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Hip dysplasia in an infant, photo. Hip dysplasia in infants

A diagnosis such as dysplasia hip joints in infants, often given to newborn children. Although diagnosing the pathology is often difficult, initial symptoms can be detected already in the 1st year of a child’s life. If therapy is not started in a timely manner, the disease may be accompanied by negative consequences that worsen the quality of life.

This pathology of the musculoskeletal system develops as a result of the influence on the body of one of the many factors that cause disruption of the intrauterine anlage of organs. These factors cause underdevelopment of the hip joints and all their elements that form the joints.

Severe pathology occurs with a violation of the articulation between the acetabulum and the head of the femur. Disorders of the musculoskeletal system cause clinical manifestations that are unpleasant for the child, including pain and complications if it is not treated in a timely manner. Congenital underdevelopment is often diagnosed: 3 out of 100 newborns have this pathology. Girls are more susceptible to the disease than boys.

In addition, underdevelopment most often affects the left side, while the right side undergoes changes less often. Bilateral pathology is also rare.

Causes and factors contributing to the development of pathology

What is hip dysplasia and what are the causes of the pathology? An incorrectly formed hip joint is a consequence of impaired fetal development during the intrauterine period, the formation of the musculoskeletal system starting from the 4-5th week of its stay in this environment.


Dysplasia causes the femoral head and acetabulum to misalign

Sources that can negatively affect the fetus include:

  • gene mutations, which contribute to the development of orthopedic abnormalities with disruption of the primary anlage and the formation of a defect in the hip region of the embryo;
  • negative physical and chemical agents that affect the fetus: ionization, chemicals, poisons, drugs that are abused by a woman during pregnancy;
  • breech presentation of the fetus or large size of the fetus, which can cause displacement of the joints due to a violation of the anatomical localization of the fetus in the uterine environment;
  • impaired water-salt metabolism in the fetus with the development of intrauterine infection or renal pathology.
Premature babies are at risk for developing hip dysplasia

Among the factors that apply to a pregnant woman are:

  • development of a severe somatic illness in a pregnant woman: cardiac dysfunction, vascular pathology, severe renal or hepatic pathology, heart defect;
  • development of vitamin deficiency, anemia;
  • disrupted metabolic processes in a woman’s body;
  • development of severe infectious and viral disease;
  • maintaining an unhealthy lifestyle (abuse of smoking or drugs, alcohol), failure to maintain proper nutrition;
  • early or late toxicosis.

There is a risk group for the development of such a pathological condition, taking into account which a doctor can promptly identify hip dysplasia in children under one year of age. This group includes premature babies, large children, as well as children who were in the breech position in the womb. They take into account how complicated the anamnesis is and how the pregnancy proceeded.

Please note: if the child has too weak muscle tone, this may indicate. This disease manifests itself in the inability of muscles to function normally.

Symptoms and severity

The first examination is carried out within the walls of the maternity hospital, immediately after birth.. If dysplasia was diagnosed during this period, it will be easier to cope with underdevelopment of the femoral area. Sometimes symptoms of hip dysplasia in children can be noticed already at home, after discharge from the hospital (read about). Parents should be alert to the following manifestations:

  • asymmetrical folds (gluteal, inguinal, femoral): if you put the baby on a flat surface, for example, on a changing table, and legs at the knees, all the inguinal, femoral and buttock folds will not be at the same level;
  • different amplitude: if you put the baby on his back, bend his knees, and then straighten them to the sides, the knees will not touch the surface or will have a different angle of inclination.

All symptoms of a condition such as hip dysplasia in infants can be classified according to severity:

  • 1st degree (pre-dislocation): the femoral part is underdeveloped, but there is no displacement of the femoral head;
  • 2nd degree (subluxation): the head of the hip bone is partially displaced;
  • 3rd degree (dislocation): the head is completely displaced.
According to the severity of the pathology, preluxation, subluxation and dislocation are distinguished

Go to to find out whether a hematoma on the head of a newborn is dangerous and how to determine its presence.

Types of dysplasia

Pathology can be unilateral or bilateral. Last view rarely diagnosed. Also in medical practice, there is a division of pathology into the following types:

  • acetabular displacement: non-standard size of the acetabulum, mostly reduced, the cartilaginous dome is underdeveloped;
  • hip dislocation: with normal development of the femoral neck and its body, the angle connecting them is 40 ° (if the angle is violated, dislocation occurs);
  • rotational displacement: the anatomical structure and placement of bones is disrupted (symptoms: clubfoot, shortening of the limb).

Diagnostics

A specialist examines the baby’s hips while still in the maternity hospital.

To make the correct diagnosis, the doctor finds out whether the newborn is at risk: whether the pregnant woman has suffered infection or intoxication, in what environmental situation she lived, whether there is a burdened family heredity, etc.

To confirm the diagnosis, instrumental diagnostic measures are prescribed.

Ultrasound examination of the hip is a mandatory method to help identify dysplasia. Ultrasound is mandatory for children under 3 months of age who show signs of pathology. The manipulation is completely safe and quite informative. Examining the deformed area, the doctor checks the condition of the bone as a whole, the cartilaginous protrusion, and the angle of inclination of the acetabulum.

X-rays will be informative in identifying pathology in babies over 7 months of age. Until 7 months, most of the acetabulum and the head of the bone are covered with cartilage tissue, and it will not be visualized on an x-ray.

Therapy methods

Experts divide treatment of hip dysplasia in newborns into several groups:

  • orthopedic;
  • physiotherapy;
  • surgical.

The choice of treatment method depends on the characteristics of the development of the pathology and the degree of its severity. In any case, it is necessary to carry out physical therapy and massage for hip dysplasia in newborns. Follow the link to learn about treatment and how this disease is diagnosed.

