Congenital hip dislocation in children. Wide swaddling of the baby. Hip dysplasia in newborns

Diseases of the musculoskeletal system, which can lead to permanent gait disturbances, are often found in children of all ages. It is better to treat such pathologies as early as possible, before serious complications arise. Hip dysplasia in children is also quite common in children.

What it is?

Developing this disease due to the influence of various provoking causes that lead to adverse effects on the joints. As a result congenital disorders structure, the hip joints cease to perform all the basic functions that are imposed on them by nature. All this leads to the appearance and development of specific symptoms of the disease.

This pathology occurs more often in babies. In boys, dysplasia is recorded much less frequently. Usually every third out of a hundred babies born orthopedists find this disease. There are also geographic differences in the incidence of hip dysplasia in babies born in different countries.

For example, in Africa there are much fewer cases of this disease. This can easily be explained by the way babies are carried on their backs, when their legs are spread wide apart different sides.

Causes

The development of the disease can lead to various factors. Large joints, including the hip, begin to form and form in utero. If certain disturbances occur during pregnancy, this leads to the development of anatomical abnormalities in the structure of the musculoskeletal system.

To the most common reasons leading to dysplasia include:

Genetic predisposition. In families in which close relatives have manifestations of the disease, there is a higher likelihood of having a child with this disease. It is more than 30%.

Violation of the formation of the baby’s joints during pregnancy as a result of an unfavorable environmental situation or exposure to toxic substances on the body expectant mother.
High hormone levels during pregnancy. Oxytocin, which is produced in the body of the expectant mother, causes improved mobility ligamentous apparatus. This property is necessary before childbirth. Oxytocin also improves the mobility of all joints, including further provoking an excessive range of motion. The hip joints are most susceptible to this effect.
Tight swaddling. Excessive tightening of the legs during this daily procedure leads to the formation of dysplasia. Changing the type of swaddling leads to improved joint functioning and prevents the development of the disease. This is also confirmed by numerous studies conducted in Japan.
Birth of a child over 35 years of age.
The baby's weight at birth is more than 4 kilograms.
Prematurity.
Breech presentation.
Close placement of the fetus. This usually occurs when the uterus is narrow or small. If the fetus is large, then it can fit quite tightly to the walls of the uterus and practically not move.

Development options

Doctors identify several various options of this disease. Various classifications allow the diagnosis to be made most accurately. It indicates the type of disease and severity.

Variants of dysplasia according to the violation of the anatomical structure:

Acetabular. The defect is located in the area of the limbus cartilage or along the periphery. Excessive intra-articular pressure leads to impaired mobility.
Epiphyseal (Mayer's disease). With this form, strong compaction and point ossification of the cartilage occurs. This leads to severe stiffness, progression pain syndrome, and may also cause deformation.
Rotary. There is a violation of the anatomical arrangement of the elements forming the joint in several planes relative to each other. Some doctors classify this form as a borderline condition, and do not consider it an independent pathology.

By severity:

Easy. Also called preluxation. Small deviations are formed, in which a violation of the architecture in the structure of the largest joints is observed child's body. Violations of active movements appear slightly.
Average. Or subluxation. With this option, the acetabulum is somewhat flattened. Movements are significantly impaired, and characteristic symptoms of shortening and gait disturbance are observed.
Heavy current. Also called a dislocation. This form of the disease leads to numerous deviations in movement.

Symptoms

In the early stages, it is quite difficult to determine the disease. Usually, the main clinical signs of the disease become possible to identify after a year from the birth of the baby. In infants, the symptoms of dysplasia are easily determined only if the disease is quite severe or after consultation with an experienced orthopedist.

The most basic manifestations of the disease include:

Audible “click” when hip joints are extended while simultaneously bending the baby's knee joints. In this case, a slight crunch appears when the head enters femur into the joint. When moving backwards, a click is heard.
Abduction disorders. In this case, incomplete separation occurs in the hip joints. At average severe course or dislocation, severe movement impairment may occur. Even if the angle of separation is less than 65%, this may also indicate the presence of persistent pathology

Asymmetrical position of skin folds. Based on this sign, one can often suspect the presence of the disease even in newborns. When examining skin folds, you should also pay attention to their depth and level, where and how they are located.
Shortening lower limbs on one or both sides.
Excessive rotation of the foot on the injured side from the outside. So, if the left hip joint the foot on the left side turns strongly.

