrees, then the child may have hip dysplasia.
It must be remembered that at this age it is possible to limit the abduction of the legs due to increased muscle tone of the lower extremities. It is worth remembering that unilateral limitation of abduction of the leg in the thigh is not characteristic of muscle hypertonicity. As a rule, muscle hypertonicity is a bilateral phenomenon, but dysplastic processes are a unilateral process.

Symptom of limb shortening.
The test is similar to the previous two. During this test, the child is placed on his back, the legs are bent at the knee joint and brought to the stomach. With dysplastic processes in the hip joint, the linear size of the femur (length) decreases, which manifests itself in the form of asymmetry knee joints and stop. Shortening of one limb indicates a dysplastic process on the shortened side.

Symptom of asymmetry of skin folds.

The child is first placed on his back and all skin folds in the area of the lower extremities are examined for symmetry, then he is turned over and the examination is continued on the opposite side. If asymmetry of skin folds is detected on any side, the traumatologist is alerted, since violation of symmetry serves diagnostic sign dysplastic process.

Symptom of external rotation of the limb.
This symptom is observed while the child is sleeping. On the affected side, external rotation of the limb is observed. However, it is worth remembering that external rotation of the limb can be observed in absolutely healthy people.

Other symptoms.
In patients older than 1 year, it can be observed following symptoms: gait disturbance (duck walk or lameness), muscle weakness in the gluteal muscles (the so-called Duchenne-Trendelenburg sign) and high position greater trochanter(due to hip displacement).

Diagnosis of congenital hip dislocation.

Diagnosis of this pathology is made on the basis of examination and identification of the above symptoms, accompanied by radiology and magnetic resonance imaging data. IN in this case is relevant precisely magnetically – resonance tomography since we are talking about soft tissues(in the child, in the area of the proximal part of the thigh, there is also cartilage tissue with areas of ossification).

Consequences of congenital hip dislocation and hip dysplasia.

The relevance of treatment of this pathology in early age lies in the fact that in the future patients will experience disorders of the hip joints - dysplastic coxarthrosis. Dysplastic coxarthrosis is observed in patients aged 25-30 years, accompanied by severe pain, limitation of movement in the joint (contracture) and gradually leading to disability in such patients.
In cases where congenital hip dysplasia is not treated, lameness and pain syndrome appear already at the age of 3-5 years. If the stage of congenital hip dislocation was observed, then pain occurs from the moment you start walking.

Congenital hip dysplasia - treatment.

As with many other diseases of the musculoskeletal system, there are two types of therapy - conservative and surgical tactics.

Conservative tactics for the treatment of hip dysplasia.

Conservative tactics must be applied from the first day of diagnosing this pathology. A specialized splint is used that immobilizes lower limbs in a certain position. This position consists of abducting the legs and flexing the hip joint. What is the principle of this therapy? Long-term and timely comparison of the head and acetabulum of the hip joint creates adequate conditions for the timely restoration of the motor and supporting function of the hip joints. It is important to start treatment early. The sooner it starts, the sooner the necessary therapeutic effect. Most good results Treatments for hip dysplasia are observed when treatment begins from the first days of the baby’s life (this is why the newborn is examined in the maternity hospital in the first few days if there is no indication for this). Timely treatment of hip dysplasia is considered when the child is not yet three months old from birth. In other cases, it is customary to call the treatment already overdue. However, despite the deadlines, in some cases treatment can be prescribed from one year onwards.

Surgical tactics for the treatment of hip dysplasia.

The best results are obtained when treatment for dysplasia begins before the child is five years old. At a later age therapeutic measures have less effect. There are two types of hip surgery in children. The first is intra-articular. The intra-articular type of treatment for hip dysplasia is used when the patient does not achieve adolescence. In this case, surgical deepening of the acetabulum is performed and, as a result, the head of the femur is fixed in the articular notch. An extra-articular type of surgical intervention is performed on older patients. The operation consists of creating and strengthening the roof of the acetabulum to fix the head of the femur inside it.
There is also a technique for hip replacement. This technique is performed in more older age and is used when there is severe dysplasia and movement disorder in the joint. As a rule, this operation is performed in middle-aged patients and endoprostheses with cementless fixation are used. Ceramic endoprostheses last longer and are stronger.

