Hip deformities. Varus deformity of the femur: causes, classification, symptoms and treatment Hip curvature
The occurrence of hip deformities is based on various reasons. Some of the deformities come from changes in the hip joint and femoral neck. Deformities in the area of the metaphysis and diaphysis of the thigh can be congenital, rickets, inflammatory, and can be associated with trauma and various tumors.
Rachitic deformities of the thigh
A characteristic feature of the pathological process in the early period of rickets is the formation of osteoid tissue, which does not undergo timely ossification.
At the end of the disease, when the process of ossification has not yet been fully restored, traction of the muscles, especially the adductors, and premature load on the legs cause the curvature of the hips, characteristic of rickets, - an O-shaped thigh (femur varum). Bilateral deformity of the thigh is more common.
Symptoms... Usually, the deformity affects the entire thigh and lower leg.
Due to the arcuate deformity of the thigh and changes in the area of the epiphyseal cartilage, the length of the limbs is reduced, there is a disproportion between the length of the trunk and limbs. Physiological axis femur is violated, and due to improper loading near the ankle joint, secondary deformity of the foot often occurs.
Prevention and treatment... During the period of fresh rickets, with a tendency to deformity of the limbs, it is necessary to fix them with a plaster splint and not allow the load on them until the bone structure is completely restored, which is checked radiographically. Temporarily give an unloading orthopedic apparatus. At the same time, vitamin therapy and ultraviolet irradiation of the patient are carried out.
Treatment of the formed deformity of the hip consists in osteotomy, correction of its axis or lengthening.
Osteotomy is done under local anesthesia. With an external incision, dissect the fascia lata, the broad lava muscle, the periosteum, and carefully stop the bleeding. At the height of the greatest deformity of the hip, an oblique osteotomy is done, skeletal traction is performed or plaster is applied for 2 months, then therapeutic exercises are applied, a careful load in the splint.
With a noticeable shortening of the limb due to deformation of the thigh, the entire limb can be lengthened in two ways: on the thigh or by surgery on the shin bones. To lengthen the femur, use the method of segmental osteotomy according to N. A. Bogoraz with the introduction of a font into the medullary canal or a Z-shaped osteotomy followed by skeletal traction.
Z-shaped osteotomy is performed as follows. After the Z-shaped dissection of the periosteum, the diaphysis is drilled with a narrow drill in the anteroposterior direction in 3-4 places, and it is ensured that the drill also passes through the back wall.
Then the femur is split along the length with a narrow sharp chisel. The canals drilled before this allow an osteotomy to be performed without any difficulty and as large as is required to eliminate the shortening of the femur.
Some, after a Z-shaped osteotomy, drives an autograft into the bone marrow canal, which does not interfere with the stretching of the fragments, prevents their displacement and guarantees consolidation.
Then, for 2 weeks, traction is applied to the skin with an adhesive plaster, cleol or zinc-gelatin paste with side rods to prevent lateral curvature.
The following complications are possible when lengthening the limb:
- temporary muscle weakness from lengthening;
- fracture at the site of a previously performed osteotomy;
- delayed consolidation;
- vicious union;
- limitation of mobility in the knee after prolonged fixation.
Patients should be kept lying down for a long time, but with active movements in the joints and with the support of the legs. With proper postoperative management of the patient, complications can be avoided.
It is also possible to achieve lengthening of the limb by osteotomy of the shin bones.
Recently, for lengthening the thigh, lower leg with good result various screw devices are used, in particular the Gudushauri apparatus.
Traumatic deformities of the thigh
Distinguish between traumatic deformity of the upper third of the thigh, the area of the diaphysis and the distal end.
Symptoms... Deformity of the thigh in the upper third occurs after damage to the epiphysis (epiphysis), fracture of the neck (coxa vara traumatica) or metadiaphyseal femur. In the latter case, an angular curvature of the hip develops with its shortening. With diaphyseal deformity of the femur, displacement of fragments in length and width, violation of the physiological axis of the femur and shortening of the limb are the most important symptoms. Displacement of the distal fragment along the periphery and recurvation of the femur, externally subtle, significantly upset the function of the limb.
