All the signs of hip dysplasia in a newborn baby: what parents should pay attention to. Hip dysplasia in newborns

Congenital diseases joints - not such a rarity in newborns. It is important for the parents of these children to understand that the health of the child’s joints and bones in adulthood depends on how quickly such pathologies are eliminated by doctors.

On the other hand, there is no need to panic, because... bone dislocations discovered after childbirth do not pose a serious danger if they are corrected in time. Such conditions are quite successfully corrected and treated by modern medicine. Hip dysplasia in newborns becomes a direct cause of congenital hip dislocation.

Until recently, domestic orthopedists identified this condition as a separate disease. But the results of studies of patients with this pathology indicated that the cause of its development is the underdevelopment of the articular surfaces, as well as other anatomical structures of the hip joint. Dislocation in this case is the result of a severe degree of impairment intrauterine development this anatomical region, which is usually referred to as dysplasia of the hip joint.

The main task of the hip joint in the human body is to ensure all functions lower limb(abduction-adduction, flexion-extension, rotation). This is a movable joint femur and the pelvis, which allows, simultaneously with the muscular system, walking, running, squats, etc. In terms of functional ability and range of motion of the limb, such a joint is second only to the shoulder. Dislocation (a process in which one of the articular surfaces leaves the joint) of the hip in such a joint leads to a complete disruption of the supporting function of the leg.

In a newborn child, mild degrees of underdevelopment of the hip joint and even its dislocation can only be diagnosed by a doctor. This is due to the fact that children in this early period of life are not yet able to walk, and accordingly, it is difficult for parents to identify such an orthopedic problem. The success of treatment of this pathology, diagnosed in the first year of life, guarantees good functional ability of the limb in adult life.

The variety of reasons that can lead to dysplasia in a baby, as well as the high incidence of this pathology, make it a relevant disease for both pediatricians and young parents.

Modern medicine has still not been able to establish a single cause that provokes the development of joint dysplasia in young children. Doctors' observations indicate that hereditary causes play an important role in the formation of this pathology. It is worth considering that the effect of various unfavorable factors environment leads to the development of genetic mutations and affects the rate of intrauterine development of the fetus. Naturally, this negatively affects the formation of such bone structures, like joints, and especially those that connect the thigh to the pelvis.

In addition to heredity and poor environmental conditions, other conditions have been identified that provoke the occurrence of this pathology. Most often, joint dysplasia in a newborn is associated with the following intrauterine factors:

Breech presentation. This is the position of the fetus in the uterus when its legs are facing the woman’s pelvis. In this position, the child's lower limbs are functionally limited to the cramped space of the uterus. This most likely results in underdevelopment of the hip joints. Childbirth in the case of such a presentation of the fetus is not easy for both the unborn child and the mother. Therefore, in the process of moving the fetus through birth canal Dislocation of the femoral head from an immature joint quite often occurs.
A child who has a prenatal body weight greater than average values, those. more than 4kg. Dysplasia in this case is also associated with a relative lack of space in the uterine cavity. This prevents the joint surfaces from fully and correctly developing due to the fact that the legs cannot move to their full amplitude.
Toxicosis during pregnancy. An increased risk of developing hip dysplasia has been established in babies whose mothers suffered toxicosis during gestation, especially in the last trimester of pregnancy. It is likely that the development of such a pathology is associated with a disruption of normal metabolic processes in the fetus. Such changes reach their maximum severity during the period when intoxication phenomena did not allow the pregnant woman to eat normally, as well as adhere to the correct daily routine.

Dysplasia of the legs in newborns, which often manifests itself as deformation of the feet, can also accompany the process of underdevelopment of the hip joint. In this case, the cause of the violation normal development lower extremities become various exogenous factors (toxins, chemicals, medications, radioactive radiation etc.) or endogenous causes (a number infectious diseases etc.).

How to identify the disease in a newborn?

Mild hip dysplasia usually does not appear in the baby after birth. However, at an older age, the occurrence of pain and the appearance of intolerance to large physical activity indicate that the joint was underdeveloped in utero. In the case when such changes in the articular surfaces lead to joint failure, its subluxation or dislocation develops, the following signs can be identified in a newborn:

When trying to separate the baby’s legs, there is a feeling of limited movement of the limb, which is accompanied by pain. Since the femoral head does not fully contact the articular surface of the acetabulum, the amplitude of abduction of the leg is reduced.
Symptom of hip slippage which is also determined when trying to separate the baby’s legs. In this case, the femoral head automatically moves into the joint (a characteristic click is felt), and then leaves it again due to the underdevelopment of the structures of this anatomical region.
Femur displacement causing the limb to become shorter. This is also manifested by visual asymmetry of the inguinal folds of skin in a newborn.

Every neonatologist and obstetrician-gynecologist knows how to identify the symptoms of the congenital form of hip dislocation that accompanies dysplasia. It is these specialists who, after identifying signs of pathology, invite a pediatric orthopedist for consultation after childbirth. Having examined the newborn, he can not only confirm the disease, but also prescribe a set of examinations to accurately determine the degree of hip dysplasia.

The pediatric orthopedist fully evaluates all segments of the lower limb, the length of both legs, and the angles at which the child’s leg can flex, abduct, or adduct. It is also assessed whether there is indeed a “clicking” symptom and an insufficient angle of abduction of the limb. To establish a final diagnosis, a specialist prescribes an ultrasound of the hip joints for a child in the first year of life, and less often, an x-ray of this area of the body. Based on the results of the examination, the doctor will be able to select the most effective method of treating this pathology in a newborn.

Hip dysplasia in a newborn is detected by the results of an objective examination, as well as ultrasound (or radiography).

Diagnosis of dysplasia

The “golden” diagnostic standard for determining whether a child has insufficient development of the hip joints is ultrasound. This study is carried out for all children without exception with symptoms of dislocation in the hip joint, as well as newborns with increased risk development of dysplasia. Unlike other examination methods, ultrasound is absolutely safe and harmless for babies. Ultrasonic waves do not cause any negative reactions in body tissues.