Gait disturbance. The child, sparing the damaged leg, begins to tiptoe or limp. Most often this sign is recorded in children aged 2 years. If a child has a complete dislocation, then his movements become more elaborate.
Pain syndrome. It usually develops in children with a fairly severe course of the disease. Prolonged course of the disease leads to progression of pain syndrome. Pain relief usually requires medication.

Muscle atrophy on the affected leg. This symptom can occur in severe cases of the disease, as well as in long-term development of the disease. Usually the muscles on the other leg are more developed. This occurs in connection with a compensatory reaction. Usually there is increased pressure on the healthy leg.

Diagnostics

In order to establish a diagnosis of dysplasia on early stages, often requires additional examination. Already in the first six months after the birth of a child, he must be consulted by a pediatric orthopedist. The doctor will be able to identify the first symptoms of the disease, which are often nonspecific.

The most common examination method is ultrasonography. This diagnostic method allows you to accurately determine all the anatomical defects that occur with dysplasia. This study is highly accurate and quite informative. It can be used even in the youngest children.

It is also quite successfully used to establish dysplasia. X-ray diagnostics. However, the use of x-rays in early childhood not shown. Such a study in infants is dangerous and can cause adverse consequences.

The use of X-ray diagnostics can be quite informative in babies who will be able to lie quietly for some time without much movement. This is needed for correct settings apparatus and accurate examination.

When establishing a diagnosis and carrying out all previous examinations, in some cases additional computed tomography or magnetic resonance imaging is required. Often these studies are resorted to before performing surgical operations. Such methods make it possible to describe as accurately as possible all the structural and anatomical abnormalities of the joints that the child has. Such examinations are very accurate, but very expensive. Instrumental studies joints are not widely used.

Arthroscopy- This is an examination of the joint cavity using special devices. It is not widely used in our country. This study is quite traumatic. If arthroscopy tactics are violated, a secondary infection may enter the joint cavity and severe inflammation may begin. The presence of such a risk has led to the fact that such studies are practically not used in pediatric practice to diagnose dysplasia.

With timely identification of specific symptoms of the disease and carrying out accurate diagnosis you can start treatment on time. However, with a severe course of the disease or with a late diagnosis, the development of dysplasia can lead to the appearance of various unfavorable abnormalities.

Consequences

A fairly common unpleasant result of the long-term development of the disease and poor treatment is gait disturbance. Usually babies begin to limp. The degree of lameness depends on baseline damage to the hip joints.

In case of complete dislocation and untimely treatment medical care the child subsequently limps heavily and practically does not step on the damaged leg. Walking causes increased pain in the baby.

In children aged 3-4 years, pronounced shortening of the lower extremities may be observed. With a bilateral process, this symptom can manifest itself only in a slight growth retardation.

If only one joint is affected, shortening can also lead to gait disturbance and lameness. The babies begin not only to limp, but also to jump a little. By doing this they try to compensate for the inability to walk correctly.

This pathology of the musculoskeletal system can cause the establishment of a disability group. The decision to issue such a conclusion is made by a whole commission of doctors. Doctors assess the severity of the violations, take into account the nature of the damage, and only then make a conclusion on establishing a group. Usually with dysplasia medium degree severity and the presence of persistent complications of the disease, the third group is established. With a more severe course of the disease - the second.

Treatment

All healing procedures, which can help prevent the progression of the disease, are prescribed to the baby as early as possible. Usually, already at the first visit to an orthopedist, the doctor may suspect the presence of dysplasia. Appointments medicines is not required for all variants of the disease.

All therapeutic measures can be divided into several groups. Currently there are more than 50 various methods, which are officially used in medicine for the treatment of dysplasia in children in at different ages. The choice of a specific scheme remains with the orthopedist. Only after a full examination of the child can you draw up an accurate treatment plan for the baby.