Treatment... In the cases shown, operative elimination of the deformity is performed by osteotomy and lengthening of the femur.
Inflammatory deformities of the hip
Inflammatory processes that occur in the proximal or distal epiphysis of the femur in childhood lead to a shortening of the limb and to a change in its shape and function.
The most significant deformities occur after the tuberculous process in the head and neck region or in the distal pineal gland. Shortening in such cases sometimes reaches 8-10 cm or more. The shape and axis of the femur also changes.
Similar femoral deformities and shortening also develop after septic (metastatic) osteomyelitis of the femur, which arose in early childhood after umbilical sepsis.
Symptoms... The main symptoms are hip shortening and lameness. On closer examination, it is possible to detect abnormal development of the medial or lateral part of the distal femoral epiphysis, impaired growth, sometimes premature synostosis and, as a result, the development of genu varum or genu valgum.
On the roentgenogram, it is possible to establish a violation of the structure of the meta-epiphyseal region and synostosis.
Treatment... Treatment of a shortened hip can be conservative or operative. The use of orthopedic devices or orthopedic shoes is indicated in children. Surgical lengthening of the femur is done with a shortening of more than 4 cm.
The article was prepared and edited by: surgeonAs well as the occurrence of deformities of the hip in general, it is based on various reasons. Some of the deformities come from changes in the hip joint and femoral neck. Deformities in the area of the metaphysis and diaphysis of the thigh can be congenital, rickets, inflammatory, and can be associated with trauma and various tumors.
Symptoms of the deformity of the femoral neck.
Deformity of the femoral neck often develops in early childhood, is often the result of rickets, may depend on congenital and dysplastic changes in the skeletal system, and is less often associated with trauma.
Curvature of the femoral neck is characterized by a decrease in the angle between the diaphysis and the femoral neck (to a straight or even acute) and is called coxa vara. On the basis of anatomical changes, functional disorders arise, manifested by swaying of the body when walking, limiting the abduction of the hip, lameness as a result of shortening of the leg.
Swaying of the body when walking at the time of load on the injured leg depends on the functional insufficiency of the gluteus medius and small muscles due to the upward displacement of the hip. To keep the pelvis in a horizontal position, the patient is forced to tilt the body towards the affected leg. Thus, the so-called duck gait is formed. Often there are complaints of increasing weakness of the lower limb, rapid fatigue, pain when walking and standing.
The deformation that has a connection with the previous one is the X-shaped legs. The development of this deformity is associated with an uneven load on the femoral condyles and their uneven growth: the proliferation of the internal condyle gradually leads to the formation of a valgus curvature of the knee joint. Clinically, this deformity is manifested by the fact that the thigh and lower leg form an angle in the knee joint open outward.
In a child with a similar deformity, the knee joints are in close contact, while the feet are at a great distance from one another. When trying to bring the feet closer, the knee joints go one after the other. Similar deformation knee joints often accompanied by a valgus placement of the feet (deflection of the heel bones outward). This deformation can, due to the progressive development of flat feet, lead to pain.
Another deformity of the legs and knee joints, O-shaped curvature of the legs, is most often based on rickets. The arcuate curvature of the lower leg bones with a bulge outward develops in the process of vertical load under the influence of muscle traction during softening of the bones by a rickety process. The curvature of the lower leg is enhanced by the traction of the triceps muscle of the lower leg, acting in the direction of the chord of the forming arc.
The vicious position of the bones is fixed in the process of their asymmetric growth. The disease manifests itself as a duck gait, a positive Trendelenburg symptom, restriction of abduction and rotation in the hip joint, however, in contrast to congenital dislocation of the hip, the head of its hallux valgus is palpable in the Scarp triangle.
Causes of the deformation of the femoral neck.
The causes of hallux valgus are varied. Allocate congenital, childhood or dystrophic, juvenile, traumatic and rickets deformities. In addition, the valgus curvature of the femoral neck is observed in systemic diseases: fibrous osteodysplasia, pathological fragility of bones, dyschondroplasia. Deformity may be the result of surgical interventions in the femoral neck or any pathological conditions of the bone in this area (consequences of osteomyelitis, tuberculosis, subcapital osteochondropathy).