The characteristics of the bones in children of this age allow the doctor to evaluate a fairly wide range of parameters of the hip joint using ultrasound. Ultimately, this helps determine whether neonatal dysplasia is present. During the examination, the following parameters are assessed:

The position of the femoral head (it should be centered relative to the acetabulum; its displacement is not observed normally).
Inclination of the acetabulum of the pelvic bone. This indirectly indicates the development of such a formation (the bony roof of the joint).
Angle of the cartilaginous roof of the joint and cartilaginous prominence

By assessing all these parameters, it is possible not only to establish the type and subtype of dysplasia, to confirm a violation of the integrity of the joint, but also to answer the question of whether dysplasia of the hip or pelvic bone is progressing over time. The resulting planar images from ultrasound give the same picture as radiography. This allows the results of both research methods to be compared.

However, the use of X-rays to diagnose dysplasia in children of the first year of life is undesirable. This is associated with both increased risks radiation exposure on the body (x-ray diagnostics emits ionizing radiation), and the low information content of the method (the proximal femur and pelvic bones still have a cartilaginous structure, and therefore are poorly distinguishable on an x-ray). If, for a number of reasons, X-rays are still preferred to determine dysplasia, then such diagnosis is carried out by drawing conditional lines and determining the angles formed by the anatomical structures in the joint.

A congruent joint is one in which the articular surfaces fit together perfectly. This should be normal.

Treatment and rehabilitation for pathology

Hip dysplasia of any degree requires competent and sometimes long-term treatment. The goal of all measures taken by the orthopedist is to ensure proper development articular surfaces that are responsible for the functionality of the joint in later life child.

Treatment of such pathology should include special provision legs (a pose in which the legs are bent and moved to the side), but without rigid fixation of the limbs. Domestic and foreign doctors have proposed a wide range of orthopedic products that can be used to treat dysplasia in children of the first year of life (Pavlik stirrups, Volkov splint, Freik pillows, etc.).

In modern medical practice used by doctors industrial medical products to give the necessary position to the child’s lower limbs. The basis for them is the principle proposed by the Czech orthopedist Arnold Pavlik. If, for various reasons, such orthopedic products cannot be used in a newborn, it is recommended to wide swaddling with giving the abduction position of the lower extremities up to 60-80 degrees. This method is also recommended for prophylactic use in children at risk of developing dysplasia.

At the first appointment with an orthopedist, the mother of a newborn may hear an alarming diagnosis: hip dysplasia. It should not be taken lightly, because in the future the child may be tormented severe pain along with inflammatory processes.

But there is no need to panic. The sooner parents begin to act, the more effectively and quickly they can help the baby. How does this most common orthopedic pathology of infancy manifest itself and what to do about it? Let's discuss.

A little anatomy

Infant hip dysplasia is a condition in which the joint is underdeveloped. Normally, it is formed by the head of the femur and the acetabulum of the pelvic bone. The acetabulum looks like a semicircular bowl, framed along the edge by a cartilaginous rim that limits movement in the joint. The cavity itself is filled synovial fluid (sticky liquid, performs the function of lubricating the joint).

The head of the femur is spherical in shape, so it fits neatly into the acetabulum. It is connected to the body of the bone through a small so-called femoral neck. The neck and head of the femur are covered by an articular capsule. Inside, the joint is supported by ligaments, which provide shock absorption during heavy loads. The main ligament contains a vessel that carries nutrients for the head of the femur.

In the figure you can see what the normal and pathological placement of joints looks like

The hip joint, which resembles a ball-and-socket joint, is much more stable than other joints in the body and is very mobile. With its help, movements such as flexion and extension, rotation, adduction and abduction are performed. Of course, ligaments and muscles make his mobility not unlimited.

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

Pre-luxation. It occurs when the joint capsule is stretched, causing the head of the femur to move slightly, but easily return to its desired position.
Hip subluxation. The femoral head is partially displaced relative to the acetabulum, and the ligament is stretched and strained.
Hip dislocation. Complete displacement of the head (it extends beyond the socket).

Whatever the situation, remember that the immaturity of the joint capsule is to some extent explained by physiological reasons. On the one hand, this means that all newborn children have a risk of developing pathology, on the other hand, the condition is not a disease as such, especially since it is successfully treated in infancy, thanks to the active process of formation.

The most dangerous thing that can happen is delay. If the problem was discovered at the beginning of life, in the first 6 months, up to a year, up to a maximum of one and a half years, you can correct the situation to an absolutely normal one. When dysplasia in newborns is diagnosed in the second half of the year, the situation becomes more complicated: treatment will take several years, but will be effective.

However, if there was irresponsibility and negligence towards the baby’s health on the part of the parents or doctors, and they “decided to save the child” when he walked with a limp on his own, you can help, but it is possible that the baby will feel the consequences of dysplasia throughout his life .

Factors contributing to the development of dysplasia

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

It is believed that main reason development of dyslasia is the hormone relaxin. It is produced by a woman during childbirth. Under its influence, the pelvic ligaments relax, and the pelvic bones “soften”, becoming as elastic and soft as possible. All this together allows the newborn to pass through the birth canal.

But the hormone affects not only the mother, it also softens the bones and ligaments of babies, and the effect is stronger on girls, whose bones are initially more plastic than men’s. If a woman gives birth for the first time, the body, experiencing stress, produces relaxin more than usual. Thus, it becomes clear why the following are at risk:

firstborn,
female babies.

Other factors are:

Breech presentation. When a baby is born bottom first, this is not entirely physiological, and there is a risk of dislocating the hip joint.
Hereditary predisposition. If there were problems with hip joints in the female line of the family, it is quite possible that the child “inherits” such a gift from the mother.
Large fruit. A baby weighing more than 4 kg does not always easily cross the birth canal. Increased pressure is placed on both the pelvic bones of the mother and the child itself, and the risk of injury increases. According to statistics, the left hip joint is damaged in 60% of cases, which is associated with the forced position of the fetus in the womb.
Low water. A small volume of amniotic fluid (less than 1 liter) complicates fetal mobility; this situation is fraught with injuries and pathologies.
Tight swaddling. It has been noted that in African countries where children are not swaddled but carried on their backs, the percentage of cases of dysplasia is minimal. And when in Japan in the 70s they began to abandon the traditional tight swaddling for their nation, congenital hip dislocation began to occur not in 3% of babies, but in only 0.2%. So the relationship is obvious.