All methods of treating dysplasia can be divided into several groups:

Looser swaddling. This option is usually called wide. With this swaddling, the baby's legs are in a slightly spread state. A broad method allows you to eliminate the first unfavorable symptoms of the disease and prevent its progression. Becker's pants are one of the options for such swaddling.
Use of various technical means. These include a variety of tires, pillows, stirrups and many others. Such products allow you to securely fix the baby’s legs apart.
The use of spreading tires when walking. They allow you to maintain the correct angle of abduction in the hip joints and are used only as prescribed by the attending physician. Volkov or Vilensky splints are usually used.
Carrying out a surgical operation. It is used quite rarely. Usually in complex cases of illness, when other methods have proven ineffective. Such orthopedic operations are performed in children older than one year, as well as in cases of frequent relapses of the disease and no effect from previous treatment.
Massage. Usually, almost all children like this treatment. Even newborns perceive massage not as therapy, but as real pleasure. It is carried out by a specialist who has not only specialized education in baby massage, but also has sufficient clinical experience in working with children diagnosed with dysplasia. During the massage, the hip joint area, as well as the neck and back, are actively worked out.

Physical therapy exercises. Have pronounced effect at initial stages diseases. Doctors recommend performing such exercises 2-3 times a week, and in some forms of the disease - daily. Typically the duration of classes is 15-20 minutes. The exercises can be carried out by the mother or nurse in the clinic. They should not be performed immediately after meals or before bedtime.
Electrophoresis on the hip joint area. Allows you to reduce the severity of pain, improves blood supply to the cartilage that forms the joint. Electrophoresis is prescribed as a course. Usually 2-3 courses are used throughout the year. The effect of treatment is assessed by an orthopedic surgeon.

Gymnastics with newborns. Typically, this method is used to identify minor deviations in the functioning of the hip joints. It helps prevent the development of dysplasia and can be used not only in medicinal purposes, but also as a preventive measure.
Carrying out physiotherapeutic treatment. To improve blood supply and improve innervation of articular cartilage, you can use different kinds thermo - and inductotherapy. Such methods are prescribed by a physiotherapist and have a number of contraindications. They are usually used for mild and moderately severe cases of the disease. Also quite successful after the surgical treatment to eliminate adverse symptoms that arose during the operation.
Mud therapy. This method is widely used not only in sanatoriums and health centers, but can also be performed in the physiotherapy room of a children's clinic. Biologically active ingredients the mud that is part of it has a healing and warming effect on the joints, which leads to a decrease in the manifestation of adverse symptoms of the disease.

Prevention

In order to reduce the likelihood of developing dysplasia in babies, parents should pay attention to the following tips:

Do not try to swaddle your baby tightly.

Choose a wide swaddle. This method is mandatory if the baby has the first signs of dysplasia.

Hold your baby correctly. When the child is incorrectly positioned in the arms of adults, the baby's legs often end up being pressed tightly against the body. This position can cause dysplasia or other pathologies of the hip and knee joints. Pay attention to the comfortable position of the baby during breastfeeding.

Choose special child seats for transporting your baby in the car. Modern devices allow you to maintain functional and correct position children's feet while in the car during the entire trip.

Don't forget to visit an orthopedic doctor. An orthopedic consultation is included in mandatory list necessary research in infants of the first year of life.
Every mother can experience hip dysplasia. Treatment of this disease is quite labor-intensive and will require enormous concentration of effort and attention of parents. Prevent development serious complications This is only possible if all recommendations are followed daily.
At timely diagnosis and prescribing treatment practically does not occur in children negative consequences, and they lead a fairly active lifestyle.

You can learn more about dysplasia in children in the following video:

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Hip dysplasia is a congenital defect of the joint that occurs as a result of abnormal development and leads to dislocation or subluxation of the femoral head.

Distinguish 3 forms of dysplasia: subluxation, preluxation and dislocation.

Stages of the disease

Pre-luxation- immaturity of an unstable joint, which may subsequently develop normally or precede subluxation. In this case, the capsule is stretched, as a result of which the head is dislocated and pushed into the cavity.

Subluxation- a morphological change in the joint, accompanied by a displacement of the femoral head relative to the socket in the upward direction to the side. In this case, the contact of the head with the socket is maintained and it does not extend beyond the boundaries of the limbus. With proper treatment, the joint can return to its full state, otherwise there is a risk of complete dislocation.

Dislocation characterized by complete displacement of the femoral head and is the most severe form of joint dysplasia. When it occurs, there is a violation of the contact of the articular surfaces of the bones with and without a violation of the articular capsule due to mechanical impact or pathological processes in the joint. Dislocations can be complete or incomplete. The part of the limb farthest from the body is dislocated.