Congenital hallux valgus is more often bilateral, and then the disease is detected when the child begins to walk along the characteristic duck gait, which often suggests a congenital dislocation of the hip. In addition, on examination, there is a limitation of leg extension and a high standing of the large trochanters. X-ray examination makes it possible to diagnose the disease. Often, the deformity of the femoral neck is combined with other congenital defects: shortening of the limb, violation of the shape of other joints.
Children's viral deformity of the femoral neck is often unilateral and is associated with dystrophic processes as a result of trophic disturbances and is accompanied by restructuring bone tissue by the type of aseptic necrosis. The disease begins at the age of 3-5 years, under the influence of stress, the deformity of the femoral neck progresses. Clinically, the disease is manifested by lameness, pain, especially after long walking and running. The affected limb may be shorter and thinner, and hip abduction is limited. The greater trochanter is located above the Roser-Nelaton line, there is a positive Trendelenburg symptom.
In other words, the clinical manifestations are largely identical congenital dislocation hips. However, there will be no symptoms characteristic of dislocation, such as displacement of the hip along the longitudinal axis (Dupuytren's symptom), a symptom of a non-vanishing pulse with pressure on the femoral artery in the Scarp triangle.
Diagnostics of the femoral neck deformity.
The diagnosis in the overwhelming majority of cases does not cause any difficulties for a traumatologist or any other specialist. In order to clarify the position of the end of the femur and exclude possible bone damage, it is necessary to conduct an x-ray study. Moreover, it must necessarily be in two projections.
In the same case, if the diagnosis is in doubt, an MRI scan of the entire described joint is performed.
Treatment of deformity of the femoral neck.
Correction of such a deformity is effective at the beginning of their formation (at the 1st-2nd year of life). The principle of complex therapy, which is common for most orthopedic deformities, is also valid for this group of deformities of the lower extremities. Application and combined with orthopedic treatment (prescribing special splints, wearing special devices).
Treatment is prompt.
It is carried out in two directions: therapy of the causes of deformity and surgical (the deformity itself). On the basis of cases of detection of the disease, it is noted that the hallux valgus appears in the patient from birth. There are rare cases when deformity occurs with traumatic or paralytic etiology.
Before starting the operation, you need to plan the upcoming operation. Find out what methods and constructions can be applied in this case. Thus, the surgeon is faced with the following questions:
- Simultaneous or staged elimination of femoral neck deformity.
- Correction of the length of the limb.
- Removing old processes if operations of this type were carried out.
- Endoprosthesis design and installation.
There are more than 100 treatments for hallux valgus:
- Exostecomia (removal of part of the head of the bone);
- Ligament restoration;
- Replacement for an implant;
In the event that the femoral neck is replaced with an implant, local or general anesthesia is performed prior to the operation. The surgeon then makes a small incision. Next, the surgeon removes the femoral neck and installs an endoprosthesis, which ideally follows its shape. The prosthesis facilitates movement, helps to correct gait, improve the quality of life, and get rid of pain. There are many types of prostheses, which are selected taking into account specific case diseases.
Prevention of femoral neck deformity.
In order to prevent dislocation in the hip area, it is recommended to carefully monitor safety in everyday life and in the process of playing sports.
In this case, there is a need for:
- training of various muscle groups, the rational receipt of physical activity;
- the use of extremely comfortable clothing and footwear to prevent falls;
- the use of professional means of protection throughout the course of sports. It is at least about knee pads and hip braces;
- refusal of any trips on ice, paying attention to slippery and wet surfaces.
In order to completely restore the hip joint after a dislocation, it will take, if there are no complications, from 2 to 3 months. This period can only be lengthened if there are concomitant fractures. So, the doctor may insist that a non-long-term traction of the skeletal type with further complexes of exercises is carried out. This is done using a device of continuous inactive movement.
Self-movement using crutches is possible only in the absence of any pain. Until the moment when lameness disappears, it is recommended to resort to additional aids for the implementation of movements, for example, a cane.