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Congenital dislocation of the hip occurs quite often, in 3-4 children per 1000 newborns, while girls suffer 5-7 times more often than boys.

The etiology of the disease remains unclear. IN clinical practice cases of hereditary pathology are known.

The disease is based on underdevelopment of the elements of the hip joint, in particular the acetabulum, head and neck of the femur.

As a rule, a newborn does not yet have a dislocation, but has congenital dysplasia of the hip joint, which, depending on a number of factors, can subsequently lead to a dislocation in the joint, or, conversely, as a result of normalization of the anatomical structures, to recovery.

The acetabulum in children with congenital dysplasia is usually less deep than normal and, most importantly, has a slanted upper edge (“roof”) of the acetabulum. This “roof”, against which the femoral head rests, is underdeveloped, as a result of which the head is not held in the acetabulum, and first, under the influence of tension in the muscles surrounding the hip joint, and then under the influence of the load, gradually, millimeter by millimeter, moves upward with the formation of a dislocation in the hip joint (Fig. 74).

Rice. 74. X-ray of bilateral congenital hip dislocation.

Some deviations in the development of the proximal femur also contribute to the formation of dislocation. First of all, the head on the affected side, lagging behind in development, is smaller in size compared to the healthy hip. This leads to inconsistency of the already widened acetabulum, which also favors superior displacement of the femur. Great importance in the relative position of the head and acetabulum, it has an angle formed by the neck and diaphysis of the femur. The cervical-diaphyseal angle is normally 130° in adults; in newborns it reaches 150-160°, which, with an underdeveloped “roof,” also contributes to the upward displacement of the femoral head. Congenital underdevelopment of the proximal femur is often accompanied by anterior deviation of the neck to a greater extent than is normal. Anteversion in newborns usually reaches 30° (in adults it decreases to 10-15°), and with congenital dislocation of the hip it reaches 60° and even 90°.

In this extreme position, anteroposterior radiography places the femoral head superimposed on the proximal end of the femur and the neck is not visible at all.

As the child grows, if treatment is not carried out, the changes increase and secondary changes occur in the bones and surrounding soft tissues.

During walking, with each step, sliding movements of the femoral head occur, up and down. As a result, a depression is formed in the upper edge of the acetabulum, a “sliding groove”, along which the femur moves further upward and rests against the ilium. There, in a new place, under the influence of a constantly acting load, a “secondary acetabulum” can form, which, of course, remains defective in anatomical and functional terms. The acetabulum, deprived of physiological irritations associated with the pressure of the head, sharply lags behind in development - it remains flattened, and its cavity is filled with scar connective tissue.

The femoral head, lagging behind in growth and constantly experiencing uneven load, gradually becomes deformed. Articular cartilage is exposed degenerative changes and in some places it becomes thinner, in others it peels off.

The capsule of the hip joint undergoes great changes, which, stretching under the action of the femoral head shifting upward, takes on the shape hourglass and often serves as an insurmountable obstacle to reduction.

The round ligament of the femoral head, attached to the bottom of the acetabulum, can also be thinned and stretched. Sometimes during surgery it is not detected at all.

Profound morphological and functional changes occur in the muscles surrounding the hip joint as a result of the convergence of the attachment points of the tendons of these muscles.

Due to the functional inferiority of the limb on the side of the dislocation, the load on it decreases, which leads to a lag in the development of the entire half of the pelvis.

Symptoms and diagnosis. The clinical picture of the disease is clear only in a later period, when pronounced morphological and functional changes are very difficult to correct.

Early diagnosis congenital dysplasia presents significant difficulties. However, clinical and x-ray examination of the patient still allows the correct diagnosis to be made in the vast majority of cases. With the aim of early detection congenital dislocation of the hip is necessary already in maternity hospital purposefully examine all children.