Orthopedic therapy

The main goal of orthopedic therapy for the disease in infants is to center the femur in the joint and “build up” its roof. The hips are given a “forced” position using devices:

  • Freik's pads;
  • diverting pants;
  • Vilensky outlet bus;
  • Koshlya outlet bus;
  • Mirzoev outlet bus;
  • Volkov outlet bus;
  • Pavlik stirrups;
  • Gnevsky's apparatus.

The choice of device and its fitting are entrusted to the orthopedic surgeon. It is strictly forbidden to select and select a device on your own, because you can not only slow down recovery, but also cause additional harm to the baby’s health. The doctor will provide a consultation on how to care for the child in the device and how to remove it.

Orthopedic devices must be worn around the clock. Its removal is possible only during water procedures, massage and physical therapy. For mild dysplasia or during the final period of therapy, the device is worn only at night.

Physiotherapeutic treatment

Dysplasia in a newborn responds well to physiotherapeutic methods. One of the main ones is. Wet plates - electrodes with Eufillin solution (most often) are applied to the diseased area. Electrophoresis for hip dysplasia in children has a minimum of contraindications.

Another method of physiotherapy is heat therapy, or rather paraffin therapy. Exposing the affected areas to white paraffin helps warm them up. For newborns, it is the white type of paraffin that is used., since it does not contain any harmful substances and impurities.

Magnetic therapy is also often prescribed. The affected area is affected magnetic field, which helps speed up metabolic processes and blood microcirculation. Such processes help accelerate the development of tissues (muscle, cartilage, connective tissue).

Increased excitability, nervousness and hyperactivity in infants can be reduced with the help of hydrotherapy. The main advantage of the method is the ability to use it at home. For example, decoctions of medicinal herbs or sea salt are added to the bathtub.

Physiotherapy can be supplemented with gymnastics, which gives good results for hip dysplasia in newborns. Exercise therapy for hip dysplasia in children is prescribed by a doctor, taking into account the characteristics of the development of the pathology.

Surgery

Surgeon intervention is necessary only for hip dysplasia in children after 1 year of age. Direct indications for surgery are true congenital dislocation and the impossibility of reduction using conservative methods. The operation is performed if, after closed reduction, re-dislocation occurs.

A common surgical technique is open reduction of the femoral bone (osteotomy). Despite its effectiveness, the risk of re-dislocation still remains. Another disadvantage is the long rehabilitation period.

Complications if measures are not taken in a timely manner

Delayed initiation of therapy can cause quite dangerous consequences. When your baby starts walking, he may limp. Lameness manifests itself either barely noticeable or pronounced (depending on the severity of dysplasia). It will be difficult for him to move his leg to the side, he will be bothered by constant pain in his knees and pelvic area. There may even be bone distortion and muscle atrophy.

With age, such unpleasant symptoms only increase in intensity. Among the consequences of hip dysplasia in children is a “duck” gait, with waddling from one leg to the other. Restriction of motor activity is dangerous due to underdevelopment of not only the hip, but also bone elements in other areas, as well as disruption of the functioning of all internal organs.

Prevention

Daily exercise is a good prevention of hip joint pathology

You can avoid such complications and the development of pathology if you follow simple recommendations:

  • daily physical activity (for example, rotational movements of the legs, spreading them to the sides, etc.);
  • bringing the legs to a moderate spread (loose swaddling);
  • preventive massage;
  • correct holding of the child in your arms: facing the mother, so that the legs cover her body.

Prevention also applies to pregnant women. The expectant mother should lead healthy image life, observe proper nutrition, exclude exposure to harmful factors.

Forecast

If you start taking treatment measures in a timely manner, you can hope for a favorable prognosis and complete recovery. In the absence of proper therapy, the outcome depends on the severity of the pathology.

conclusions

A child who has been diagnosed with this condition is registered with an orthopedic doctor until the age of 16. Even in infancy, pathology cannot be eliminated in a short time, and if you start treating it at the wrong time, correction will take even more effort and time.

Finally, watch the following video. In it, Dr. Komarovsky will talk about what hip dysplasia is and how to identify it in a baby.

Dysplasia is a disorder in the development of the joint, which results in a predisposition to dislocation—the head of the bone coming out of the joint capsule. In newly born babies, this defect most often affects the hip joints. Dysplasia in newborns is quite common: in some regions of Russia, up to 20% of children suffer from it.

Causes of joint malformations

The musculoskeletal system of the fetus begins to form at 4-5 weeks of pregnancy. This process ends after birth, when the baby begins to actively walk. Contrary to popular belief, hip dysplasia in newborns does not appear as a result of improper actions of doctors during childbirth, but occurs gradually during pregnancy. Experts consider heredity to be the most common risk factor: more than a third of children suffering from this disease are born in families where cases of dysplasia in newborns have already been observed. The gender of the child also matters: in girls, congenital defects in joint development are diagnosed 4 times more often than in boys. Dysplasia most often affects the left joint (in 60% of cases); developmental defects of the right joint and both joints simultaneously account for 20% of cases.

The causes of hip dysplasia in newborns can also be:

  • Breech presentation of the fetus. If the baby is not positioned correctly in the mother's belly, this prevents him from actively moving. As a result, the tissues of the joints can be formed in such a way that the child is born with the first stage of dysplasia (the so-called preluxation - a condition of the joint when the head of the femur is not yet displaced);
  • The baby's birth weight is too high or too low;
  • Infectious diseases suffered by a woman during pregnancy;
  • Disorders of metabolic processes in the mother’s body and, as a consequence, disturbance of water-salt metabolism in the fetus;
  • Severe cases of early or late toxicosis;
  • Chronic heart disease that affects the baby's mother.