Why did we consider all these factors? To know how to minimize the risk of developing dysplasia. For example, if a woman’s first birth is a large girl, and also a breech birth, there is every reason to perform a cesarean section. And this is not because it is easier and more profitable for aunt-midwives. First of all, this is caring for the child, because the risk is in this case big.

Asymmetrical folds indicate joint problems

Symptoms

There are signs that should alert the mother and prompt her to visit an orthopedist unscheduled. These include:

Asymmetry of folds. Infants are placed on their tummy and their legs are straightened. Normally, all folds (gluteal, inguinal, popliteal) should be mirrored. The depth of the folds is also assessed. However, this method itself is not very reliable, since with bilateral dysplasia the asymmetry will not be noticeable. Additionally, up to 3 months, uneven folds may be normal.
Hip extension is incomplete. In practice, it looks like this: the infant is placed on the table on his back and, holding his knees, spreads his legs to the sides. Normally, the exercise is done without much effort, so that the knees touch the table. But if you feel resistance in your legs when you try to separate them, or one leg fits well but the other does not, this is an alarming signal.
Clicking sound when moving legs apart(symptom of slipping). It is also checked when spreading the hips to the sides. At some point, the doctor feels that the hip cannot be abducted any further, after which the hand “hears” a characteristic click. This is a reliable diagnostic method, but only in the first three weeks.
The situation when one leg is shorter than the other. The baby's limbs are stretched out and they are checked to see if the kneecaps are at the same level. Shortening indicates a severe form of dysplasia when the hip is dislocated.

If you find one of the symptoms in your toddler, this does not mean that he has dysplasia. This just means that you need to consult a doctor for advice.

Diagnostics

Dysplasia in newborns, as well as subluxation, is determined during a routine examination by an orthopedist. This examination is carried out at birth, at one month, at 3 months, at six months and at one year. Then, as a preventative measure, it is recommended to visit a doctor annually.

Right on x-ray you can see the dislocation

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

What if you don't treat it?

If the immaturity or underdevelopment of the joint is slight, they speak of dysplasia mild degree. In half of the cases it will go away on its own. But only half!

When children are diagnosed with dislocation, subluxation of the hip or severe dysplasia of the hip joints, treatment is necessary, otherwise, as mentioned earlier, the baby will complain of pain in the limbs, fatigue when walking, and the gait will resemble that of a duck.

Treatment methods

Plastering

The essence therapeutic activities Correcting the condition involves fixing the joint in the correct position. It takes enough time for the ligaments to strengthen and securely hold the joint. For these purposes, plaster casting is used, when the legs are fixed in an extended, semi-bent position using a plaster cast. The disadvantage of gypsum is its hygroscopicity and very heavy weight.

Orthopedic devices

There are a lot of orthopedic devices that can correct the deviations that have arisen.

Unlike rigid structures that led to complications (in particular, necrosis), Pavlik stirrups allow the baby to move more or less freely. The design includes a chest bandage and boot linings, connected by strips. A pair of straps in the front helps you bend your knees, and a pair in the back spreads your shins out to the sides. Stirrups are made from soft fabrics.

Freyka's pillow

It looks like panties, made of dense material that helps maintain the legs in a state of dilation at 90 OC. Wear a bandage if subluxation or dysplasia without dislocation is diagnosed.

Vilensky tire

A device consisting of two leather straps with laces connected by a metal spacer. They come in three types, tailored to the age of the baby. The length of the spacer is adjusted by an orthopedic surgeon, who also shows parents how to put it on correctly. To prevent the child from accidentally moving the adjustment wheel while playing, it is secured with electrical tape. The straps are laced tightly, otherwise they will slip off. The tire can be worn for up to six months. You can only take it off to swim. A variation of this design is the CITO splint.

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

Tire Volkov

Nowadays it is almost never used, as it practically immobilizes the child, is difficult to select in size and is quite expensive.

Gymnastic and massage techniques

Massage and gymnastics are another means of accelerating the development of joints. All manipulations are carried out only as prescribed by the doctor and only by a good specialist. Usually the course is divided into 10 sessions, repeated every month. In addition to therapeutic massage, parents at home can do relaxation exercises daily, including stroking and rubbing.

With the help of therapeutic exercises it is possible to:

strengthen the thigh muscles;
return the original configuration to the joint;
maintain good blood circulation and trophism of joint tissues, prevent complications such as necrosis;
develop the baby's physical activity.

For children under one year old, passive gymnastics is recommended as elements of a comprehensive massage.

Physiotherapy

Electrophoresis with calcium and phosphorus. Electrodes with a solution are applied to the joint area. Thus, the elements entering the body strengthen the joints.
Warm bath. Water with sea salt has a relaxing effect on the body, improving blood circulation and accelerating regeneration processes.
Applications with ozokerite. They also affect tissue nutrition, promoting speedy recovery.
Ural Federal District. The treatment regimen using ultraviolet rays is selected on an individual basis. Its goal is to stimulate the immune system and accelerate regeneration.

Congenital dislocation - how to reduce it

If x-rays or ultrasound indicate hip dislocation in a child aged 1 to 5 years, closed reduction is indicated unless the displacement is severe (otherwise surgery is necessary). What is this method?

Under anesthesia, based on ultrasound data, the doctor returns the femoral head to the correct position, after which a plaster cast is applied for six months, fixing the legs in an extended state. When the bandage is removed, it begins rehabilitation period, including massages, physiotherapy, etc.

Surgery

Sometimes the displacement is so strong that in a closed way it cannot be eliminated. The situation may be complicated by entrapment of the joint capsule, underdevelopment of the femur, or late diagnosis. Then they resort to open surgery.

The disadvantage of surgical interventions is that they are fraught with complications: large blood loss, inflammatory processes, suppuration or tissue necrosis. Therefore, it is important to undergo recommended examinations on time and follow all doctor’s instructions.