After that, it is recommended to use fortifying drugs that will affect the structure of the bone tissue. It is also important to carry out certain exercises, a list of which should be compiled by a specialist. The regularity of their implementation will be the key to recovery. In addition, it is necessary to treat the damaged area of the thigh as carefully as possible, because now it is she who is one of the weakest points of the body.
Remembering all the rules of prevention and treatment, it is more than possible to quickly and permanently get rid of any consequences of hip dislocation while maintaining the optimal rhythm and tone of life.
In most patients, deformity of the femur is associated with changes in the structure of its neck. Only 10% of patients have a deformity of the femoral head. Basically, this group includes patients after a fracture of the femoral neck with improper fusion of bone tissue.
Primary changes begin with shortening of the neck and thickening of its section in the area of the diaphyseal joint with the acetabulum of the pelvic bone. the axis of the neck and the central diaphysis undergo insignificant deformation, which is further aggravated by the contraction of certain femoral muscles. With varus deformity, shortening occurs along the inner surface. With hallux valgus, the curvature passes with damage to the external muscles.
In about 70% of cases, for such a disease of the musculoskeletal system, the prerequisites are formed at the stage of intrauterine development of the baby. And only in 25% of patients, the deformity of the femur is associated with degenerative lesions of cartilage and bone tissue. Usually the first signs in this case appear in old age, in menopause against the background of the development of osteoporosis. The traumatic nature of hip curvature is present in only 5% of patients with clinically diagnosed cases. This is due to the fact that recently, for fractures of the femoral neck, they are actively used operational methods restoration of tissue integrity. This allows for complete recovery without the formation of various kinds of degenerative deformities.
In the proposed material, you can learn more about the potential causes of the development of femoral deformity in children and adults. It also describes what methods of manual therapy can be used to effectively and safely carry out treatment in order to completely restore the physiological state of the femur.
Why does hip deformity occur?
Primary deformity of the hip occurs only in the form of congenital pathology, which may not appear until the onset of adulthood. The gradual deformation of the femoral necks is a consequence of the influence of negative factors, such as:
- maintaining a sedentary lifestyle;
- overweight;
- smoking and drinking alcoholic beverages;
- incorrect positioning of the feet when walking and running;
- hard physical labor with maximum stress on the hip joints;
- hip fractures;
- wearing high-heeled shoes.
Secondary deformity of the femoral necks always develops against the background of other diseases of the lower extremities. Among the most likely pathologies are:
- deforming osteoarthritis of the hip joints (cosarthrosis);
- deforming osteoarthritis of the knee joints (gonarthrosis);
- curvature of the spine in the lumbosacral region;
- symphysitis and discrepancy of the pubic bones during pregnancy in women;
- improper placement of the foot in the form of flat feet or clubfoot;
- tendinitis, tendovaginitis, bursitis, cicatricial deformities of the soft tissues of the lower extremity.
It is also worth considering risk factors. These include intrauterine pathologies of the development of the bone skeleton, rickets in early childhood, osteoporosis in middle and old age, vitamin D and calcium deficiency, endocrine diseases (hyperthyroidism, diabetes mellitus, adrenal hyperfunction, etc.).
For successful treatment of hip deformity, it is necessary to eliminate all possible reasons and negative risk factors. Only in this case it is possible to obtain a positive effect.
Varus deformity of the femoral neck (femur)
Pathology is divided into two types: hallux valgus and varus deformity of the femur, in the first case, the curvature occurs in the X-shaped type, in the second - in the O-shaped. Both types are associated with a change in the angle between the head and the shaft of the femur. Normally, its parameter ranges from 125 to 140 degrees. An increase in this value to 145 - 160 degrees leads to the development of an O-shaped curvature. A decrease in the angle entails a varus deformity of the femoral neck, in which the rotation of the lower limb will be sharply limited.
Abduction of the leg to the side of the body with varus deformity of the thigh is difficult and causes severe pain in the hip joint. Therefore, the primary diagnosis is often incorrect. The doctor suspects destruction and deformation of the femoral head and acetabulum. To confirm the diagnosis of deforming osteoarthritis, an X-ray of the hip joint in several projections is prescribed. And during this laboratory examination, a varus deformity of the femoral neck is revealed, which is clearly visible on radiographic images in frontal and lateral projections.