Classification of subluxations

Congenital dislocation is the most severe form of the disease and is characterized by complete displacement of the femoral head. This stage of dysplasia is detected at the time of birth of the child, and develops as a result of incorrect treatment or lack of treatment at all. The cause of the disease is heredity, pathological condition during pregnancy or clinical signs of joint instability.

Acquired subluxation develops as a result of swaddling children, using restrictive child seats or cribs that lock the hip joint for a long time.

The cause of the pathology is also a genetic factor or a narrow uterus, which contributes to displacement of the joint during intrauterine development.

Symptoms of pathology

Symptoms of hip subluxation can be suspected even before the baby is born. Breech presentation, toxicosis during pregnancy, dysplasia in parents, foot deformity or large fruit should be wary in terms of possible illness. Even if there are no orthopedic symptoms, children are still classified as risk group.

Highlight 4 groups clinical features joint subluxation:

shortened thigh;
asymmetry of skin folds;
Marx-Ortolani slip symptom and Barlow modification;
limited hip abduction.

During inspection, pay attention to such details as symmetry of skin folds. Moreover, asymmetry is more informative 2-3 months after birth. The gluteal, inguinal and popliteal folds are deeper and their number is greater.

The phenomenon of femoral shortening- an important diagnostic criterion, characterized by shortening of the femur due to posterior displacement of the femoral head in the area of the acetabulum. It indicates congenital subluxation of the hip joint and is confirmed by the fact that if a child is lying on his back in a position with the knees bent and the hip joints, one knee is lower than the other.

Marx-Ortolani sign— it can be used to detect subluxation only for up to 3 months, after which it disappears. It is determined as follows: the baby’s legs are bent at the knee and hip joint at a right angle, then brought to midline and carefully move to the side. From the side of the dislocation, you can hear something like a click, when the child’s leg shudders.

Diagnosis of the disease

The diagnosis of “subluxation of the hip joint” is made primarily on the basis of existing clinical symptoms, as well as the results ultrasound examination and x-ray.

Newborn screening examination- Most countries use it to diagnose hip subluxation in newborns.
Another way to find out about the disease is Marx-Ortolani method. If during the examination a click or dull sound is heard in the hip area, carry out additional methods, allowing you to clarify the diagnosis and what caused the disease.
Ortolani and Barlow methods— diagnostic methods for newborns used in modern medicine.
Ultrasound and X-ray examination- secondary after clinical signs diagnostic methods. With their help, you can visualize anatomical features.
Asymmetrical gluteal folds and obvious lower limb length differences may indicate unilateral dysplasia.
Harris hip score- one of the main ways to evaluate normal work and joint function after surgery.

An orthopedic doctor should suspect and diagnose the disease in a timely manner when examining a newborn child while still in maternity hospital. After which the risk group or sick children are observed by an orthopedist at their place of residence. Assign special orthopedic treatment which continues until a final diagnosis is made.

Final diagnosis placed on the basis of visual inspection, results instrumental methods diagnostics and constant monitoring of the child.

Methods and devices used to treat the disease

The basic principles of treatment include the following: standard methods:

early onset;
the use of special orthopedic devices for prolonged retention of the legs in the position of flexion and abduction;
exercises and movements in the hip joints.

The disease cannot be neglected, since subluxation of the hip joint in adults is practically untreatable due to the established position of the bones of the joint relative to each other.

In the treatment of hip subluxation in children with or without displacement of the femoral head, various types of pillows, splints, panties, stirrups and other apparatus. Their goal is to keep the legs in the spread position, providing them with the function.

In infants under 3 months, clinical symptoms are sufficient to confirm the diagnosis; X-ray examination is not required. All children of this age are prescribed the same treatment and preventive measures - spreading legs using pads(wide swaddling, Pavlik stirrups, elastic splints or Frejk pillow), as well as gymnastics- abductor-circular movements in the joint and massage of the gluteal muscles.

IN at a young age It is unacceptable to use rigid structures - splints that impede the movement of the limbs.

Mainly for the treatment of congenital hip subluxation apply:

Freyk's pillow;
Volkov or Vilensky tires;
Pavlik stirrups;
wide swaddling - used for prevention purposes and for mild degrees of subluxation;
immediate reduction of the dislocation and a coxite bandage - used in especially severe cases.