Those children who are tightly swaddled by inexperienced parents are also at risk. In these babies, a mild form of congenital dysplasia that is not diagnosed in time can develop into subluxation or dislocation of the hip joint.

Signs of dysplasia in newborns

Until the middle of the last century, only obviously severe forms of dysplasia: dislocations and subluxations were considered defects in the development of hip joints in infants in our country. Today, pre-dislocations are also diagnosed, which makes it possible to avoid serious complications and promptly help babies born with improperly formed joints. Therefore, every child is examined by an orthopedic doctor in the first days of life. If the baby is at risk or has clinical signs of the disease, the doctor prescribes an ultrasound: this method is the most reliable in diagnosing hip dysplasia in newborns under the age of one and a half to two months.

Attentive parents may notice the following signs of dysplasia in their child:

  • Limitations of leg abduction. With a baby lying on his back, his legs bent at the knees can be spread so that the angle between the hips is 160-170 degrees (“frog pose”). A sign of dysplasia in a newborn is the inability to assume such a position: the affected joint does not fully extend;
  • "Click Syndrome" When the baby's legs bend, a characteristic clicking sound is heard at the knees and hips;
  • Asymmetry of the buttocks and gluteal folds. A baby lying on his tummy has buttocks different shapes. The folds on the affected leg are higher than on the healthy one. An additional fold appears on the thigh.

If the mother notices at least one of these signs, she should show the child to the doctor. It should be remembered that if a newborn has dysplasia, the count is literally days - the baby needs immediate help, since without it the severity of the disease will increase, and the result can affect the entire future life of the child, even to the point of limited mobility and disability.

Treatment of dysplasia in newborns

To restore full motor functions in children suffering from subluxations or dislocations of the hip joints, manual therapy, massage, physiotherapeutic procedures, physical therapy. An experienced chiropractor can correct a mild form of joint dysplasia in a newborn in several sessions. In such cases, when caring for a baby, wide swaddling is recommended: a folded piece of cloth or a flat pad is placed between the baby’s legs, which gently holds the hip joints in a moderately apart position. In more severe cases, complex treatment of dysplasia in newborns is used, which takes much longer. In this case, the baby has to wear special “spacers” (Feik’s feather bed or Pavlik’s stirrups), which fix the legs in the “frog pose” and ensure further normal development of the joints. Parents who find this treatment too harsh should not worry: this position does not cause any discomfort to the baby. On the contrary, it is natural for him. By the way, in those regions of the world where it is customary to carry children on their backs with this position of their legs, cases of dysplasia in newborns are relatively rare. votes)

3 out of 1000 newborns are diagnosed with joint dysplasia, a disease associated with congenital dysfunction of joints. Most often, the largest joints in the human body - the hip - are subject to such damage; the consequences of violations of their functions can be very serious and even lead to disability. Therefore, it is important to diagnose the disease on time and begin treatment before irreversible processes develop.

Table of contents:

Causes of hip dysplasia in children

In medicine, there are three main reasons for the development of the considered pathology of the hip joint:

  • genetic predisposition;
  • violations of tissue formation during intrauterine development of the fetus;
  • hormonal influence.

According to statistics, hip dysplasia (HJ dysplasia) is diagnosed in 25% of cases in children whose parents have a history of the same disease. Quite often, the disease in question is diagnosed simultaneously with myelodysplasia - a disorder in the process of formation of blood cells in the red bone marrow. Doctors associate this disorder directly with hip dysplasia.

We're talking about unstable hormonal background pregnant – the body notes high level progesterone. This hormone has a relaxing effect on ligaments, joints and cartilage - this is necessary for labor and successful delivery. But the “trick” is that progesterone has high placental permeability and enters the fetal bloodstream - this provokes softening of the ligamentous apparatus of the unborn child.

Note:such a negative effect of the hormone progesterone is especially intense in the case of abnormal fetal position or birth in the breech presentation.

Improper tissue formation in the fetus

The rudiment of the hip joint is observed already at 6 weeks of age in the fetus; its first movements unborn child takes place in the 10th week of intrauterine development. And if at these stages the pregnant woman (and therefore the fetus) is affected by negative/harmful factors, then the likelihood of developing hip dysplasia increases significantly. Such harmful factors may include:

  • various chemicals, this includes certain medications;
  • unfavorable environmental situation;

Note:Viral diseases play the biggest role in the formation of tissue in the fetus - if a woman has had one in the 1st trimester of pregnancy, then the risk of giving birth to a child with hip dysplasia increases sharply.

In addition, the disease in question is diagnosed in the following cases:

  • the fruit is too large;
  • the mother is diagnosed with oligohydramnios;
  • breech presentation of the fetus;
  • diseases of the mother of a gynecological nature - for example, adhesions and others.

Classification of hip dysplasia

There are three degrees of development of the disease in question, each of them is characterized by certain symptoms.

1st degree – immaturity of joint tissue components

Most often observed in the case of the birth of a premature baby, doctors define it as a transient condition between a healthy and a diseased joint.

Often, grade 1 hip dysplasia is diagnosed in full-term children, but born with low birth weight. This happens if the mother had feto-placental insufficiency during pregnancy.

2nd degree – pre-dislocation of the hip joint

Doctors note a change in the shape of the acetabulum, but the femur itself does not leave the socket and remains within its boundaries. There are no pathological changes in the anatomical structure of the acetabulum.

3rd degree – subluxation of the hip joint

At this stage of hip dysplasia, a change in the shape of the femoral head is already noted; it moves freely within the joint, but does not extend beyond its limits.