Several stages can be identified in the development of hip curvature:
- slight deformation with a change in the angle of inclination by 2-5 degrees does not cause unpleasant sensations and gives no visible clinical signs;
- the average degree is already characterized by a significant curvature and leads to the fact that the patient has problems with performing some movements in the hip joint;
- severe deformity leads to shortening of the limb, complete blockage of rotational and rotational movements in the projection of the hip joint.
In adults, varus deformity often becomes a result of aseptic necrosis of the femoral head. Also, this pathology accompanies mucopolysaccharidosis, rickets, bone tuberculosis, chondroplasia and some other serious diseases.
Hallux valgus (femur)
Often diagnosed with juvenile and congenital hallux valgus of the femur, which is characterized by a rapid progressive course. When looking at a patient with such a deviation, it seems that he is bringing his knees together and is afraid to unclench them. X-shaped hallux valgus can be a consequence of hip dysplasia. In this case, the first signs of hip curvature appear at about the age of 3-5 years. Subsequently, the deflection angle will only increase due to the ongoing pathogenic processes in the cavity of the hip joint. Shortening of the ligaments and contraction of muscle fibers will exacerbate curvature and deformity.
Congenital deformity of the femoral neck in a child can be caused by the influence of the following teratogenic factors:
- pressure on the growing uterus from the side internal organs abdominal cavity or when wearing tight, squeezing clothing;
- insufficient blood supply to the uterus and growing fetus;
- severe anemia in a pregnant woman;
- violation of the ossification process in the fetus;
- breech presentation;
- transferred viral and bacterial infections to later dates carrying a pregnancy;
- taking antibiotics, antivirals and some other drugs without medical supervision.
Congenital hallux valgus of the femur is characterized by a strong flattening of the articular surface of the acetabulum and a total shortening of the diaphysial portion of the femur. X-ray examination shows the displacement of the femoral head anteriorly and upward with a curvature of the neck and shortening of the bone site. Fragmentation of the pineal gland may appear at a later age.
The first clinical symptoms of hallux valgus in children appear at the beginning of independent walking. The baby may have a shortness of one leg, lameness, a kind of gait.
The youthful type of pathology is that the hallux valgus begins to actively develop in adolescence. At the age of 13 - 15, hormonal changes in the body take place. With an excessive amount of produced sex hormones, the pathological mechanism of epiphysis (destruction of the femoral head and its neck) can be triggered. With the softening of bone tissue under the influence of the growing body weight of a teenager, hallux valgus begins with a deviation of the distal end of the femur.
At risk are children with obesity and overweight, leading a sedentary, sedentary lifestyle, addicted to carbohydrate foods. It is necessary to periodically show such adolescents to an orthopedic doctor for timely detection of the disease at an early stage of its development.
Symptoms, Signs, and Diagnosis
The clinical symptoms of hallux valgus and varus deformity of the femur are hard to miss. A characteristic deviation of the upper leg, lameness, specific positioning of the legs are objective signs. there are also subjective feelings that can signal such a problem:
- pulling, dull pain in the hip joints, occur after any physical exertion;
- lameness, dragging feet, and other changes in gait;
- feeling that one leg has become shorter than the other;
- dystrophy of the thigh muscles on the affected side;
- the rapid appearance of a feeling of fatigue in the leg muscles when walking.
Diagnosis always begins with an examination by an orthopedic surgeon. An experienced doctor will be able to make the correct preliminary diagnosis already during the examination. Then, to confirm or exclude the diagnosis, an x-ray of the hip joint is prescribed. If there are characteristic signs, the diagnosis is confirmed.
How is femoral deformity treated?
Hallux valgus of the femur in a child lends itself well to conservative methods of correction. But only in the early stages can the physiological state of the head and neck of the femur be fully restored. Therefore, when the first signs of trouble appear, you should seek medical help.
The following methods of manual therapy can be used to treat deformity of the femoral head:
- kinesiotherapy and remedial gymnastics are aimed at strengthening the muscles of the lower extremities and by increasing their tone to correct the position of the bone head in the acetabulum;
- massage and osteopathy allow, due to physical external influence, to carry out the necessary correction;
- reflexology starts the recovery process by using the body's hidden reserves;
- physiotherapy, laser treatment, electromyostimulation are additional methods of therapy.