The most reliable sign of congenital dislocation of the hip is the symptom of “slipping,” or the symptom of “reduction and dislocation,” of the femoral head. It is determined in a child lying on his back, with the legs flexed and abducted to an angle of 90°. If the head is located outside the acetabulum, when the hip is abducted, it jumps over the posterior edge of the acetabulum and is reduced into the joint. At this moment, the examiner’s hand feels a characteristic push, and in some cases the reduction is accompanied by a characteristic clicking sound. Adduction of the hip leads to dislocation of the head and is also accompanied by a similar pushing sensation. It should be noted that the symptom of “slipping” is not necessarily detected during the first separation of the legs and often disappears with repeated examinations. A single determination of the “slipping” symptom is sufficient to diagnose congenital hip dislocation. This symptom can be detected from the first day of birth of the child and in some cases persist until 6 months of age. The “slipping” symptom is detected in approximately half of the cases of established dislocations.

The second sign of dislocation is a symptom of limited abduction of the hip or hips with bilateral pathology. It is also determined in the position of the child on his back with flexion and abduction of the hips. This symptom is especially valuable in case of unilateral dislocation, when it is possible to compare the degree of abduction of both hips. This symptom with congenital dislocation occurs frequently - in 80-90% of sick children.

An inconsistent symptom of congenital dislocation may be looseness in the hip joints, which occurs more often with breech presentation. In the immediate period after birth, laxity may disappear, giving way to limited hip abduction.

An important diagnostic sign is the asymmetry of skin folds: with unilateral dislocation there are more of them, and they are deeper on the affected side (Fig. 75). Although asymmetry of the folds can occur in healthy children, in patients with congenital hip dislocation it occurs in approximately 70% of cases.

Rice. 75. Asymmetry of skin folds in congenital hip dislocation.

Variable but alarming symptoms are slight shortening and external rotation of the leg on the side of the dislocation.

Thus, already in newborns a number of signs of hip joint pathology can be identified. However, given the variability of symptoms and their insignificant severity, it is impossible to make a diagnosis based only on clinical data.

Radiography is a great help in diagnosis. X-rays should be performed in such a way that both hip joints are visible on one film. When studying radiographs, pay attention to both the structure bone formations, and on their relationships.

In newborns, the head is not visible. The ossification nucleus of the head normally appears in boys at 6 months, and in girls - 4 months after birth. On the side of the dislocation, the ossification nucleus is less pronounced. With bilateral lesions, this sign loses its significance, however, the delayed appearance of ossification nuclei is characteristic. For early X-ray diagnosis of congenital hip dislocation, various schemes, which make it possible to more accurately determine the underdevelopment of the hip joint (Fig. 76).

Rice. 76. Early X-ray diagnosis of congenital hip dislocation (explanations in the text).

Normally, horizontal line A, drawn through the right and left light Y-shaped cartilage that makes up the floor of the acetabulum, crosses the middle or top part bony nucleus of the femoral head. The distance of the femur from the center of the joint - lateroposition - is determined using the vertical line B, which is drawn through the superolateral protrusion of the acetabulum. The femoral head is normally located medial to this line. If a horizontal line C is drawn through the base of the neck, then it intersects the lower part of the “loop” or “tear drop” or “Köhler’s comma”. It is necessary to study Shenton's line - D. Normally, this is a regular arcuate line connecting the lower contour of the horizontal branch of the pubic bone with the contour of the femoral neck. Shenton's broken line indicates upward displacement of the hip.

The most important radiological sign is the so-called acetabular index, which determines the angle of inclination of the “roof” of the acetabulum. The angle of inclination is determined by two lines - a horizontal line drawn through the Y-shaped cartilage, and a line drawn along the outer edge of the bony part of the acetabulum. Normally, the angle of inclination of the “roof” does not exceed 25°.

Diagnosis of congenital hip dislocation in children after one year of age, when the child begins to walk, usually does not cause difficulties. With unilateral dislocation, shortening of the leg, a limping gait is observed, and with bilateral dislocation, a “duck gait”, limited hip abduction, high location of the greater trochanter, absence of the head on palpation in the groin area, and positive symptom Trendelenburg (Fig. 77) is done clinical diagnostics almost unmistakable. Previously listed radiological signs more clearly expressed, and they are supplemented by deformation of the head and expansion of the femoral neck.