Very important: The most serious option is considered to be a dislocation of the hip joint, which is characterized by:

  • gross violation of the anatomical structure of the joint;
  • changes are observed in the ligaments, muscles, and joint capsule;
  • the head of the femur extends beyond the glenoid cavity and is located either on the side or behind it.

Most often, the disease in question is diagnosed in girls, moreover, in the first year of life.

Symptoms of hip dysplasia

Signs of hip dysplasia can be divided into two large groups:

  • characteristic clinical picture in children of the first year of life;
  • symptoms characteristic of children over 12 months of age.

It is very difficult to diagnose grades 1 and 2 of hip dysplasia - there are no obvious signs; a pediatrician or orthopedist can pay attention to the manifestations during a routine examination. But parents themselves should carefully monitor the appearance and behavior of the newborn. The following factors should be of concern:

  • asymmetrical arrangement of folds on the buttocks and popliteal cavities;
  • it is problematic to separate the legs, bent at the knees;
  • the child shows obvious dissatisfaction and cries loudly when spreading his legs with bent knees.

With such signs, parents should visit a doctor and undergo a full examination by an orthopedist. The specialist will definitely prescribe ultrasonography hip joint, which will help identify late ossification of the femoral head. In some cases, it is advisable to conduct an X-ray examination - the image will clearly show the bevel of the outer edge of the acetabulum and the flattening of its roof.

Dysplasia of the hip joint is much more intense in grade 3 and with dislocation. In these cases, the following characteristic signs will be present:

  1. "Click" symptom. This sound is heard when the doctor or parent begins to spread the legs, bent at the knees, to the sides - the head of the femur at this moment begins to enter the glenoid cavity and does this with a characteristic click. When moving back, the same sound is heard - the head of the femur again extends beyond the glenoid cavity.
  2. Asymmetry of skin folds. This symptom is checked in a child lying on his stomach and lying on his back. It is worth paying attention not to the number of folds (it varies even in healthy children), but to their depth and height of location.

  1. Spreading the legs to the sides is carried out with restrictions. It is this symptom that makes it possible to diagnose hip dysplasia in newborns in the first 5-7 days of life with 100% confidence. They adhere to the following indicator: if the limitation reaches 50%, then the disease in question is definitely present.
  2. Leg shortening relative nature . This symptom is checked as follows: lay the baby on his back, bend his legs at the knees and place them with his feet towards the table/sofa. In a healthy child, the knees will be at the same level, but if one knee is clearly higher than the other, then this means the presence of shortening of the leg.
  3. Erlacher's sign. Doctors determine it by bringing the straightened leg of the newborn to another leg, then try to bring the limb under study behind the other (fold the legs crosswise). In a healthy newborn, the intersection of the legs occurs in the middle or lower part of the thigh; with hip dysplasia, this phenomenon is observed in the upper third of the thigh.

In the case of congenital dislocation of the hip, the painful leg will be observed to be turned outward (in an unnatural way). This is determined when the newborn lies on his back with the leg straightened at both the hip and knee joints.

Signs of hip dysplasia in children older than 12 months

It is very easy to identify the disease in question in children over 1 year of age - a characteristic sign is a gait disorder: the child limps on one leg if hip dysplasia develops on one side, or has a “duck” gait if pathology develops on both sides.

In addition, small forms of the gluteal muscles will be noted on the affected side, and if you press on the heel bone, mobility will be noticeable from the foot to the femur (the child should lie on his back with his legs straightened).

As soon as hip dysplasia is diagnosed, treatment must be started immediately to ensure recovery.

In the first month after birth, doctors prescribe wide swaddling for the baby. It is done as follows: a regular flannel diaper is folded into a rectangle 15 cm wide (approximately, +- 2 cm is allowed), it is laid between the child’s legs, which are bent at the knees and spread apart by 60-80 degrees. The edges of the diaper reach to the knees, and it is secured to the baby's shoulders with ties.

Note:The newborn quickly gets used to this type of swaddling, does not become capricious and calmly endures the moments of “packing” the legs into the desired position. After some time, the child himself begins to put his legs in the desired position before swaddling, but you will need to be patient - at first it will be difficult to calm the child down.

Wide swaddling is almost always combined with therapeutic exercises - it is elementary: with each diaper change or next swaddling, you need to slowly spread your legs to the side and return them to their place. Swimming on your stomach will also be effective.

Any procedures for diagnosing hip dysplasia can only be prescribed by a specialist! The first few times he performs therapeutic exercises medical worker, and parents learn to do the procedure correctly.

An orthopedic doctor (or pediatrician) conducts dynamic monitoring of the child’s condition, and if no positive changes are observed, then specific orthopedic devices may be prescribed. These include:




Treatment with specific orthopedic devices is aimed at fixing the child’s hip joints in the correct position of the legs.

The doctor prescribes devices as the child grows and physically develops:

  • from 1 month to 6 months– it is advisable to use Pavlik stirrups; in some cases, a splint with popliteal splints will be effective;
  • from 6 to 8 months the doctor prescribes a splint with femoral splints;
  • aged 8 months to 12 months If the child is subsequently allowed to walk, the child must wear a walking splint.

Specific orthopedic devices must be worn daily, so parents are always concerned about the issue of caring for a child in this position. To make your work easier, you need to remember the following rules:

  1. When changing the diaper, you should not lift the baby by the legs - you need to put your hand under the buttocks and gently lift them.
  2. To change the vest, there is no need to remove the orthopedic device - you just need to untie the ties on the shoulders.
  3. Suits, dresses, vests and any clothing can be worn on top of the splints/stirrups.
  4. If the doctor has prescribed wearing splints, then get ready to bathe your child more rarely: 3 times a day, parents should examine the baby’s skin under belts and garters to avoid skin irritation and diaper rash. Instead of bathing, you can use regular wipes with a rag soaked in warm water. If you need to completely wash the child, you can unfasten one strap, but hold the leg in a given position during the hygiene procedure, and then wash the other side of the body in the same way.
  5. Constantly monitor the condition of the splint itself - it should not be wet, and talc, baby powder or cream should not get under its belt/strap, as this can cause irritation of the skin.