Any correction course is developed individually. An experienced orthopedic surgeon should be consulted before treating a deformity of the femur.
In our clinic for manual therapy, each patient has the opportunity to receive professional advice from an experienced orthopedist completely free of charge. To do this, just make an appointment for the first appointment.
Varus deformity of the femoral neck- the basis is the shortening of the neck and a decrease in the cervico-diaphyseal angle. It is manifested by the limitation of abduction and rotation of the hip in the hip joint, lumbar lordosis and duck gait. Radiographically, the following deformities are distinguished: congenital isolated, childhood, adolescent and symptomatic. Congenital varus deformity is rare.
Have newborn shortening of the limb is determined, the greater trochanter of the thigh is located high. In the absence of ossification nuclei, it is difficult to make a diagnosis. When ossification sets in, then a bent neck and a shortening of the shaft of the thigh are found. The distal end of the femur is shown. The epiphyseal growth zone is located vertically, the femoral head is displaced downward and posteriorly, the acetabulum is flattened, the greater trochanter is coracoidly rearranged and stands high.
With children's varus deformations which develops before the age of 3-5 years, a triangular bone fragment is formed in the lower medial part of the femoral neck laterally from the growth cartilage zone, forming a picture with the upper vertical zone of enlightenment in the head and neck region, similar to an inverted letter "U". The course of the gap is usually tortuous, the bony edges are serrated, uneven, slightly sclerotic.
Further slit expands up to 10-12 mm, the neck is shortened, the head lags behind in development, shifts caudally and approaches the femoral diaphysis, the greater trochanter is located 4-5 cm above the upper edge of the acetabulum.
Youthful varus deformation is characterized by changes in the growth zone, and not in the bony part of the neck, as in the child's form. At an early stage, the enchondral growth zone expands, loosen up due to resorption of bone tissue. In the future, the femoral head begins to slowly and gradually slide down, inward and posteriorly, that is, epiphysiolysis of the femoral head develops.
Symptomatic varus deformity is caused by a pathological process of the femoral neck or its upper metadiaphysis.
Hallux valgus- deformation opposite to varus. It happens congenital and acquired. If normally the cervico-diaphyseal angle fluctuates between 115-140 °, then with hallux valgus it can approach 180 °, then the axis of the femur diaphysis serves as a direct continuation of the neck axis.
Congenital dislocation of the hip- population frequency 0.2-0.5%. It accounts for 3% of orthopedic diseases. The incidence of hip dysplasia is 16 cases per 1000 births. Dislocation is unilateral and bilateral in 20-25% of cases. Dislocation is based on hip dysplasia, which concerns all its components: the acetabulum (hypoplasia, flattening), the femoral head (hypoplasia, slowing ossification), the neuromuscular apparatus (developmental anomalies).
At congenital subluxation of the acetabulum underdeveloped, the head is in an eccentric position. Then congenital dislocation develops. The main clinical signs are: slipping symptom - Marx's symptom (a symptom of instability, clicking), limitation of hip abduction, asymmetry of the gluteal folds, shortening of the lower limb, and with the beginning of the child's walking - gait disturbance.
Main radiological symptoms: in the absence of ossification nuclei, the vertical line passing through the superior external protrusion of the acetabulum crosses the inner edge of the so-called beak of the thigh, which is more distant from the ischium than on the healthy side; the acetabular index (acetabular index) reaches 35-40 °; the ledge-like line of Menard - Shenton and the dashed line of Calvet are characteristic; the distance from the most protruding proximal femur to the Hilgenreiner line (acetabular line connecting both Y-shaped cartilages) is less than 1 cm.
With cores ossification, in addition to these symptoms, the following are revealed: the Hilgenreiner line crosses the head or is located below it; ossification on the side of dislocation is delayed, the point of ossification of the head is less, sciatic-pubic synchondrosis is open more widely, on the side of dislocation there is bone atrophy, deformation of the head, shortening and thickening of the femoral neck, antetorsion of the neck. The horizontal, drawn along the lower edge of the femoral neck, passes above the so-called teardrop, or Kohler's comma, the Maykova-Stroganova symptom is characteristic - the "crescent shape" is superimposed on the medial contour of the femoral neck, etc.