The attending physician should determine how exactly to treat subluxation of the hip joint and what structures to install for the child.

When is surgery scheduled?

If positive effect from treatment conservative ways no, corrective operations are used. Used to treat joint dysplasia many surgical techniques:

reduction of dislocation is open;
derotational and corrective varus osteotomies;
surgery on the pelvic component - the method of pelvic osteotomy according to Chiari;
palliative operations (König and Shants).

Conservative treatment methods are effective in childhood. The older a person is, the more likely it is that surgical intervention will help get rid of the disease.

Possible complications

Early diagnosis and correctly prescribed treatment will help to avoid complications and you can completely get rid of the disease. Some people, other than an external defect and lameness, do not experience any symptoms or signs of the disease.

In others, on the contrary, without timely therapy can be serious consequences . In addition to limping, pain may be felt in the knee and hip joints, misalignment of the pelvic bones or severe atrophy of the muscles of the limb may occur. In rare cases it suffers lumbar region spine (hyperlordosis), decreased function pelvic organs, lower back and pelvic bones hurt.

Preventive measures

To avoid the onset of disease or its further development, regular examination by an orthopedist is necessary. Wide swaddling is one of the effective preventive methods subluxation of the hip joint in a newborn.

Its essence is to place two diapers between the baby’s legs and give the position of flexion or abduction of the legs at the hip joints, and use the third diaper to secure the legs. Wide swaddling maintains a flexion and extension position of 60-80 degrees.

Video: What does hip subluxation look like on x-ray?

How to do it right provide first aid for sprains how to eliminate congenital hip dislocation in a child and what treatment effective for traumatic hip dislocation in children? In this material, we will consider in detail all the issues related to congenital hip dislocation and tell you how to properly provide first aid if, after an injury, a child experiences symptoms of a traumatic hip dislocation.
Congenital hip dislocation called a developmental defect of the fetal hip joint. This is a fairly common pathology in newborns. 84% of patients are girls. Congenital hip dislocation occurs due to inadequate development of each element of the hip joint in the womb. The head of the femur does not correspond to the parameters of the acetabulum and is not fully fixed in it.

A simple and effective way to prevent and treat the disease is to swaddle the baby widely. Thus, it is necessary to swaddle the baby already in the maternity hospital, regardless of whether the baby has a dislocated hip or not. Parents should swaddle a child under 3 months of age only using this method at home.

Methods for eliminating congenital hip dislocation differ depending on the age of the child - the earlier treatment of the pathology begins, the faster problem will be resolved and you will not have to have surgery.
To correct a hip defect, a child under 12 weeks of age needs diverting pads, which eliminate the dislocation within a few months. Sometimes pads are not enough, the orthopedist prescribes wearing Pavlik stirrups and other similar devices. Treatment is carried out under the supervision of a doctor.

When congenital dislocation the hip was identified at 3 months, the baby will have to wear plaster cast(functional). The dislocation is corrected with a bandage from 5 to 26 weeks. If it is ineffective, the patient has the dislocation reduced under anesthesia. The procedure is safe and very effective.

Traumatic hip dislocation in children is rarely diagnosed. Every 20 dislocations from injuries occur in the hip joint.

Hip dislocations are divided into posterior and anterior. The first case is much more common. The reason is a sharp bend or inward direction of the hip. Anterior (indirect) hip dislocation is a rare occurrence. This rotation of the joint occurs when a child falls from a great height onto the leg that was abducted. The articular head of the femur moves lower and the capsule ruptures.

Posterior hip dislocation caused by a bent leg, the knee is directed to the inside. With extreme flexion, the likelihood of sciatic dislocation increases. If the child's leg is slightly bent, an iliac dislocation is more likely.

Anterior hip dislocation is caused by the bending of the leg at the hip and knee, which is directed outward. The leg turns out to be motionless; if you try to move with force, resistance is felt in the joint, which “springs” due to the compression of the muscles.

Treatment of hip dislocation- returning the bone to its natural position. There are many muscles around the joint, the patient feels severe pain. Before reduction is carried out complete anesthesia, muscle relaxants are used.