Have your child examined by an orthopedist in a timely manner

Prevention

To minimize the possibility of this problem developing, follow these recommendations:

Do not practice tight swaddling. Instead, secure the arms with a diaper and let the legs remain free. If your baby is at risk, master the wide swaddling technique: lay the baby on his back, place two diapers between his legs and secure them with a third one on the baby’s belt.
Slings. Use slings, baby carriers, and kangaroo-style backpacks as appropriate for your age. In African countries, where this method of transporting children is a tradition, the problem under discussion practically does not exist.
Use diapers one size larger. In addition to the fact that it is simply convenient, filled diapers spread the legs to the sides - an excellent preventive measure.
Massage and gymnastics. Exercise strengthens muscles, so general massage For prevention purposes, it is done daily.

Summarize. We looked at the causes of hip dysplasia and how to treat it. Wearing restraint devices seems like a draining task. Of course, I feel very sorry for the baby, especially when his peers begin to stomp. But in this situation, as they say, time heals, and treatment cannot be interrupted, otherwise all your efforts will be nullified.

Untreated hip subluxation leads to severe chronic diseases. Therefore, follow all the doctor’s recommendations and do not try to put the child on his feet unless the orthopedist gives the go-ahead.

Hip dysplasia in a newborn – serious problem, requiring a qualified and comprehensive approach. Early detection of the disease increases the effectiveness of therapy many times. What does the effectiveness of treatment depend on? Swaddling: benefit or harm? The role of parents at the stage of diagnosis and therapy. You will find answers to these questions in the article.

A bit of geometry

First, let's deal with the main question - a diagnosis of hip dysplasia in children has been made, what is it?

The shape of the hip joint is spherical. Movements are carried out in 3 planes (sagittal, frontal, vertical). The joint consists of:

Articular head. This is the head of the femur.
Acetabulum. Has a crescent shape.
Vertabular lip. A cartilaginous plate that serves as a protective barrier against displacement of the head upward outside the joint.
Joint capsule. Connective tissue, forms a hermetic cavity due to the weaving of its fibers into the structures of the joint.
Ligaments and muscles. Keep all elements of the joint in the correct position.

Normally, the articular head occupies a mid-position in the capsule. The angle formed by 2 lines (1 line along the femur, 2 parallel to the socket) is 90º. This ensures even pressure distribution.

In the picture on the left is normal, on the right is dysplasia (dislocation) of the hip joint in a child

With the correct development of the components of this complex system, there are no functional problems. But if something goes beyond the norm, hip dysplasia develops in the newborn.

In other words, dysplasia is the inferiority of structures.

With untimely and inadequate therapy, serious complications arise in the form of subluxation and joint dislocation. Treatment is complex and not always 100% successful.

First symptoms: what to look for?

Everyone looks at their sleeping baby with tenderness. But often a child’s sleeping position can tell a lot. When the baby sleeps, his muscles are relaxed, he lies on his back with his legs spread wide apart. In some cases, with pronounced muscle tone () or problems with the joint, the child’s arms and legs are compressed.

Parents often wonder and worry that their baby has uneven legs. However, we hasten to reassure them and note that this shape of the legs at this age is the necessary conditions for proper development of the joint.

How to determine hip dysplasia in newborns? For this purpose orthopedist conducts mandatory routine examinations of children. The first time is in the maternity hospital, then every month, at 3 months, at six months and a year.

Signs and diagnosis of hip dysplasia in children

The folds on the legs are located asymmetrically

To do this, the child is placed on the table, first on his back. The inguinal folds are examined, their severity (depth) is noted by the symmetry of the level of placement on both legs.

Next they turn over onto their stomach. The gluteal and popliteal folds are assessed. On the leg where the problem is fixed, there are more folds and they are deeper. When diagnosing hip dysplasia in a newborn, the photo shows a clear picture of the location of the folds. This method is informative from 2 months of age.

This test is not worth taking as a panacea.. Because there are cases of completely healthy children with asymmetry of the folds. If bilateral hip dysplasia is diagnosed in an infant, the folds, on the contrary, are symmetrical.

One leg is shorter than the other

The child is placed on his back. The doctor bends the legs at the hip and knee joint. If the level of one kneecap is lower, this is a bad prognostic sign. Occurs when a dislocation occurs.

Clicking symptom

Diagnostic symptom of dislocation. The baby lies on his back, the legs are flexed at the hip and knee joints and taken to the sides.

This is done without pressure! At a certain moment, the doctor feels a characteristic click. The reason is that the head goes beyond the socket. This test is additional, since in 4 out of 10 newborns examined it will be positive, although the children are completely healthy. Information content decreases with age.

Legs abducted to the sides

The baby lies on his back, legs are bent in the same way as described in the previous test, and moved to the sides. Normally, the outer side of the leg should touch the table. This may not be the case with muscle hypertonicity.

You can detect dysplasia in a child up to one year old on your own at home. But To 100% confirm the diagnosis, you must conscientiously visit a pediatric orthopedist within the time allotted for scheduled inspection.

X-ray examination of a child’s hip joint is more indicative after a year

If symptoms of hip dysplasia in children are detected, in this case, additional examination is carried out to clarify the diagnosis.

For these purposes, ultrasound and radiography are used. Ultrasound is prescribed more often in children under one year of age, because At this age, cartilage is not yet visible.

Reasons: good information content in early age, the child’s health is not in danger, unlike radiation exposure during radiography.

In more complex clinical situations, X-ray diagnostics are performed. To decipher it, certain lines are drawn and angles are measured.

What are the causes of hip dysplasia in newborns?

Let us note the main cases.

Antenatal (intrauterine) period. Toxicoses. Taking medications.
Childbirth. Breech presentation. This position of the fetus is a complex task and requires skilled labor management. Often, in order to avoid complications with a breech fetus, a caesarean section is performed. A large fetus (more than 4 kg) is also at risk.
Genetic predisposition. In 30% of cases, this disease is hereditary.
Tight swaddling. The baby is swaddled, arms and legs are tightly wrapped in diapers. The legs are aligned - this is highly undesirable!

With this swaddling method, the necessary conditions for the normal development of joint structures are reduced to zero, which is fraught with consequences. Hands can be swaddled, but legs - under no circumstances.

What will the statistics say?

