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Congenital dislocation of the hip joint. Congenital dislocation of the hip joint in children and adults: treatment and prevention Dislocation of the hip in children, symptoms and treatment

Congenital dislocation of the hip is a common pathology of the musculoskeletal system. Early detection and timely treatment are important tasks of modern orthopedics. Disability prevention is based on adequate therapy immediately after the diagnosis of the disease. Full recovery without the development of any complications is possible when treating children from the first days of life.

Congenital dislocation is found in one newborn out of 7000 examined. Girls are 5 times more likely to develop intrauterine anomalies than boys. Bilateral lesion of the hip joint is detected almost two times less often than unilateral.

If congenital dislocation is not diagnosed, or medical assistance was not provided, then conservative therapy will not be successful. In this case, it is possible to avoid the disability of the child only with the help of a surgical operation.

Characteristic features of pathology

The anatomical elements of the hip joint are the femur and the acetabulum of the pelvic bone, the shape of which resembles a cup. Its surface is lined with elastic but strong hyaline cartilage that has a shock-absorbing function. This connective tissue with an elastic intercellular substance is designed to hold the head of the femur within the joint, limiting movements with too high an amplitude that can damage the joint. Cartilage tissue completely covers the head of the femoral bone, ensuring its smooth sliding, the ability to withstand serious loads. The anatomical elements of the hip joint are connected by a ligament equipped with many blood vessels through which nutrients enter the tissues. The structure of the hip joint also includes:

• synovial bag;
• muscle fibers;
• extra-articular ligaments.

Anatomy of a healthy hip joint.

Such a complex structure contributes to reliable attachment of the femoral head, full extension and flexion of the articulation. With dysplasia, some structures develop incorrectly, which causes the head of the femur to shift in relation to the acetabular cavity, its slipping. More often, with congenital dislocation of the hip in children, the following anatomical defects are found:

• flattening of the cavity, leveling of its surface, modification of the bowl-like shape;
• defective structure of the cartilage at the edges of the cavity, its inability to hold the head of the femur;
• anatomically irregular angle formed by the head and neck of the femur;
• excessively elongated ligaments, their weakness, provoked by an abnormal structure.

Any defect causes dislocations, subluxations of the femoral head. When combined with poorly developed muscles, the situation is further aggravated.

Causes and provoking factors

Why there is a congenital dislocation of the hip joint, scientists still argue. There are various versions of the development of pathology, but each of them does not yet have a sufficiently convincing evidence base. It was found that approximately 2-3% of anomalies are teratogenic, that is, they are formed at a certain stage of embryogenesis. Several theories have been put forward about what can serve as an anatomical prerequisite for the onset of orthopedic pathology:

• premature birth, provoked by impaired blood circulation between the placenta and the fetus;
• deficiency of trace elements, fat- and water-soluble vitamins in a woman's body while carrying a child;
• hereditary predisposition, joint hypermobility caused by the peculiarities of collagen biosynthesis;
• trauma to a woman during pregnancy, exposure to radiation, heavy metals, acids, alkalis and other chemicals;
• trauma to the newborn during his passage through the birth canal;
• violations of the correct development and functioning of individual organs and systems of the fetus due to defective tissue trophism;
• sharp fluctuations in hormonal levels, insufficient or excessive production of hormones that affect the production of cells in bone and cartilage tissues;
• taking by a woman pharmacological drugs of various groups, especially in the first trimester, when the fetus forms the main organs of all vital systems.

All these factors cause the free prolapse of the femur from the acetabular cavity with a certain movement. Congenital dislocation of the hip joint should be differentiated from acquired pathology, usually resulting from injury or the development of bone and joint diseases.

Classification

Congenital dislocation of the hip in newborns is preceded by dysplasia. This term refers to the consequences of a violation of the formation of individual parts, organs or tissues after birth or during embryonic development. Dysplasia is an anatomical prerequisite for dislocation, which has not yet occurred, since the shapes of the contacting articular surfaces correspond to each other. There is no symptomatology of the pathology, and it is possible to diagnose changes in tissues only with the help of instrumental studies (ultrasound, radiography). The presence of a clinical picture is typical for the following stages of the disease:

When choosing a method of therapy, the site of the anatomical defect must be taken into account. With dysplasia of the acetabulum, it is localized in the acetabular incision. The anomaly is also found on the femoral head.