Unfortunately congenital hip dislocation in children V Lately is becoming more common. This pathology develops in utero. Insufficient development of hip joint elements in newborns contribute to the mother’s unhealthy lifestyle during pregnancy, not entirely quality food, and genetic predisposition. It is important to diagnose the pathology as early as possible and begin treatment for congenital hip dislocation from the very birth of the child.
Below we will tell you in more detail about the symptoms and treatment methods of congenital hip dislocation, as well as posterior and anterior dislocations resulting from injury. You will learn how to provide first aid for hip dislocations and what treatment for a dislocation the doctor prescribes during hospitalization.

Now you know what symptoms of congenital hip dislocation appear in a child and how to recognize them correctly. The sooner start treatment congenital dislocation ,those faster baby get rid of hip pathology.
You also learned how to treat a hip dislocation that occurred in a child during an injury and before hospitalization.

Next article.

A hip dislocation is a disorder in which the head of the femur protrudes from its attachment to the pelvis - the acetabulum. Pathology accounts for 5% of total number all dislocations in adults. In children, such damage is more common.

Types of hip dislocations

Depending on the nature of origin, dislocations are distinguished:

Traumatic - a consequence of strong mechanical impact on the tissue of the thigh.
Pathological - occur due to tissue destruction due to inflammatory processes.
Congenital - diagnosed in infancy. The main reason is a violation of the intrauterine development of the musculoskeletal system.

Depending on the location, dislocations are:

Front. Characteristic: rupture of the joint capsule and displacement of the head of the bone forward (it can be felt in the groin area). The affected limb is bent at the knee and everted. The patient feels severe pain and cannot move his leg. Sometimes there is numbness in the lower leg and foot.
Rear. The head of the femur pops out of the joint and moves backward. This type of injury is common among car accident victims. Main symptoms: strong pain and swelling in the hip area, its deformation, shortening of the injured leg.
Central. The most complex ones are combined with a bone fracture. The victim experiences severe pain, numbness and stiffness in the leg.

Hip dislocation in children

This deviation in children is usually a consequence congenital pathology. One in 7,000 newborns is diagnosed with hip dislocation. Dysplasia, an extreme form of manifestation of this disease, is important in the development of pathology. There are three degrees of dysplasia:

I degree - the hip joint is underdeveloped, but the spatial relationship of its parts is completely preserved.
II degree - subluxation: the constituent parts of the hip are underdeveloped and slightly displaced in relation to each other.
III degree - the joint is not only not formed, but the head of the femur is completely displaced in relation to the socket of the joint.

Diagnosis is made using x-ray or ultrasound. A pediatric orthopedist deals with the treatment of dislocation and dysplasia.

In making a diagnosis, it is important to have characteristic symptoms diseases:

Limited limb abduction. The child is placed on his back, legs bent at the knees and spread apart as far as possible. Normally, the legs are symmetrically separated and an angle of 160–180 degrees is formed between them. In the presence of pathology, this angle is significantly smaller. With a unilateral lesion, the healthy limb will be retracted further than the affected one.
"Click" symptom. It is determined only in children in the first 3 months of life. The legs of a child lying on his back, bent at the knees, are spread in different directions. If there is dysplasia on the side of the affected leg, a click will be heard. At this moment, the leg itself may tremble slightly.
Asymmetry of the limbs. To determine it, the child’s legs, lying on his back, are bent at both joints, brought together and brought to the stomach. If there is pathology, one knee will be located higher than the other.

Additional symptoms: asymmetry of skin folds in the thigh area, a “duck” gait and insufficiency of the buttock muscles.

There are two types of treatment for congenital dislocation:

Conservative - involves applying a special splint that fixes the joint in its physiological position. The effectiveness of this type of treatment decreases significantly with age. Therefore, it is not suitable for children over one year old.
Surgical treatment - more effective method treatment, especially in the case of chronic dislocations in children older than 3 months. The type of operation depends on what specific defect caused the damage. During the operation, the surgeon reduces the dislocation and eliminates its cause. Joint replacement may also be used.

Additionally, physiotherapy is used, physiotherapy and massage.

Due to the immaturity of the protective apparatus of the joint in children over one year of age, dislocation can occur even due to minor trauma.

Hip dislocation in adults

Hip dislocation is most common in older people, victims car accident or falling from a height.