One of the rare anomalies in the development of femurs is their deformity according to the varus type. The disease occurs no more often than in 0.3-0.8% of cases among newborns. Along with the valgus curvature of the proximal femur, congenital varus deformity of the femur belongs to skeletal defects. It can lead to serious impairment of the functioning of the musculoskeletal system.
Description of varus deformity of the thighs
At the heart of the curvature of the hip joints according to the varus type is the shortening of the femoral neck and a decrease in the degree of the cervico-diaphyseal angle. Another name for the disease is juvenile epiphyseolysis, although in fact the latter is one of the forms of hip deformity and is very rare, only in adolescence. Changes in the hip joints with this pathology are significant - dystrophy of the spongy tissue of the neck, destruction of the bone, the formation of cysts, the phenomenon of fibrosis.
Deformity of the hip of the varus type includes a whole range of symptoms from the lower extremities. With this disease, the following symptoms can be combined:
- change in the shape of the articular heads of the pelvic bones;
- shortening of the leg;
- hip joint contractures;
- dysplasia, dystopia of the leg muscles;
- lumbar lordosis.
In a child with a deformity of the hip, a serious violation of the rotation and abduction of the leg is noted, so the gait becomes "duck". When an anomaly occurs in a newborn, the leg is shorter than the second from birth, and the trochanter of the thigh is higher than it should be. If the pathology is not treated for a long time, it continues to progress, ossification occurs. The femoral neck bends, the diaphysis is shortened.
When the deformity of the joint according to the varus type occurs at 3-5 years old, a triangular bone fragment appears in the femoral neck. Visually, the head and neck of the femur resemble an inverted U. The joint gap becomes convoluted, the edges of the bone are serrated, uneven, and foci of sclerosis appear in them. After the slit of the hip joint expands to 1-1.2 cm, the neck is shortened, and the head ceases to develop normally.
If, in the childhood form of varus curvature, changes are observed in the bone zone, then in the juvenile disorder there are in the growth zone. The latter is loosened, the bone is absorbed, the head slowly slides down. Therefore, the pathology is called "epiphysiolysis of the femoral head."
Causes of the disease
Usually, varus deformity of the congenital type becomes a consequence of intrauterine damage to the cartilage of the femur or a violation of the process of their compaction. In 2/3 of patients, the defect is unilateral, in other cases it is bilateral. Thus, the disease occurs due to various problems in the embryonic period, which can happen for the following reasons:
- severe infections of the mother during pregnancy;
- alcohol abuse, taking drugs, toxic drugs;
- poisoning, intoxication;
- advanced age of the mother;
- endocrine diseases;
- the effect of radiation.
As for the acquired forms, they can arise for various reasons. So, juvenile epiphysiolysis develops at 11-16 years old - during puberty, or precedes puberty. The femoral head begins to deform precisely against the background of a general restructuring of the body, when some parts of the skeleton are most vulnerable. It is believed that the cause of pathology in adolescents is hormonal disorders, therefore, other phenomena are also often noted in patients:
- lack of secondary sexual characteristics;
- delayed menstruation in girls;
- too tall;
- obesity.
Also, varus deformity of the femur is associated with trauma and rickets, with a number of systemic diseases - pathological fragility of bones, fibrous osteodysplasia, dyschondroplasia. Also, the cause of the pathology can be:
- unsuccessful hip surgeries;
- osteomyelitis;
- bone tuberculosis;
- osteochondropathy.
Symptoms of the disease
The childhood form of pathology usually begins to develop no later than 3-5 years, since during this period there is an increase in the load on the lower extremities. Parents may notice the following symptoms:
- lameness after long walking;
- pain in the legs in the afternoon with fatigue;
- inability to run for a long time, play outdoor games;
- discomfort in the thigh and knee, in the popliteal region;
- knee pain.
Over time, the leg on the affected side becomes somewhat thinner, hip abduction becomes more difficult, and more on the inside (on the outside, it can, on the contrary, increase). In a number of children, symptoms begin with pain in the knee, and it is not always possible to establish a connection with a lesion of the hip immediately.