Rice. 77. Trendelenburg's sign with left-sided congenital dislocation.
a - negative; b - positive, when standing on the left leg

Congenital hip dislocation is congenital disorder development of the osteochondral, ligamentous-capsular and muscular structures of the hip joint, leading to persistent displacement of the articular ends of the bones that form this composition.

Etiology and pathogenesis. Congenital dislocation of the hip is associated with a delay in its development in the embryonic stage. Signs of hip dysplasia are noted at birth. As the child grows, joint dysplasia progresses, which leads to displacement of the femoral head outward and upward, and flattening of the acetabulum. The development of the nucleus and ossification of the head of the femur are delayed, which together with the neck is deformed. The joint capsule stretches significantly.

Classification of congenital hip dislocation

Pre-dislocation is characterized by maintaining the relationship between the femoral head and the acetabulum, but dysplasia of the ligamentous-capsular structures of the joint contributes to the dislocation of the femoral head from the acetabulum, followed by its easy reduction.

Subluxation is characterized by upward displacement of the femoral head beyond the acetabulum, while the acetabulum is flattened and elongated.

Dislocation is accompanied by stretching of the ligamentous-capsular structures of the joint with flattening of the acetabulum and displacement of the femoral head outside the acetabulum.

Symptoms of congenital hip dislocation

The symptom of the femoral head slipping (dislocation and reduction) indicates instability of the hip joint and is detected in the newborn period. The symptom is detected by abduction and traction of the hips in the distal direction with light pressure on the greater trochanter. In this case, the head of the femur is reduced into acetabulum, making a characteristic clicking sound. When the hips are adducted, the femoral head dislocates.

Symptom of limited hip abduction The symptom is detected in the supine position with the hips spread to the sides. The legs should be bent at the knees and hip joints. Normally, the hips are abducted to horizontal plane, while their outer surfaces touch the changing table. In the presence of congenital dislocation, there is a limitation of hip abduction on the affected side.

Symptom of asymmetry of the skin folds of the thighs. In the supine position and fully extended legs, the location of the skin folds along the anterior inner surface of the thighs is checked. With congenital dislocation of the hip, an asymmetrical location of the skin folds is noted with a proximal displacement on the side of the dislocation. When lying on the stomach, there is a displacement of the gluteal fold higher on the side of the hip dislocation.

Symptom of limb shortening. It is determined in a supine position with the legs bent at the hip and knee joints. The feet are strictly placed on the surface of the table. Limb shortening is determined by the level of the knee joints. On the hip dislocation side, the knee joint is located lower.

Children older than 1 year have an unsteady gait, lameness, or a swaying “duck” gait with bilateral dislocation.

Diagnosis of congenital hip dislocation

To treat hip subluxation, spacer splints are used, which allow the head to be centered in the acetabulum within 3-4 weeks. The period of fixation of the limbs in the spacer splint is up to 5 months.

Congenital dislocation diagnosed in the newborn period is treated with spacer splints for up to six months. In case of late diagnosis (after 6 months), a combined treatment method is used, including diverting splints and spacers. plaster casts for fixing the head in the acetabulum.

In children aged one year, reduction of congenital dislocation is carried out using single-stage orthopedic adjustments followed by the application of plaster casts.

Prognosis for congenital hip dislocation. Early diagnosis and treatment make it possible to achieve complete anatomical and functional restoration of the joint in 100% of children.

The article was prepared and edited by: surgeon

Congenital hip dislocation - This is a fairly serious defect. This disease occurs 5-10 times less often in boys than in girls. Unilateral lesions occur 2 times more often than bilateral ones.

Literally 10 years ago it was believed that this defect occurs as a result of some kind of injury or inflammatory process. But in our time this theory is considered untrue. During research, modern scientists have found that the basis of congenital hip dislocation is dysplasia - a deviation from the normal formation of the hip joint. Moreover, the beginning is laid during intrauterine development. This developmental defect leads to displacement of the femoral head, underdevelopment of the pelvic bones, as well as slower ossification of the bone elements of the joint.