Note:While feeding the child, the mother must ensure that the child’s legs are not brought together by the hips if this process is carried out without specific orthopedic devices.

The duration of wearing such support devices is quite long, so parents must be patient, be prepared for the whims and excessive anxiety of the baby, and in no case be cowardly! The option “let the child take a break from these terrible tires” and “nothing terrible will happen in 30-60 minutes” can result in disability in the future.

Paying attention to the dynamics of the disease in question, seeing the results of wearing specific orthopedic devices, the doctor can prescribe therapeutic exercises and massage.

Under no circumstances should you carry out such procedures yourself - this can significantly worsen the baby’s health. Only a specialist who constantly monitors a small patient can give any recommendations.

Therapeutic exercises for hip dysplasia

If such a procedure is prescribed, then the parents of a child diagnosed with hip dysplasia should attend several classes with a physiotherapist - the specialist will show how to do the exercises correctly and give a specific schedule of classes. Exists general description exercises:

  1. The child lies on his back, the parents lift the baby’s legs up one by one, while bending the knee and hip joints.
  2. The baby remains lying on his back, and the parent bends his legs in knee joints and in the hips, without lifting them above the surface. Next, you need to spread the child’s legs moderately, giving minimal load, and also make rotational movements with the hips.
  3. In a similar starting position, the child’s legs, bent at the knees and hip joints, are spread as far apart as possible, trying to get the knees closer to the table surface.

Note:each of the described exercises should be performed at least 8-10 times, and at least 3 such “approaches” should be done per day.

You will receive more complete information about the diagnosis of dysplasia and exercises for hip dysplasia in a child by watching this video review:

The following can be said about massage:

  • despite the fact that for newborns and children under the age of 12 months it is carried out in a gentle manner, the benefits from it are enormous - the disease in question can be cured;
  • if you do the recommended exercises with the frequency prescribed by the specialist, the first results can be noticed after a month of such treatment;
  • massage by itself is unlikely to have any positive effect on the child’s health - it is important to carry out complex therapy.

The doctor will tell you the rules for performing a massage for hip dysplasia, and the physiotherapist will show and teach parents how to perform all the procedures correctly. Recommended set of massage exercises:

  1. The baby lies on his back, the parent strokes his feet, hips, kneecaps, arms and stomach. Then the child needs to be turned over on his stomach and the entire body should be warmed up in the same way with soft stroking. Don’t forget to “work” on the inside of the legs, especially the hips - for free access to these places you just need to move the child’s legs to the sides.
  2. The child lies on his stomach, and the parent strokes/rubs the lower back, smoothly moving to the buttocks, at the end we perform gentle pinching of the gluteal muscles.
  3. We turn the child onto his back and begin to work on the thigh muscles - stroking the legs, shaking, gently pinching. Under no circumstances should you apply any force during this part of the massage - the thigh muscles may sharply contract (spasm), which will provoke severe pain. After rubbing and relaxing the muscles, you can begin to flex/extend the legs at the knee and hip joints, but only within the limits indicated by the orthopedist.
  4. Internal rotation of the hip - the parent should fix the hip joint with one hand, the second should hold the knee and, with slight pressure, rotate the hip inward. Then work on the other hip joint.

After the massage, you need to give the child a rest - stroke him, rub his body effortlessly.

Note:The massage is done once a day, each exercise must be performed at least 10 times. It is impossible to take breaks in the massage course - this risks stopping the positive dynamics. The duration of the massage course is determined by the doctor.

During therapeutic exercises and massage, it is important to understand that physiotherapeutic procedures - paraffin baths, electrophoresis using medications that contain calcium and phosphorus - will also be effective.

If the diagnosis of hip dysplasia was carried out late, or the above-described therapeutic methods do not give a positive result, then doctors prescribe long-term step-by-step casting. In especially severe cases, it is advisable to carry out surgical treatment. But such decisions are made exclusively on an individual basis, after a thorough examination of the patient and long-term monitoring of the progression of the disease.

In the case of severe forms of hip dysplasia, disturbances in the functioning of this apparatus are lifelong, even if diagnosis and treatment were carried out in a timely manner.

Recovery period

Even if the treatment was successful, a child diagnosed with hip dysplasia remains under the care of an orthopedic doctor for a long time - in some cases until growth stops completely. Experts recommend performing a control X-ray examination of the hip joints once every 2 years. The child is subject to restrictions on physical exercise, it is recommended to visit special orthopedic groups in preschool and school institutions.

Hip dysplasia is a rather complex disease; many parents literally panic when they hear such a verdict from doctors. But there is no reason to be hysterical - modern medicine copes well with the pathology, timely treatment and the patience of parents make the prognosis quite favorable.

Comprehensive information about the signs of hip dysplasia, methods of diagnosis and treatment of hip dysplasia in children - in the video review of the pediatrician, Dr. Komarovsky:

Tsygankova Yana Aleksandrovna, medical observer, therapist of the highest qualification category.

The hip joint connects the largest bones in the human body, so it has mobility and can withstand increased loads. This is ensured by the connection of the head of the femur with the acetabulum of the pelvis using four ligaments. Their cords are penetrated by nerve endings and blood vessels, so their damage or pinching provokes degenerative phenomena in the head of the bone.

In newborns, hip dysplasia (HJD) is manifested by the incorrect formation of one of its parts, and the ability to hold the femoral head in a physiological position is lost. This condition, depending on the characteristics of the displacement of the structures, is characterized as subluxation or dislocation.