Clinical picture

Signs of congenital hip dislocation are not specific. Even an experienced orthopedist does not diagnose the disease only after examining the patient. Pathology may be indicated by different leg lengths due to displacement of the femoral head. To detect it, a pediatric orthopedist places the newborn on a horizontal surface and bends the knees, placing the heels at the same level. If one knee is higher than the other, then the child is shown further instrumental diagnostics. Pathology is characterized by the following clinical manifestations:

• asymmetric arrangement of the gluteal and leg folds. For examination, the doctor puts the newborn on its back, then turns it over on its stomach. In case of violation of the asymmetric arrangement of the folds and their unequal depth, there is a high probability of dysplasia. This symptom is also nonspecific, and sometimes is generally an anatomical feature. Large babies always have many folds on their bodies, which makes diagnosis somewhat difficult. In addition, sometimes the subcutaneous fatty tissue develops unevenly, and subsequently its distribution is normalized (usually after 2-3 months);
• an objective sign of the disease is a sharp, slightly muffled click. This symptom manifests itself in a supine position with legs apart. A characteristic click is heard when the injured limb is pulled to the side. The reason for its occurrence is the reduction of the femur into the acetabulum, the adoption of the anatomically correct position by the hip joint. The click also accompanies the reverse process, when the child makes a passive or active movement, and the head of the bucket slides out of the acetabulum. When children reach 2-3 months, this symptom loses its information content;
• in children with congenital dislocation of the hip joint, after 2 weeks of life, there is a limitation when trying to move the leg to the side. In a newborn, the ligaments and tendons are elastic, so it is normally possible to deflect its limbs so that they lie on the surface. If the joint is damaged, abduction is limited. Sometimes there is pseudo-limitation, especially when examining infants up to 4 months. It occurs due to the occurrence of physiological hypertonia, which also requires correction, but not as dangerous as a dislocation.

If, for any reason, the pathology was not diagnosed in a timely manner, then it can affect the soft tissues located near the thigh. For example, congenital dislocation in children older than one and a half years is clinically manifested by poor development of the muscles of the buttocks. The child tries to stabilize the hip joint and sways during movement, his gait resembles a "duck".

Diagnosis

In addition to clinical examination, instrumental studies are carried out to make a diagnosis. Despite the informativeness of radiography in identifying pathologies of the musculoskeletal system, ultrasound is indicated for newborns. Firstly, it is absolutely safe, since there is no radiation load on the body. Secondly, when conducting an ultrasound scan, it is possible to assess the state of all connective tissue structures with maximum reliability. On the images obtained, the bone roof, the location of the cartilaginous protrusion, and the localization of the bone head are well visualized. The results are interpreted using special tables, and the angle of inclination of the acetabular cavity serves as an assessment criterion.

Radiography is shown from 6 months, when the anatomical structures begin to ossify. When making a diagnosis, the trough angle is also calculated. Using X-ray images, it is possible to assess the degree of displacement of the femoral head, to detect the delay in its ossification.

Basic therapy methods

Treatment of congenital hip dislocation is carried out by conservative and surgical methods. When pathology is detected, splints are used in therapy to completely immobilize the limb. An orthopedic device is applied when abducting and flexing the hip and knee joints. The head of the femur is aligned with the cavity, and this allows the joint to form and develop correctly. The treatment carried out to the newborn immediately after the detection of the pathology is almost always successful.

Treatment of children under 3 months is considered timely. As the tissues ossify, the likelihood of a favorable outcome of conservative treatment decreases. But with a combination of certain factors with the help of a splint, a complete recovery of a child over 12 months is possible.

Surgery is also performed immediately after diagnosis. Orthopedists insist on intervention until the child is five years old. Intra-articular surgery with deepening of the acetabular cavity is indicated for children under 13-14 years of age. When operating on adolescents and adults using the extra-articular method, a cartilaginous rim is created. If congenital dislocation is diagnosed late, complicated by dysfunction of the joint, then arthroplasty is performed.

Early consequences of untreated congenital hip dislocation in adults. Pathology usually manifests itself after 25 years of pain syndrome, stiffness of the hip joint, often leads to loss of performance. To avoid such a development of events, only the examination of the newborn by a pediatric orthopedist and immediate therapy can help.

This is a dislocation of the femoral head from the acetabulum, caused by congenital joint inferiority. Dislocation of the hip, which was not diagnosed in infancy, is manifested by the lameness of the child during the first attempts to walk on his own. The most effective conservative treatment of congenital hip dislocation in children during the first 3-4 months of life. If it is ineffective or late diagnosis of pathology, surgical interventions are performed. Lack of timely treatment of congenital hip dislocation leads to the gradual development of coxarthrosis and disability of the patient.

General information

Dysplasia of the hip joint and congenital dislocation of the hip are different degrees of the same pathology arising from a violation of the normal development of the hip joints. Congenital dislocation of the hip is one of the most common malformations. According to international researchers, this congenital pathology affects 1 out of 7000 newborns. The disease affects girls about 6 times more often than boys. Unilateral lesion occurs 1.5-2 times more often than bilateral.