The hip joint is not very accessible for research, since it is surrounded by a fairly thick layer of muscles and is located deeper than the other joints. So some kind of violation is indicated mainly indirect signs. When examining infants, only a very thorough examination of all clinical trials may help diagnose abnormal development of the hip joint. The most difficult thing is that based on clinical signs At this age it is very difficult to make a diagnosis. Accurate diagnosis congenital hip dislocation becomes available only as the child grows.

Symptoms of congenital hip dislocation in children

Diagnosis of this rather serious pathology should be carried out exclusively by a doctor. At home, you should not even try to examine the baby’s pelvis, since the bones and joints are very fragile and can cause additional injury. Let's look at the main symptoms that a specialist pays attention to when diagnosing congenital hip dislocation:

Symptom of slipping (also called the symptom of clicking or instability) When this symptom is detected, the specialist places the baby on his back, bends his legs at the hip and knee joints, thumbs should be located on the inner thigh, and the rest on the outer. The symptom of a click can manifest itself in different ways: in one case, the head is dislocated into the socket, and in another, it is reduced. If the baby is fine and there is no dislocation, there should not be a click. IN healthy child There may be a slight crunch in the knees. This crunch appears due to the fact that the growth rates of the ligaments and bones do not correspond, but there is nothing wrong with that.

If there is a positive symptom of a click, the specialist feels a piston-like slipping of the head of the femur, resulting in a click being heard. However, this moment is typical for newborn children, but when normal development should disappear in a week.

Limiting hip extension
With congenital dislocation of the hip in children, this symptom appears in the first year of life. It is detected when the baby is lying on his back. To do this, the specialist bends the child’s legs at the hip and knee joints. After this, without violence, he tries to spread the legs of the subject to the sides. If there are no deviations, in the first months of life the child’s hips in the hip joint are moved apart to an angle of 80-90 degrees. But it is worth noting that this symptom can also appear in other diseases or even during normal development. It all depends on muscle tone.

Asymmetry of folds on the buttocks
To determine this symptom in children, you need to put them on their stomach. Attention is drawn to the level of the gluteal folds. If they are at the same level and have the same degree of depth, then there are no deviations from the norm. But this symptom can also manifest itself in other diseases, and not everyone can persuade a child to lie absolutely flat and not spin around for a while.

Leg shortening
This sign is extremely rare in healthy newborns and can only appear when the hip is dislocated. This sign cannot be determined using a measuring tape. It is necessary to bend the baby’s legs at the hip and knee joints; if the level of the knee joints is different, it means there is a defect.

External curvature of the leg
If a child exhibits this symptom, it is very easy to identify: the foot will be slightly turned outward. This sign appears on the side where there is a dislocation. The symptom is very noticeable when the child is sleeping. But external clubfoot can also cause this symptom.

In children over one year of age, a number of other symptoms appear, such as: insufficiency of the gluteal muscles, gait disturbance, high standing of the greater trochanter, as well as the symptom of a disappearing pulse. But, in addition to the symptoms described above, to determine congenital hip dislocation in children, you need to undergo radiography and ultrasound diagnostics of the hip joint.

Treatment of congenital dislocation of the hip joint in children

Dislocations are treated using two methods: surgical and conservative. If the diagnosis is made correctly and on time, then you can manage conservative treatment. This method is that each child is selected custom tire, which is needed to keep the legs in a flexed position at the knee and hip joints. This leads to normal formation and development.

Reduction of the femoral head must be done very slowly, atraumatically and gradually. Rough actions in this case should not take place, as they can cause harm to the tissues of the joint and the head of the femur. The most appropriate time to start treatment is considered to be the first week of the baby’s life. It is at this age that secondary changes in the proximal end of the femur and socket are minimal. But this method can also be used in older children, up to 1 year of age.

For old dislocations, surgical intervention is used. But parents need to remember that timely visits to the doctor will help their baby avoid surgery. So check your children regularly.