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Hip dysplasia in children

Hip dysplasia is a congenital underdevelopment of the hip joint with the violation of its functions.

It occurs in about 3 out of 100 newborns. Girls suffer from it 5 times more often than boys. Hip dysplasia is found on all continents of the globe, and the frequency of its occurrence does not depend on nationality and race.

For a long time it was believed that congenital abnormalities in the structure of the hip joint found in the peoples of Africa and Asia less than Europe. In fact it is not, the frequency of formation of pathology in the prenatal period are the same, but the number of newborns who have persistent impairment in the hip joint as they grow older, in countries with a warm climate is actually less. This is due to the traditional way of carrying the child on back or hip with extended legs and lack of tight swaddling and the close of the cradles.

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The symptoms of hip dysplasia

All the symptoms of hip dysplasia can be subdivided into 2 large groups:

  • observed in newborns (0 to 12 months);
  • typical for children older than 1 year.

Symptoms in newborns

Underdevelopment and redviva hip joints manifests itself very poorly. And often is found incidentally during preventive examination by a pediatrician or orthopedist. A careful observation of the newborn can be noted slight asymmetry of the gluteal and popliteal folds, stiffness and dissatisfaction with the child when trying to breed the legs bent at the hip and knee joints in the hand. Ultrasound noted later, the formation of nuclei of ossification in the femoral head. The x-rays can detect a slight flattening of the roof of the acetabulum, the outer edge of the skewness.

Subluxation and dislocation of the hip is characterized by a rich clinical picture.

Characterized by the following symptoms:

  • the symptom "click";
  • restrictionbreeding legs;
  • symptom of Elahera;
  • the asymmetry of the buttock cheek meets the thigh and popliteal folds;
  • the relative shortening of the leg on the affected side;
  • turn foot outward.

The best time for diagnosis is the first week of life the newborn. In this period, dominated by the physiological hypotonia of the muscles of the lower extremities, therefore, to define all pathological symptoms quite easily. After 7 days of life in neurologically healthy infants developed physiological hypertonus and some of the manifestations of subluxation and dislocation can not be overlooked.

  • The symptom is a "click" is determined at the moment when the doctor or parent is trying to raise the knees bent legs the child in the hip joints. Released from the glenoid cavity the head of the femur with a characteristic crunch comes back into the joint. When casting feet again you hear a click, which means that the hip was back outside of the joint.
  • Limited breeding of the legs helps to identify subluxation and dislocation of the hip joint is almost in 100% of cases, the study of this symptom in children without pathology of the nervous system at day 5-7 of life. If the legs are divorced 50-60%, it is a sure sign of trouble in the hip joint.

  • Symptom of Erlacher is verified as follows: a straightened leg of the child, which is suspected subluxation or dislocation, slowly lead to the opposite healthy leg. And then also gradually give birth to a sick leg to the healthy one. Normal leg crosses the opposite limb in the lower or middle third of the thigh in severe forms of hip dysplasia this occurs in the upper third.
  • Asymmetry of skin folds it is necessary to check the position of the child lying on the back or on stomach. Attention is paid not on the number of skin folds, which are normal and may vary on both limbs, and the depth and height of their arrangement.
  • Relative shortening of the legs revealed the following: the newborn is placed on his back, legs bent at the knee and hip joints, feet pressed against the couch. Assesses the level at which your knees are in relation to each other. Normally, they should raspolagetsya on the same level. If one of them below, it says about the relative shortening of the legs.

In congenital dislocation of the hip bad leg splayed out unnaturally, it is determined when straightened at the hip and knee joint of the leg inlying on the back.

Symptoms in children after 1 year

In children after 1 year to identify hip dysplasia easily enough, as by this time disappear or turn into a more severe form difficult to diagnose mild forms of the disease.

Observed limping on the injured leg, and with bilateral hip dislocation – the "duck walk". There has been a significant reduction in the size of the gluteal muscles on the affected side. When pressure on the heel bone when the child is supine with straight legs determines the movement axis of the leg from the foot to the hip joint.


The reasons for the development of hip dysplasia

Can be allocated 3 theory of the development of hip dysplasia:

  • violation of laying the tissues of the embryo;
  • genetic predisposition;
  • the effect of hormones.

Violation of laying the tissues of the embryo

The first rudiment of the hip joint comes from a human embryo at 6 weeks of fetal development. Movement in this joint is possible from the 10th week of pregnancy. Under the influence of external and internal damaging factors disrupted the formation of elements of joint.

The external causes can be classified as:

  • radiation;
  • chemical substances, including certain drugs;
  • the unfavourable environment.

The most important internal damaging factor is transferred by the mother in the first trimester of pregnancy viral infections, including influenza, rotavirus infection.