Juvenile forms of hip deformity often do not give clinical signs at all, only in advanced cases do they begin to manifest themselves. There is a slight lameness, increased fatigue when walking. Some adolescents have a protruding stomach, there is a pathological lordosis of the spine. The strength and tone of the gluteus muscles are reduced. With bilateral lesions of the hips, the child begins to walk like a duck, waddling, swaying.
Classification of pathology
Due to the appearance and radiological signs, deformity of the femurs can exist in the following forms: children, youth, symptomatic, rickets, tuberculosis. Also, the disease is isolated or affects other joints, feet of the child. Another classification involves the division of the disease into three stages (degrees).
First degree of severity
At the first stage, pathological changes begin in the growth area of the femur. Gradually, it loosens and expands, but the pineal gland does not move.
Second degree of severity
At the second stage, there is a progression of the processes of restructuring of bone tissue and displacement of the pineal gland. The picture shows a thinning of the femoral neck, the fuzziness of its structure.
Third degree of severity
At the third stage, a complication of the pathology is already recorded - deforming arthrosis. There is also atrophy of the muscles of the lower limb and pronounced changes in gait.
Diagnosis of varus deformity
The most popular and informative diagnostic method is the x-ray of the hip joint. At the very beginning of the deformity of the femur, the heterogeneity of the bone mass in the area of the femoral neck is revealed. Later, other structural changes appear, as well as violations of the anatomy of the hip joint.
Examination by an orthopedist reveals abnormalities in adduction and abduction of a limb from one or both sides. In parallel, kyphosis, scoliosis, lordosis, wedge-shaped deformity of the vertebrae, and other disorders in the area of the knees, sacrum, ankles can be diagnosed.
Pathology treatment
In the early stages, conservative therapy helps well, later surgical treatment is used. Initially, as a rule, the patient is hospitalized for extremity traction (skeletal traction), after which the treatment is continued at home.
Conservative treatment
With a congenital form of pathology, conservative therapy is indicated for all babies up to 3 months of age. The goals are to normalize blood supply to the hip joint and accelerate bone recovery, improve tone muscle tissue, reducing the influence of muscles on the condition of the joint. For this, the following methods of therapy are performed:
- wide swaddling for 14 days, after - Freik's pillow for 2.5 months;
- solux, paraffin applications;
- from 6-8 weeks - electrophoresis on the joint area with calcium, phosphorus, with vasodilating drugs - on the area of the sacral spine.
Other forms of varus deformity are treated with the complete elimination of any load on the leg, strict bed rest. The patient is given a cast of the limb, traction with a load of up to 2 kg. Treatment can take several months, so it is often carried out in specialized sanatoriums.
Operation
If the processes of bone remodeling have already ended and there is a pronounced degree of deformity of the hip according to the varus type, surgical treatment should be planned. It will help lengthen the limb, restore the integrity of the articular surfaces and prevent the development of coxarthrosis.
In babies older than 3 months with contractures of the hip joint, surgery is also indicated. The goals are to create conditions for correct development the head of the bone and prevention of deformity of the cervico-diaphyseal angle.
During the operation, the adductor muscles of the thigh, the broad fascia of the thigh, and a number of tendons are dissected. Fibrous cords in the gluteal muscle are removed. In children from 3 years of age, a corrective osteotomy is additionally performed if there is excessive ossification of the femoral neck. The operation includes plastics of the cervix. It is performed in the second stage after the bone tissue has healed - a few months after the first intervention.
Rehabilitation treatment
After the operation, the patient must be prescribed a complex of exercise therapy, physiotherapy, and general restorative medication. Children use braces and other orthopedic devices. So, with a hip curvature in adolescents, the use of orthoses can last for several years. Dispensary supervision is carried out until the child reaches the age of 18 years.
If untreated, the pathology will progress steadily, which causes the formation of a false joint of the femoral neck (in 50-70% of cases). Further, coxarthrosis develops, which, ultimately, will require joint arthroplasty. With an early start of treatment, the outcome is often favorable.