Disease statistics:

  • Deviations in the development of this area are recorded in infants quite often. On average, these figures reach 2–3% among children. In Scandinavian countries, hip dysplasia is recorded somewhat more often, while in southern Chinese and Africans it is rare.
  • The pathology most often affects girls. They make up 80% of patients diagnosed with hip dysplasia.
  • Evidence of hereditary predisposition is indicated by the fact that family cases of the disease are recorded in a third of patients.
  • In 60% of cases, dysplasia of the left hip joint is diagnosed; damage to the right joint or both simultaneously accounts for 20%.
  • A relationship has been noted between tight swaddling traditions and increased morbidity rates. In countries where it is not customary to artificially limit the mobility of children, cases of hip dysplasia are rare.

CAUSES

Elements of the musculoskeletal system are formed at 4–6 weeks of pregnancy. The final formation of joints is completed after the child begins to walk independently.

Most common cause disorders that occur during intrauterine development are genetic abnormalities (25–30% of cases) that are transmitted through the maternal line. But other factors can also negatively influence these processes.

Causes of hip dysplasia in newborns:

  • A large fetus is susceptible to anatomical displacement of the bones when it is abnormally located inside the uterus.
  • Influence on the fetus of physical factors and chemicals (radiation, pesticides, drugs).
  • Malposition. First of all, we are talking about breech presentation, in which the fetus rests on the lower part of the uterus not with its head, as it should be normally, but with its pelvis.
  • Kidney disease in the unborn child.
  • Genetic predisposition if parents have the same problems in childhood.
  • Severe toxicosis at the initial stage of gestation.
  • Uterine tone during pregnancy.
  • Maternal diseases - diseases of the heart and blood vessels, liver, kidneys, as well as vitamin deficiencies, anemia and metabolic disorders.
  • Viral infections suffered during pregnancy.
  • The influence of increased concentrations of progesterone in the last weeks of pregnancy can weaken the ligaments of the unborn child.
  • Bad habits and poor nutrition expectant mother, in which there is a deficiency of microelements, vitamins B and E.
  • Dysfunctional environment in the region where parents live, it causes frequent (6 times more) cases of hip dysplasia.
  • Traditions of tight swaddling.

CLASSIFICATION

Types of anatomical disorders in DTS:

  • Acetabular dysplasia is a deviation in the structure of the acetabulum. The limbus cartilage, located along its edges, is affected. Pressure from the femoral head causes its deformation, displacement and inversion into the joint. The capsule is stretched, cartilage ossifies, and the femoral head moves.
  • Epiphyseal. Such dysplasia of the hip joints in newborns is determined by stiffness of the joints, deformation of the limbs and the occurrence of pain. It is possible to change the diaphyseal angle towards increasing or decreasing.
  • Rotational dysplasia. The placement of the bones when viewed in the horizontal plane is incorrect, resulting in clubfoot.

DTS severity:

  • I degree – pre-dislocation. A developmental deviation in which the muscles and ligaments are not changed, the head is located inside the beveled cavity of the joint.
  • II degree – subluxation. Only part of the femoral head is located inside the articulation cavity, as it moves upward. The ligaments are stretched and lose tension.
  • III degree – dislocation. The head of the femur comes completely out of the socket and is located higher. The ligaments are tense and stretched, and the cartilaginous rim fits inside the joint.

SYMPTOMS

The first signs of hip dysplasia in infants may appear when they reach the age of 2–3 months, but they need to be diagnosed in the maternity hospital.

Main symptoms:

  • Restriction during abduction of the unhealthy hip is typical for grades II and III dysplasia. In healthy children, the legs are bent at the knees and easily spread apart at an angle of 80–90 degrees. Pathological changes prevent this, and they can be separated by no more than 60 degrees.
  • Asymmetry of folds under the knees, buttocks and groin. Normally they are symmetrical and of the same depth. Attention should be paid if, when lying on your stomach, the folds on one side are deeper and located higher. This sign is not considered objective, since it cannot indicate a problem with bilateral dysplasia. For many children, the pattern of folds evens out by three months.
  • Symptom of sliding, or clicking. The head of the femur slips during movement, this is accompanied by a characteristic click when the legs are extended or adducted. This sign is a reliable symptom of abnormalities 2-3 weeks after the birth of the child. When examining children of other ages, this method is not informative.
  • Shortening one leg is reliable sign dysplasia and is detected when the kneecaps are aligned in the supine position. This symptom may indicate a mature hip dislocation.
  • Late standing on your feet and improper walking can be observed already in the last stages of hip dysplasia.

Identification of at least one of the listed signs is a reason to contact a pediatric orthopedist.

The main symptoms of hip dysplasia in newborns can be identified simultaneously with associated symptoms.

Secondary symptoms of the disease:

  • violation of the searching and sucking reflex;
  • Muscle atrophy in the affected area;
  • reduced pulsation of the femoral artery from the side of the changed joint;
  • signs of torticollis.

DIAGNOSTICS

In a baby, signs of hip dysplasia in the form of a dislocation can be diagnosed in the maternity hospital. The neonatologist should carefully examine the child for the presence of such abnormalities in certain pregnancy complications.

The risk group includes children who belong to the category of large children, children with deformed feet and those with heredity burdened by this characteristic. In addition, attention is paid to toxicosis of pregnancy in the mother and the gender of the child. Newborn girls are subject to mandatory examination.