Hip dysplasia in a newborn occurs more often in girls. In this case, there are several hypotheses. The main one among them: “it’s about the hormone relaxin, which is produced in the mother’s body during childbirth. Its task is to soften the ligaments and bones necessary for the baby to pass through the birth canal. It is believed that girls’ bodies are also sensitive to the influence of the hormone.”
The right joint is most often affected.
Residents of the tropics have a low incidence rate, while Scandinavians, on the contrary, have the highest.
If parents are diagnosed with the disease, the risk of developing the disease in children increases 10 times.

Main forms of the disease

Impaired development of the acetabulum. It takes on a flattened, beveled appearance. Accordingly, the head of the femur, due to the altered anatomy, cannot be maintained in the median position (which is the norm). In addition, in infants, the ligaments are very elastic. This leads to the formation of subluxation and an even more dangerous complication, such as dislocation.
Problems associated with impaired development of the proximal femur. To diagnose this form, the neck-diaphyseal angle is determined, the value of which varies depending on age.
Dysplasia due to changes in bone geometry in horizontal plane.

Treatment

Examination and therapy (when the first symptoms are detected) are carried out by a pediatric orthopedic surgeon.

Massage for hip dysplasia in newborns is performed to improve blood circulation and eliminate muscle hypertonicity.

The course consists of 10-15 procedures. Repeat after 1-1.5 months.

Execution technique

The baby is lying on his back. Stroke the outer surface of the thigh and lower leg, then proceed to rubbing these areas. Make spiral kneading movements with the main and index fingers. Without much pressure, but you should press deeper to improve trophism in the muscles and ligaments.
The baby is turned over on his stomach. Stroke the lumbar region, the outer surface of the thigh. Rub these areas with spiral movements.
Next, the buttocks are massaged. Local massage is performed on the dysplastic area. The joint is fixed with one hand, and the leg is abducted with the other, rotating the thigh inward.

After carrying out the stroking, rubbing, kneading movements described above, 3 main exercises are performed for hip dysplasia in newborns.

Execution technique

The child lies on his back. Alternately bend and unbend each leg.
Move the leg bent at the knee to the side (without pressure). Up to 10-15 repetitions at a time and up to 300 repetitions/day.
"Bike". Use your feet to imitate a child riding a bicycle.

Note that Exercise therapy for hip dysplasia in children is important and an effective element of treatment. Electrophoresis helps saturate bones with calcium ions. The procedure lasts up to 5 minutes. Carry out under the supervision of a doctor.

To treat hip dysplasia in newborns, by holding the legs apart, Pavlik stirrups, Becker panties, and Freik's pillow are most often used.

Pavlik stirrups are most often used for up to 3 months, then in combination with Volkov splints.

In case of a serious form of the disease, the method of hip reduction with the application of a plaster cast is used (performed for children aged 2 to 5 years).

Devices for conservative treatment hip dysplasia

After 5 years, an open surgical reduction method is used.

Consequences of hip dysplasia in children

Limitation of mobility in the joint.
Severe inflammatory process.
Severe pain syndrome.
Lameness.

In the absence of adequate diagnosis and rational treatment, dysplasia can cause disability.

5 steps to prevent the development of the disease

Complete refusal of swaddling. The baby is dressed in ordinary clothes.
Using diapers. When Evgeniy Olegovich was asked what is a preventive measure for hip dysplasia in a newborn, Komarovsky replied that wearing a diaper every day is not only a help to parents, but also good prevention diseases.
Use of kangaroo backpacks and slings.
Proper carrying of the baby. When the little one begins to confidently hold his head, parents can carry him in an upright position away from him. One hand holds the little one at chest level, the other holds the feet with knees bent and legs apart.
Swimming on your tummy. Hydro procedures are very useful. The baby, overcoming the resistance of the water, develops different muscle groups.

Immaturity of the hip joints occurs in 20% of newborns. In medicine, this phenomenon is also called dysplasia. By this pathology, orthopedists and related specialists mean congenital abnormalities in the development of joint structures and their inferiority (underdevelopment). Graf type 2a (ultrasound classification) is an immature dysplastic joint. The initial stage is pre-dislocation, and if you do not respond in time and start treatment, then pre-dislocation will develop dangerous consequences: subluxation or dislocation hip head in children.

Hip dysplasia in newborns is the most frequently heard diagnosis in the orthopedic office.

Even in absolutely healthy children who have just been born, the structure of the hip joint is not a fully formed structure (immaturity), and possible problems are associated with this.

For reference. Immaturity of the hip joint in an infant (type 2a) is a physiological component, a concept that includes delayed development of the joint due to various reasons. Dysplasia is the initially incorrect formation of the hip joint. Both of these concepts were previously combined into one, and the treatment was the same. However, it should be remembered that the line between these two diseases is very thin, and if you do not start observing a newborn with a diagnosis of “underdevelopment of the hip joints (type 2a)” in time, then you can get all the “delights” of dysplasia with all the ensuing consequences.

The ligament system in children has the following differences from the adult hip joint:

Newborns have a large vertical size glenoid cavity.
In newborns, the ligaments are more elastic.
In newborns, the acetabulum has a more flattened structure.

The femur does not move upward thanks to the limbus (cartilaginous plate of the articular cavity). If there are congenital abnormalities in the development of the joint (underdevelopment), the cavity becomes flatter. Excess elasticity prevents the ligaments from holding the hip joint head in one position. If there are disturbances in its development, the shape, size and overall geometry of the bones may change.

If treatment is not started in time and congenital dysplasia (immaturity) in children is not corrected, the limbus becomes everted with an upward displacement. Having become severely deformed, it is no longer able to hold the head inside the acetabulum. The slightest careless movement of the baby can lead to subluxation and even dislocation.

Forms of the disease

Immaturity of the hip joint in newborns has several varieties:

Acetabular ( congenital pathology acetabulum).

Immature dysplastic joint of newborns (Graf type 2a) is a fairly common phenomenon. If the elasticity of the ligaments and changes in the centralization of the head in the acetabulum have minor deviations, the usual massotherapy plus charging quickly corrects this deviation. Almost all children in the first month of life may experience some degree (usually type 2a) of underdevelopment (immaturity) of the hip joint. Therefore, examination of babies begins from the second month, when a tendency for cartilaginous strengthening of the hip joint is already visible. If serious concerns appear earlier, an unscheduled ultrasound examination is performed (according to Graf - underdeveloped dysplastic joint of newborns - type 2a).