Genetic predisposition

There is a high frequency of hip dysplasia from parents who suffered this disease. Among all cases of this pathology is the disruption to the structure of the hip joint caused by a variety of genetic factors is about 25%.

Also hip dysplasia is often found in conjunction with congenital myelodysplasia – a disease which is based on the violation of the formation of red blood cells in the red bone marrow. Perhaps this is due to the fact that red marrow located in the bones of the pelvis, undergoing a pathological process that disrupts the development of the acetabulum.

Hormonal effects

Towards the end of pregnancy in the female body there is a high level of the hormone progesterone, which hasrelaxing effect on the ligaments, muscles and cartilage. This is necessary in order that the pelvis of the mother is prepared for childbirth. However, progesterone is able to penetrate the placental barrier and enter the bloodstream of the fetus. This leads to softening of the ligaments and capsule of the hip joint, which may be the cause of his malformation. The development of this condition may contribute to anomalies of the fetus, and difficult labor in foot and breech presentation.

Classification

Hip dysplasia is divided into 4 degrees of severity depending on the intensity changes of the articular components:

The easiest degree is the immaturity of components of the tissue. It is defined as the state between disease and transient feature of a healthy joint. Most often seen in premature infants. Children born at term may also have the immaturity of the hip joint. This is especially true for underweight newborns whose mothers suffered from Feto-placental insufficiency during pregnancy.

Next in severity comes previva. It is based on changing the shape of the acetabulum, but the femoral bone does not leave the limits of the joint, in addition its very structure is not modified.

When subluxation can change the shape of the femoral head, she moved inside the joint to its very border, but never goes for it.

Congenital dislocation is the most severe degree of hip dysplasia. The structure of the joint is grossly violated. Observed strong changes not only the shape of the glenoid cavity, but also of the femur, ligaments, muscles and joint capsule. The head of the femur leaves the joint cavity and is located behind its front or rear edge.


Diagnosis

Detection of hip dysplasia in the stage of underdevelopment and previlige presents great difficulties.

In children not available tiglic the age of 3 months to be diagnosed using the following techniques:

  • a survey of the child's mother;
  • inspection;
  • ultrasound;
  • The x-rays.

The survey helps to find out the mother during pregnancy, transferred in this period of infection, existing hereditary disease. During the inspection attention is paid to the presence or absence of characteristic symptoms.

For children under the age of 6 months study of the hip joint is produced by ultrasound. It involves 2 phases: static, during which studied the stationary joint, and dynamic, performing passive movements of the baby's legs in the hip joint.

Ultrasound is used to determine the degree of ossification of the femoral head, joint stability during movement. In a healthy child the size of the nuclei of ossification in millimeters corresponds to the age in months, e.g. 1 month – 1 mm in 2 months – 2 mm. If the diameter of the points of ossification does not correspond to physiological norms, this may indicate dysplasia.

Currently there is no mandatory screening ultrasound of the hip joints of all children at the age of 1.5 months.

X-rays performed in newborns older than 6 months and children of any age, with suspected subluxation and dislocation. The x-ray images to accurately determine the structure of the bony components of the joint. The radiologist determines the value of the angles of the acetabulum and on the basis of additional lines estimates the location of the femoral head.


Treatment of hip dysplasia in children

The choice of a particular technique in the treatment of hip dysplasia depends on how heavily modified joint elements.

The immaturity of hip joints

If this condition does not give any clinical manifestations, in particular, does not cause difficulty in breeding the legs of the child, we used conservative methods:

  • wide swaddling without the use of orthopaedic appliances;
  • therapeutic exercises aimed at motion in the hip joint;
  • massage, physiotherapy.

The treatment is carried out within one month, after which the child is sent for re-ultrasound and x-ray. If the immaturity of the joints is accompanied by limited dilution legs, it is recommended that the wearing of the tyres-spacers according to the type of pillow frejka re-control after 1 month.

In both cases, the fixation of the feet is accompanied by a daily set of physical therapy, a course of massage and physiotherapy (electrophoresis withcalcium, paraffin baths, salt baths).

Redviva

Is treated conservatively. For holding the feet in a diluted state through the use of orthopedic appliances, pillow frejka, abduction tires, Pavlik's stirrups. Also apply massage, physiotherapy and physiotherapy.

Subluxation and dislocation

While the severity of hip dysplasia applies to the imposition of plaster bandages that fix the legs in the desired position. Duration of wear of the plaster bandage is determined individually.

With the ineffectiveness of conservative methods, severe lesions of the acetabulum, and delayed diagnosis operative treatment with restoration of the normal shape of the hip joint and fixation of its constituent elements.