Examination methods:

  • External examination and palpation are carried out to identify characteristic symptoms of the disease. In infants, hip dysplasia has signs of both dislocation and subluxation, which are difficult to identify clinically. Any symptoms of abnormalities require a more detailed instrumental examination.
  • Ultrasound diagnostics is effective method identifying abnormalities in the structure of joints in children in the first three months of life. Ultrasound can be performed multiple times and is acceptable when examining newborns. The specialist pays attention to the condition of the cartilage, bones, joints, and calculates the angle of the hip joint.
  • The X-ray image is not inferior in reliability to ultrasound diagnostics, but has a number of significant limitations. The hip joint in children under seven months of age is poorly visible due to the low level of ossification of these tissues. Radiation is not recommended for children in their first year of life. In addition, placing an active baby under the device while maintaining symmetry is problematic.
  • CT and MRI provide a complete picture of pathological changes in the joints in various projections. The need for such an examination appears when planning surgical intervention.
  • Arthroscopy and arthrography are performed in severe, advanced cases of dysplasia. These invasive techniques require general anesthesia to obtain detailed information about the joint.

TREATMENT

Pediatric orthopedists should treat hip dysplasia in infants. The treatment method is determined by the severity of the dysplastic process. The main principle of therapy is the early start of functional treatment, which helps to normalize the anatomical shape of the hip joint and maintain its motor function.

It is noticed that when the hip is abducted, the bones acquire the correct position, and self-reduction of the dislocation occurs. This position helps improve blood supply to the muscles of the limb and prevents their dystrophy.

Methods for treating dysplasia:

  • Wide swaddling is recommended when treating very young patients. A folded diaper 15–20 cm wide is placed between the legs, bent at a right angle.
  • Becker pants have the same principle as a wide swaddle, but are more convenient to use.
  • Freik's pillow resembles Becker's pants with sewn-in stiffening ribs.
  • Fixing spacer splints - elastic Vilensky and Volkov splints, as well as fixing gypsum splints.
  • Pavlik stirrups are a bandage made of soft fabric that provides a therapeutic effect on the desired area and does not limit the child’s movements.
  • Reduction of dislocation with further immobilization of the limb in severe cases of the disease in children under 5–6 years of age. This procedure is contraindicated for older patients.
  • Skeletal traction is performed in complex cases of dysplasia when treating children under 8 years of age.
  • Corrective surgery, in which the dislocation is reduced during open or endoscopic surgery. It is performed in case of obvious ineffectiveness of conservative treatment or if it is impossible to reduce the dislocation using gentle methods.
  • Physiotherapy. The exercises are aimed at bending, straightening the legs, bringing them together and spreading them apart.
  • Physiotherapy - massage, electrophoresis, paraffin baths, mud therapy, ozokerite and warm baths.

Treatment of hip dysplasia in a newborn can be a long and painstaking process. Despite this, you cannot arbitrarily adjust or cancel doctor’s prescriptions, since improper treatment can lead to serious consequences.

COMPLICATIONS

The disease requires early diagnosis and initiation of therapy as soon as possible. In infants, the consequences of hip dysplasia can provoke severe abnormalities leading to disability.

Complications of DTS:

  • dysplastic coxarthrosis in adulthood;
  • impaired mobility of the spine, legs and pelvic girdle;
  • scoliosis;
  • flat feet;
  • neoarthrosis;
  • change in posture;
  • osteochondrosis;
  • tissue death of the femoral head.

PREVENTION

In infants, treatment of hip dysplasia is a mandatory measure to prevent severe complications. The development of dysplasia can be prevented by following preventive measures.

Measures to prevent dysplasia:

  • warning of any negative influences to the fruit;
  • thorough examination of children at risk in the first 3 months after birth;
  • nutritious nutrition for a nursing mother or the use of adapted formulas for feeding the baby;
  • free swaddling of a newborn;
  • diapers that do not put pressure on the pelvis.
  • strict adherence to the doctor’s recommendations when identifying any stages of dysplasia.

PROGNOSIS FOR RECOVERY

Hip dysplasia is a treatable disease. Provided that therapy is started early under the supervision of an orthopedist and his recommendations are followed, a complete recovery is possible.

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The health of any child depends on the care of the parents. A newborn baby requires more attention. At one month it is necessary to do a full examination of the baby to exclude age-related developmental deviations. The diagnosis is hip dysplasia, a fairly common occurrence for children in the first days of life. Should we be afraid of such a verdict from doctors? What causes the development of dysplasia? Is it possible to save a child from such a diagnosis? We will give recommendations to parents on all issues.

What is hidden under the diagnosis of “dysplasia”?

Dysplasia is the abnormal development of the hip joint caused by physiological factors. In fact, the baby has a broken connection between the head of the joint and the bursa (acetabulum), in which this head should be located. At the time of birth, newborns do not have ligaments that hold the hip joint in a special socket. Overgrowth of these ligaments occurs in the first year of life. Nature, trying to make the birth process easier for both mother and baby, made the joints flexible and soft.

If there are no problems during pregnancy and childbirth, then hip dysplasia in newborns is not detected during the initial and subsequent examinations. Such changes in the connections of the head of the joint and the acetabulum are due to the following reasons:

  • Pelvic diligence of the fetus. If the baby spent the second half of pregnancy sitting on his butt and did not turn around, then it is more difficult for him to pass through the birth canal. Normal births are those when the baby is born with the head. It’s hard for a baby to push her butt. Therefore, the pelvic bones suffer and dislocations occur, which lead to dysplasia.
  • Large fruit (about 4000 grams). The more a child weighs, the more difficult it is for him to be born. The pelvic bones experience strong pressure, and the head falls out of its place. Then it may be impossible to return to the place on your own.
  • Heredity. Relatives or the mother herself had problems with the development of the hip joint or brittle bones. Then the risk of pathology increases.
  • Gender of the child. Girls are most often affected by dysplasia. Experts explain this feature by referring to the action of the hormone relaxin, which softens the hip bones of the pregnant woman and the fetus before childbirth. Girls are more susceptible to this process than boys. Therefore, the hip joints suffer more.
  • You are expecting your first child. In first-time mothers, relaxin is released more than during all subsequent births. Therefore, softening of the fetal bones occurs more, which leads to the risk of joint dislocation in the infant.
  • Negligent attitude of doctors. It also happens that the obstetricians themselves, through their actions, lead to dislocation of the hip bones if they pull the baby too hard. But in such a situation, complications will arise not only in the pelvic, but also in the cervical and lumbar regions.