Proximal femoral dysplasia.

Congenital disorders of bone development in the proximal region (underdevelopment) are changes in the neck-diaphyseal angle. The indicator is calculated along the line connecting the centers of the neck and head of the femur, and along the line of the diaphysis. A frontal x-ray can detect pathology in children.

Rotational dysplasia (immaturity).

In girls, underdeveloped hip joints are 5 times more common than in boys.

This is a developmental disorder in which the angle between the axis of the hip joint and the axis of the knee changes (in the horizontal plane). Geometric anatomical measurements healthy person have the following indicators: in infants - about 35°, in children by the age of three - 25°, in adults - 15°. With age, the angle decreases due to the vertical position of the body. With excessive antetorsion (change in degree of angle), the centering of the hip joint in the acetabulum is disrupted.

Risk areas

Congenital underdevelopment (immaturity) of joints in children can be a consequence of how the mother’s pregnancy proceeded, therefore the following factors influence the occurrence of pathologies:

Treatment with potent drugs during pregnancy.
Acute toxicosis.
Poor nutrition, vitamin deficiency.
Availability chronic diseases in a pregnant woman.
Family predisposition.
First birth.
Very large fruit.
Breech presentation of the fetus.
Early birth (immaturity of the mother's body).
Premature birth (fetal prematurity).

Infants who are at risk are immediately registered with an orthopedist and treatment begins. Pregnant women in the case of a large fetus or its malpresentation are usually prescribed a cesarean section. Natural childbirth are dangerous due to their possible consequences: when the fetus passes through the birth canal, its already weak hip joints may be damaged.

Significantly affects the likelihood of dysplasia and the gender of the child. Statistics note that in girls, immaturity (underdevelopment) of the hip joint is five times more common than in boys. In female infants, the ligaments have higher elasticity, which leads to a greater risk of “instability” of the head of the hip joint in the acetabulum.

Stages, diagnosis and treatment of the disease

The stages of dysplasia include preluxation and subluxation of the joint - underdevelopment (immaturity) of the hip joint without displacement or with a slight displacement of the femoral head relative to the acetabulum. The most complex type of dysplasia is bone dislocation. A dislocation causes pain in children when walking and changes in gait (clubfoot, lameness and other defects).

Preluxation, subluxation and dislocation are identified through visual inspection and application modern technologies. Clinical manifestations of immaturity of the hip joint can be noticed by an orthopedic surgeon or the parents themselves.

To treat the disease, massage and the use of various orthopedic devices are prescribed.

Symptoms and treatment of different stages of immaturity:

1. Pre-dislocation.

Symptoms of the initial stage of pathology in newborns are mild (look at the photo or video - children with pre-dislocation are almost indistinguishable from children without pathology of the hip joints). There is no asymmetry of skin folds on the legs and buttocks. The legs of a newborn do not differ in size from each other. initial stage immaturity may be indicated by the following: if you put the newborn on his back and bend his legs slightly to the side, you will feel a slight push and perhaps a slight crunch - this is the head of the femur entering the acetabulum. If this symptom is detected, you should immediately consult a doctor to make a more accurate diagnosis. The pathology is completely correctable even with simple conservative methods:

Massage.
Therapeutic exercises (with a trainer or using a special video at home).
Electrophoresis.
Wide swaddling of newborns.

2. Subluxation.

The main signs of subluxation are as follows:

Asymmetry of skin folds in the area of the legs and buttocks of a newborn.
Limiting the angle of leg extension.
Different leg lengths or different knee heights when bending the legs.
A characteristic click when spreading the legs to the sides (sliding Marx-Ortolani symptom).
Restlessness of the newborn when moving, loss of sleep and appetite.

Suspicions of subluxation obtained during examination should be confirmed by ultrasound. Ultrasonography provides comprehensive indicators. X-rays are used only when the baby reaches three months of age. In case of subluxation, treatment is usually prescribed with conservative methods: massage, exercises, electrophoresis. Surgical intervention is primarily recommended only in complex cases of dislocation.

If the baby's hip joint is underdeveloped, massage gives a good result.

To reduce subluxation, orthopedic devices are prescribed to infants and older children:

Freyka pillows.
Becker's special pants.
Pavlik stirrups.
Vilensky or Volkov tires.
Coxite bandage.

The action of the listed devices is aimed at fixing a stable position in order to get rid of subluxation, allowing the joint to strengthen and acquire ligaments.

The symptoms of dislocation are similar to the symptoms of subluxation, only more pronounced - asymmetrical skin folds, limited range of motion in the joint, different leg lengths, etc. To treat dislocation, one-step reduction of the hip joint can be used. In most cases, corrective surgical intervention is prescribed, although this is last resort. After successful reduction of the dislocation, the doctor prescribes a course of restorative procedures, including electrophoresis, therapeutic massage and a complex physical exercise which mothers can do on their own (use the advice of experts from the training videos that will allow you to choose the right exercises).

Features of health procedures

Most common medical procedures, which are used in parallel with drug treatment dysplasia in newborns are:

Massage.
Health-improving gymnastics.
Electrophoresis.

While many articles and reviews have been written about the first two procedures, the last procedure is covered rather poorly - let’s look at it in a little more detail.
Electrophoresis is a physiotherapy procedure in which small current pulses are applied to the patient’s skin. Since the current passes through gauze soaked in the medicine, the drug enters the epidermis through the skin, and then, together with the blood, enters the desired area of the body. The procedure is completely safe and therefore suitable even for infants. To treat dysplasia, the electrode plate is applied to the gluteal muscle. The medicine used is aminophylline, dissolved in pure distilled water or dimexide. Electrophoresis normalizes blood circulation in the tissues surrounding the diseased joint, saturates them with nutrients. When treating neonatal dysplasia, a course of 10 electrophoresis procedures will be sufficient.

It is important that immaturity (dysplasia) of the hip joint in newborns is identified at the earliest early stages. The sooner the orthopedist prescribes treatment, the more effective it will be.