In all cases, the main diagnostic method is X-ray examination. In particularly severe situations, CT or MRI are used.

Treatment for hip dislocations involves surgical intervention. Under general anesthesia A two-stage operation is performed: the hip joint is reduced and fixed with a splint.

In case of fragmentation of the joint or prolonged inflammation of its tissues, it is replaced with an endoprosthesis. The peculiarity of surgical treatment is its long duration postoperative period. To restore the patient after such an operation, various physiotherapeutic procedures, massage, exercise therapy and medications (anti-inflammatory drugs, antibiotics and vitamins) are used.

Important condition effective treatment- complete and unquestioning implementation of medical recommendations.

In 4% of patients, after installation of a prosthesis, a complication such as dislocation of the hip joint endoprosthesis occurs. The following categories of people are most likely to experience complications:

elderly;
tall;
who have an incorrectly installed prosthesis;
low quality prosthesis;
when a dislocation is combined with a fracture of the femur.

Treatment involves reduction of the dislocation under anesthesia. Performed open or in a closed way. The closed, less traumatic method is predominantly used.

Lack of treatment or failure to follow all medical recommendations can lead to severe complications: disability and even amputation of a limb (with the development of necrosis). Therefore, if these symptoms occur, you should consult a doctor as soon as possible.

Hip dysplasia is one of the most common diagnoses that young parents have to face today. Evidence of this is the concerned questions of mothers on our http://nnmama.ru/forum/.

“Dysplasia was discovered in us at 1 month, they did an X-ray and immediately sent us to the Scientific Research Institute of Traumatology and Orthopedics to see Troitsky. The splint was placed at 2 months and removed at 5.5. Electrophoresis was done twice. Once when the tires were standing, the second time after removal. Until now (the child is now 1.3 months old) we go to Troitsky once every six months. “We’ve never had a massage,” mom Yulia.

“We were diagnosed with hip dysplasia one year, when the child was almost ready to go, and most babies are diagnosed with hip dysplasia at 3 - at the latest 5-6 months. We were treated, wore a Vilensky splint, had massages, but we only did physical therapy once - it was a long drive to the hospital. Now we are almost two, we will soon go to the State Institute of Orthopedics for an examination, but I’m scared - what if nothing has changed, after all, in children, after a year, dysplasia is more difficult to correct.” mom Oksana

“We were diagnosed with dysplasia at 3 months, put on a Vilensky splint, and were in bed for 2 months. They did X-rays 3 times, the last one showed that everything was almost normal. 4 courses of massage, the same amount of electrophoresis, gymnastics and no attempts to teach him to walk. They crawled for a long time, they are a year old,” - Julchik’s mother.

Hip dysplasia: what is it?

Hip joint- most large joint in the human body, its function is decisive for the formation of a person’s gait and quality of life. Dysplasia (underdevelopment) of the hip joints is congenital disease and occurs very often - from 5 to 20% of births. In girls, dysplasia is 4-7 times more common than in boys. Congenital hip dislocation– this is an extreme degree of dysplasia, when between the underdeveloped components of the joint ( glenoid cavity and head of the femur) are violated correct ratios. Congenital hip dislocation is 10 times more common in children born in the breech position. Among close relatives, dysplasia and congenital hip dislocation are 3-4 times more common.

External signs The newborn child does not have dysplasia. But! Dear mothers!

When dysplasia is diagnosed in the first days of a child’s life and carried out correct treatment– more than 90% of children become practically healthy by the end of the first 1.5 years of life. If the diagnosis is made after 6 months, treatment of dysplasia extends to 5 years or until the end of the growth period, possibly severe surgical treatment and the results are much worse. Well, then, when dysplasia is diagnosed after the child has already walked independently and the parents have noticed a gait disturbance, count on full recovery no longer necessary. Now you, dear parents, can imagine what responsibility you and your pediatrician have to your child.

No specific causes for the occurrence of hip dysplasia have been identified, therefore, for normal development fetus, a pregnant woman should, if possible, exclude all harmful substances and take multivitamins in combination with minerals, calcium-phosphorus drugs and eat right.

What should a young mother pay attention to?