If any point is directly related to you, then it is necessary to conduct a full examination for the presence of dysplasia.

Symptoms indicating pathology

What should the parents of a baby or an older child be wary of? Are there any features that can be seen with the naked eye at home? Of course yes.

The first examination of a newborn is carried out within the walls of the maternity hospital and all pathologies must be identified at the initial stage. This will help you cope with underdeveloped joints earlier and easier.

But it also happens that dysplasia in a newborn begins to manifest itself after discharge home. Therefore, be careful and watch the baby yourself.

Contact your doctor immediately if:

  • We noticed asymmetry of the gluteal, inguinal, and femoral folds. To do this, undress the child and place him on a flat surface. First, straighten both legs, and then bend your knees, trying to align them at the same level. All folds in the groin, butt and thighs should be the same.
  • The knees of the legs should be at the same level. If one is higher than the other, then there is a deviation in the development of the joint. But if the dislocation was on both sides, then the knees may not differ in level.
  • Different amplitude. Lay the baby on his back. First, bend your knees, and then spread them from this position in different directions. Ideally, your knees should touch the surface. But don't overdo it. Don't put too much pressure on your legs. This can lead to serious consequences. If the legs do not fall to the sides without effort, or have a different angle of inclination, then there is a suspicion of dysplasia.

If you notice at least one of these symptoms, then do not waste precious time. The orthopedist will carry out all the necessary manipulations at the first visit and establish the correct diagnosis. Specialists have their own methods to help accurately determine the presence or absence of dislocation of varying degrees.

The earlier the diagnosis is made, the easier it will be to cope with it. Dysplasia is not a disease that cannot be treated. But delay can play a role. Then your child will take a long time to overcome this barrier.

Professional diagnosis of dysplasia in newborns

The pediatrician prescribes a scheduled visit to an orthopedic surgeon every month. But don't wait a month if you have suspicions. The orthopedist will see the baby and prescribe all the necessary tests:

  • Ultrasound (ultrasound examination) of the hip joints. This procedure has become mandatory for all children of one month of age. The procedure will not cause discomfort if you approach it calmly. There is no harm to the baby from ultrasound. This method is not always sufficient to determine the degree of joint dislocation. Then X-rays are used.
  • X-ray examination is possible only in a calm position of the baby. If he cries and twitches, then the results cannot be considered accurate. Prepare for this procedure. It is good if the baby sleeps during the x-ray. This image plays a big role in prescribing treatment.

All stages of the examination have been completed. The diagnosis is confirmed. What to do next?

Treatment methods for dysplasia in newborns

Hip dysplasia is not a death sentence. Be patient and love. The process of returning the head of the joint to the acetabulum and acquiring elastic ligaments is a long process. It may take from six months to one and a half years. You can overcome anything, you just need to do it in time. Don't stop mid-treatment.

What will help the baby and parents?

So, the cause of dysplasia is the displacement of the head from its place. It is necessary to return the joint to its original position. This can be achieved if you bring the baby’s legs to a certain position: bend them and spread them apart. This position is comfortable for the child. You may have noticed that children without pathology themselves try to raise their legs to their tummy. If the dislocation is not very severe, then even diapers and proper swaddling will correct a slight deformity.

Wide swaddling of baby

The peculiarity of the method is that the arms are fixed tightly along the body, and the legs remain in a free position. Then the child can raise them to the desired angle.

It has been proven that in countries where the climate is warm and babies are always without diapers, the percentage of hip dislocation is close to zero.

Specialist massage, physiotherapy

If an incorrect location of the joint is detected, the orthopedist prescribes a massage, which must be done in courses. Only a specialist knows how to help the baby. Therefore, contact only children's massage therapists with extensive experience.

Gymnastics are done at home. An orthopedist teaches a certain complex to mom and dad. All movements should be performed smoothly and daily. In the first days, this process will be unpleasant for the child, because the joint needs to return to the correct position. But both you and your child will gradually enjoy daily activities. Here are the most useful types of exercises aimed at correcting the hip joints:

— Bend the child’s knees to the maximum possible position and straighten them completely.

— We bend the legs at right angles and try to spread them apart. After this, we begin to smoothly rotate our hips in a circle.

— We bend the legs and spread them apart, trying to touch the surface.

The exercises are performed lying on your back without fanaticism when the baby good mood. Repeat up to ten times. During the day you need to do three to four approaches and follow the doctor's recommendations.

Often the orthopedist also prescribes physiotherapy:

  • calcium electrophoresis;
  • heating with wax.

Special orthopedic gadgets

It is impossible to treat dysplasia without special devices that have passed all clinical trials and have benefited many patients.

Operative method of treatment

Sometimes there are risks of exacerbation of the pathology. This happens when the diagnosis is made too late: at six months or even later. Then all the methods listed above are not enough. There is a need for surgical intervention. If this is not done, the child will limp or may remain disabled and bedridden for life. This measure also occurs when parents are negligent in the early stage of treatment: they remove orthopedic devices without the doctor’s permission, do not engage in physical development (gymnastics, massage), and try to put the baby on straight legs early. Then all efforts are in vain. The consequences can be very serious.