After birth, hip dysplasia is common in newborns. Diagnosis of such diseases is quite difficult. Parents will be able to suspect the first signs in children under one year old. This disease is dangerous due to the development of adverse complications that can significantly worsen the baby’s quality of life.

What it is?

This pathology of the musculoskeletal system arises from the influence of numerous causes that lead to disruption of the intrauterine anlage of organs. These factors contribute to underdevelopment of the hip joints, as well as all the articular elements that form the hip joints.

With severe pathology, the articulation between the head of the femur and the acetabulum, which form the joint, is disrupted. Such violations lead to the appearance of unfavorable symptoms of the disease and even complications.

Congenital underdevelopment of the hip joints is quite common. Almost every third of a hundred children born is diagnosed with this disease. It is important to note that susceptibility to this disease is higher in girls, and boys get sick somewhat less frequently.

In European countries dysplasia large joints more common occurrence than in African countries.

Pathology is usually found on the left side; right-sided processes are recorded much less frequently, as are cases of bilateral processes.

Causes

There are several dozen provoking factors that can lead to the development of physiological immaturity of large joints. Most of the impacts that lead to immaturity and disruption of the structure of large joints occur in the first 2 months of pregnancy from the moment the baby is conceived. It is at this time that the intrauterine structure of all elements of the child’s musculoskeletal system takes place.

The most common causes of the disease include:

Genetics. Typically, in families where cases of this disease have occurred, the likelihood of having a baby with pathologies of large joints increases by 40%. At the same time, girls have a higher risk of getting sick.
Exposure to toxic chemicals during pregnancy. This situation is most dangerous in the first trimester, when intrauterine development of the musculoskeletal system occurs.
Unfavorable environmental situation. Harmful factors external environment have a negative effect on the development of the unborn child. Not sufficient quantity incoming oxygen and a high concentration of carbon dioxide can cause intrauterine hypoxia of the fetus and lead to disruption of the structure of the joints.
Future mom over 35 years old.
The baby weighs more than 4 kilograms at birth.
The birth of a baby ahead of schedule.
Breech presentation.

Carrying a large fetus with an initially small uterus. In this case, the baby physically does not have enough space for active movements. This forced passivity during fetal development can lead to limited mobility or congenital dislocations after birth.
Infection with various infections of the expectant mother. During pregnancy, any viruses or bacteria easily pass through the placenta. Such infection in the early stages of a baby’s development can lead to birth defects in the structure of large joints and ligaments.
Poor quality nutrition, lack of vital vitamins, which are necessary for the full development of cartilage and ossification - formation bone tissue.
Excessive and very tight swaddling. Excessive pressing of the child's legs to the body can lead to the development of various types of dysplasia.

Kinds

Various shapes Doctors classify diseases according to several main criteria. For dysplasia, such criteria are combined into two large groups: according to the anatomical level of the lesion and according to the severity of the disease.

According to the anatomical level of the lesion:

Acetabular. There is a violation in the structure of the main large elements that make up the hip joint. Basically, with this option, damage to the limbus and marginal surface occurs. At the same time, the architecture and structure of the joint changes greatly. These injuries lead to disruption of movements that should be performed by the hip joint normally.
Epiphyseal. A pronounced impairment of mobility in the joint is characteristic. In this case, the norm of the angles that are measured to assess the work of large joints is noticeably distorted.
Rotary. With this variant of the disease, a violation may occur anatomical structure in the joints. This is manifested by the deviation of the main structures that form the hip joint from the median plane. Most often, this form is manifested by gait disturbance.

By severity:

Mild degree. Doctors also call this form preluxation. Severe disorders that arise with this option and lead to disability, as a rule, do not occur.
Medium heavy. It may also be called a subluxation. At this option the head of the femur usually extends beyond the articulation during active movements. This form of the disease leads to the development of adverse symptoms and even long-term negative consequences diseases that require more active treatment.
Heavy current. Such a congenital dislocation can lead to adduction contracture. With this form, a pronounced violation and deformation of the hip joint occurs.

Symptoms

Identification of the first symptoms of anatomical defects of large joints is carried out already in the first months after the birth of the baby. The disease can already be suspected in an infant. When the first signs of illness appear, the baby should be shown to an orthopedic doctor. The doctor will conduct all additional examinations that will clarify the diagnosis.

To the most characteristic manifestations and signs of the disease include:

Asymmetry in the location of skin folds. They are usually quite well identified in newborns and infants. Estimate this symptom every mother can. All skin folds should be approximately at the same level. Pronounced asymmetry should alert parents and suggest that the child has signs of dysplasia.
The appearance of a characteristic sound resembling a click, during adduction of the hip joints. This symptom can also be detected with any movements in the joint in which abduction or adduction occurs. This sound occurs due to active movements of the femoral head along the articular surfaces.
Shortening of the lower limbs. It can occur on one side or on both. With a bilateral process, the baby often experiences growth retardation. If the pathology occurs only on one side, then the child may develop lameness and gait disturbance. However, this symptom is detected somewhat less frequently when the baby tries to stand on his feet.
Pain in large joints. This sign intensifies when the child tries to stand on his feet. Increased pain occurs when performing various movements at a faster pace or with a wider amplitude.
Secondary signs of the disease: slight muscle atrophy in the lower extremities, as a compensatory reaction. When trying to determine the pulse in the femoral arteries, a slightly reduced impulse may be observed.

Consequences

Dysplasia is dangerous due to the development of unfavorable complications, which can occur with a long course of the disease, as well as with insufficiently effective and well-chosen treatment of the disease in the initial stages.

With a long course of the disease, persistent gait disturbances may develop. In this case, surgical treatment is required. After such therapy, the baby may limp slightly. However, later this unfavorable symptom completely disappears.

Also, if signs of the disease have been observed for a long time, muscle atrophy may occur in the injured lower limb. On the contrary, the muscles on a healthy leg may be excessively hypertrophied.

Severe shortening also quite often leads to gait disturbances and severe lameness. IN severe cases This situation can even lead to the development of scoliosis and various violations posture. This occurs due to a shift in the supporting function of damaged joints.