Most early sign dysplasia- limitation of passive abduction of the hip on the affected side - normally, abduction of the hips with the knee and hip joints bent at an angle of 90º will be almost complete (to the level of the horizontal table for a child lying on his back). As the disease progresses, the limitation of abduction increases over time, and a vicious position of the lower limb is formed - external rotation in combination with tight mobility of the hip joint and shortening of the leg. This symptom is most likely characteristic of congenital hip dislocation. Asymmetry of skin folds on a child’s hips is not always a reliable sign of dysplasia. These symptoms may appear together or separately. If in doubt, you should immediately consult a doctor. But in our time such a situation should not arise. According to existing standards, a child must be examined by an orthopedist in the maternity hospital at the age of 1 month, 3 months, if indicated at 6 months, and certainly by 1 year.

Methods for diagnosing dysplasia

Currently, the most objective and informative and, importantly, harmless method for diagnosing dysplasia is ultrasound examination of the hip joints (in children in the first 4–6 months of life). The procedure is painless and does not require anesthesia. In this case, the degree of dysplasia is revealed, which is decisive in the choice of one or another treatment method. For older children age group(from 6 months) X-ray examination is necessary. The image not only confirms the diagnosis, but also allows you to more accurately judge the degree of dysplasia and the prognosis of treatment, as it gives an idea of possible changes occurred in the head, neck, cavity and its roof, which also affects the choice of treatment method. This diagnostic method is basic and mandatory.

Treatment methods and measures to prevent dysplasia

THE MOST IMPORTANT RULE FOR TREATING DYSPLASIA IS THE EARLIEST POSSIBLE APPLICATION OF A FUNCTIONAL TREATMENT METHOD WHICH WILL HELP COMPLETELY RESTORING THE ANATOMICAL SHAPE OF THE HIP JOINT AND PRESERVING ITS MOBILITY

Recovery anatomical shape joint development (i.e. its maturation) is facilitated by three main factors.

Avoid vertical loads on your legs until your orthopedist gives permission!
As many rotational movements as possible in the hip joints in the position of spreading the legs.
Constant position of the legs in a position of moderate separation.

I would like to advise all parents to use only wide (loose) swaddling of the child from the first days of life, regardless of whether he has signs of hip dysplasia or not, since abduction of the hips with this type of swaddling helps to center the heads in the acetabulum and is a preventive measure congenital hip dislocation. And swaddling children using the “log” type should be left in the last century. For wide swaddling, between the baby’s legs, bent at the knee and hip joints ~90º and with the hips abducted ~60-80º, place a multi-layer starched diaper, wide to the popliteal areas, gripping the pelvis in front and behind (like a diaper). Subsequently, special splints are used in certain positions of the lower extremities or, in children under 3 months, various soft devices that create the necessary correct positioning of the patient. When treating severe dysplasia, various types of splints are used in the Lorenz I position (the position of bending the legs at right angles in the hip and knee joints and full abduction of the hips to the plane of the bed), for example, the CITO splint and special Vilensky abduction splints. The child is in the splint throughout the entire day for 3 months. X-rays are then taken and, if a deeper acetabulum is formed, the splint is removed. In rare cases, treatment on a splint lasts up to 6 months. The treatment period for the mildest dysplasia on the Vilensky strut is 3 months. Methods of treatment and timing of immobilization are determined only by an orthopedic surgeon. It is very correct if your child is observed and treated by one experienced pediatric orthopedist throughout the entire required period. Very important point treatment is massage and therapeutic exercises. Even healthy children should receive a restorative massage once every 3 months, and children with orthopedic pathologies should receive massage from specialists. All of the above activities can be carried out at home. But besides this, physiotherapy is necessary (ozokerite, electrophoresis with Ca ++, mud therapy, amplipulse), massotherapy. Exercise therapy includes rotational movements along the axis of the thigh with a slight effort of bending the knee and hip joints of the legs; bending the child’s legs at the hip and knee joints towards the stomach with abduction of the hips to a horizontal position, then to the reverse position and straightening them. The exercise should be performed 5-6 times a day before feeding the baby 15-20 times in 1 session for 3-4 months.

So! If you are faced with the problem of dysplasia, but your child was examined in a timely manner by an experienced pediatric orthopedist, and you conscientiously follow all his recommendations, I am sure that your joint efforts will be crowned with success, you will grow up healthy child, grateful to you and your doctor.