Large joint dysplasia can lead to various adverse consequences in adulthood. Quite often, such people have cases of osteochondrosis, flat feet or dysplastic coxarthrosis.

Diagnostics

As a rule, this pathology begins quite mildly. Only a specialist can identify the first symptoms; it is quite difficult for parents to do this on their own at home.

The first step in establishing a diagnosis is a consultation with an orthopedic doctor. Already in the first year of a child’s life, the doctor determines the presence of predisposing factors, as well as primary symptoms of the disease. Usually, the first orthopedic signs of the disease can be recognized during the first six months of a child’s life. To accurately verify the diagnosis, different kinds additional examinations.

The safest and most informative method that can be used in infants is ultrasound. Interpretation of ultrasound allows you to establish various signs characteristic of the disease. This method also helps to establish the transient form of the disease and describe the specific changes that occur in the joint characteristic of this variant. Using ultrasound, you can accurately determine the timing of ossification of the nuclei of the hip joints.

Ultrasound diagnostics is also a highly informative method that clearly describes all anatomical defects observed in various types of dysplasia. This study absolutely safe, and is performed from the very first months after the birth of the baby. There is no significant radiation exposure to the joints during this examination.

X-ray diagnostics is used only in the most complex cases of the disease. X-rays should not be performed on children under one year of age. The study makes it possible to fairly accurately describe various anatomical defects that arose after birth. Such diagnostics are also used in complex clinical cases, in which the exclusion of concomitant diseases is required.

All surgical methods for examining large joints in newborns are not used. During arthroscopy, doctors use instrumental instruments to examine all the elements that make up the hip joint. During such studies, the risk of secondary infection increases several times.

Usually magnetic resonance and computed tomography large joints are carried out before planning various surgical interventions. In difficult cases, orthopedic doctors can prescribe examination data to exclude various diseases which may present with similar symptoms.

Treatment

Diseases of the musculoskeletal system need to be treated for a long time and with strict adherence to the recommendations. Only such therapy makes it possible to eliminate as much as possible all the unfavorable symptoms that arise with this pathology. A complex of orthopedic therapy is prescribed by an orthopedic doctor after examining and examining the baby.

Among the most effective and commonly used treatment methods are the following:

Using wide swaddling. This option allows you to maintain the most comfortable position for the hip joints - they are in a slightly apart state. This type of swaddling can be used even for babies from the first days after birth. Becker's pants are one of the wide swaddling options.
Application of different technical means. The most commonly used are various tires and spacers. They can be of different rigidity and fixation. The selection of such technical means is carried out only on the recommendation of an orthopedic doctor.
Exercise and exercise therapy complex must be performed regularly. Typically, such exercises are recommended to be done daily. The complexes should be performed under the guidance medical personnel clinics, and subsequently – independently.
Massage. It is prescribed from the first days after the birth of the baby. Courses are conducted several times a year. With this massage, the specialist works well on the baby’s legs and back. This method of treatment is well accepted by the child and, when carried out correctly, does not cause any pain.
Gymnastics. A special set of exercises must be performed daily. Abduction and adduction of the legs in a certain sequence allows you to improve movement in the hip joints and reduce the manifestations of stiffness in the joints.
Physiotherapeutic methods of treatment. The baby can undergo ozokerite and electrophoresis. Also, various types are actively used for children. heat treatment and inductotherapy. Physiotherapeutic procedures for the treatment of dysplasia can be performed in a clinic or specialized children's hospitals.

Spa treatment. Helps effectively cope with adverse symptoms that arise from dysplasia. Staying in a sanatorium can significantly affect the course of the disease and even improve the baby’s well-being. For children with hip dysplasia, it is recommended to undergo sanatorium-resort treatment annually.
Adequate nutrition with the obligatory inclusion of all necessary vitamins and microelements. Children with musculoskeletal disorders must eat enough fermented milk products. The calcium they contain has a beneficial effect on the structure of bone tissue and improves growth and physical development child.
Surgical treatment in newborns is usually not performed. Such therapy is possible only in older children. Usually, before reaching 3-5 years of age, doctors try to carry out all the necessary treatment methods that do not require surgery.
The use of painkillers, non-steroidal anti-inflammatory drugs to eliminate pronounced pain syndrome. Such drugs are prescribed mainly for severe variants of the disease. An orthopedic doctor or pediatrician prescribes painkillers after examining the child and identifying contraindications to such medications.
Plaster application. It is used quite rarely. In this case, the affected leg is fixed quite tightly plaster cast. After some time, the cast is usually removed. The use of this method is quite limited and has a number of contraindications.

In order to reduce the risk possible development dysplasia, use the following tips:

Try to choose a looser or wider swaddle if the child has several risk factors for the development of dysplasia of large joints. This method of swaddling can reduce the risk of developing disorders in the hip joints.
Monitoring a healthy pregnancy. Try to limit the impact of various toxic substances on the body of the expectant mother. Severe stress And various infections can cause various intrauterine malformations. The expectant mother must ensure that she protects her body from contact with any sick or feverish acquaintances.
Using special car seats. In this case, the child's legs are in an anatomically correct position throughout the entire trip in the car.
Try to hold your baby correctly. Do not press the baby's legs tightly to the body. An anatomically more advantageous position is considered to be a more abducted position of the hip joints. Also remember this rule while breastfeeding.
Preventive complex gymnastic exercises . Such gymnastics can be performed from the first months after the birth of the child. The combination of exercises and massage significantly improves the prognosis of the disease.
Choose the right diapers. A smaller size can cause a forced adducted state of the child’s legs. Avoid overfilling the diaper and change them often enough.
Get regular check-ups with an orthopedic surgeon. Every baby must attend such consultations before the age of six months. The doctor will be able to identify the first signs of the disease and prescribe the appropriate treatment package.

With high-quality treatment, most negative manifestations of dysplasia can be eliminated almost completely. Medical supervision of a child diagnosed with dysplasia should be carried out over a long period of time. Such babies undergo regular examinations by a neurologist and orthopedist. Controlling the course of the disease helps prevent the development of dangerous and unfavorable complications.

To learn about what hip dysplasia is, how it is treated and at what age it is best to start treatment, watch the following video.