Hip dysplasia is a serious condition. Modern traumatology and orthopedics have accumulated quite a lot of experience in the diagnosis and treatment of this pathology. The data obtained indicate that in the absence of timely treatment, the disease can lead to early disability. The earlier treatment is started, the better the result will be, therefore, at the slightest suspicion of congenital dislocation of the hip, it is necessary to show the child to an orthopedist as soon as possible.

Classification

There are three degrees of dysplasia:

• Dysplasia of the hip joint. The articular cavity, head and femoral neck are changed. The normal ratio of the articular surfaces is maintained.
• Congenital subluxation of the hip. The articular cavity, head and femoral neck are changed. The ratio of the articular surfaces is disturbed. The femoral head is displaced and located near the outer edge of the hip joint.
• Congenital dislocation of the hip. The articular cavity, head and femoral neck are changed. The articular surfaces are separated. The femoral head is located above and away from the glenoid cavity.

Symptoms

The hip joints are deep enough, covered with soft tissues and powerful muscles. Direct examination of the joints is difficult, therefore, pathology is detected mainly on the basis of indirect signs.

• Click symptom (Marx-Ortolani symptom)

It is detected only in children under the age of 2-3 months. The baby is laid on his back, his legs are bent, and then gently brought together and bred. With an unstable hip joint, dislocation and repositioning of the hip occurs, accompanied by a characteristic click.

• Lead limitation

It is detected in children under one year old. The child is laid on his back, his legs are bent, and then, without effort, they are thrown to the sides. In a healthy child, the hip abduction angle is 80–90 °. Abduction restriction may indicate hip dysplasia.

It should be borne in mind that in some cases, limitation of abduction is due to a natural increase in muscle tone in a healthy child. In this regard, unilateral limitation of hip abduction is of greater diagnostic value, which cannot be associated with a change in muscle tone.

• Limb shortening

The child is laid on his back, his legs are bent and pressed against his stomach. With unilateral dysplasia of the hip joint, the asymmetry of the location of the knee joints is revealed, caused by the shortening of the hip on the affected side.

• Asymmetry of skin folds

The child is placed first on his back and then on his stomach to examine the inguinal, gluteal and popliteal skin folds. Normally, all folds are symmetrical. Asymmetry is evidence of congenital pathology.

• External rotation of the limb

The child's foot on the affected side is turned outward. The symptom is best seen when the baby is asleep. It should be borne in mind that external rotation of the limb can also be detected in healthy children.

• Other symptoms

Children over the age of 1 year have a gait disorder ("duck gait", lameness), insufficiency of the gluteal muscles (Duchenne-Trendelenburg symptom) and a higher location of the greater trochanter.

The diagnosis of this congenital pathology is made on the basis of radiography, ultrasound and MRI of the hip joint.

Complications

If the pathology is not treated at an early age, the outcome of dysplasia will be early dysplastic coxarthrosis (at the age of 25-30 years), accompanied by pain, limited joint mobility and gradually leading to the patient's disability. With untreated subluxation of the hip, lameness and joint pain appear at the age of 3-5 years, with congenital dislocation of the hip, pain and lameness occur immediately after the start of walking.

Treatment of congenital hip dislocation

• Conservative therapy

With the timely start of treatment, conservative therapy is used. A special individually selected splint is used to keep the child's legs abducted and bent in the hip and knee joints. Timely alignment of the femoral head with the acetabulum creates the normal conditions for proper joint development. The earlier the treatment starts, the better the results can be achieved.

It is best if treatment begins in the first days of the baby's life. The start of treatment for hip dysplasia is considered timely if the child is not yet 3 months old. In all other cases, treatment is considered belated. Nevertheless, in certain situations, conservative therapy is quite effective in treating children over 1 year old.

• Operative treatment

The best results in the surgical treatment of this pathology are achieved if the child was operated on before the age of 5 years. Subsequently, the older the child is, the less effect one should expect from the operation.

Surgery for congenital hip dislocation can be intra-articular and extra-articular. Intra-articular interventions are performed for children under adolescence. During the operation, the acetabulum is deepened. Extra-articular operations are shown to adolescents and adults, the essence of which is to create the roof of the acetabulum. Hip arthroplasty is performed in severe and late diagnosed cases of congenital hip dislocation with severe joint dysfunction.

Hip dislocations in children are almost always the result of indirect injuries. The femur plays the role of a kind of lever that negatively affects the hip joint. Dislocation is usually accompanied by the following injuries:

• tearing of the capsule in the joint;
• destruction or injury of the ligaments;
• exit of the bone from the cavity to the joint area.

Hip dislocations differ in type. There is a posterior hip dislocation, which occurs most often in car accidents. In this case, the leg is unfolded to the inside. Anterior hip dislocation is most often the result of a fall from a great height, during which the abducted limb turns outward in a bent position.

Symptoms

Signs of a dislocated hip in a child vary and always depend on the type of injury. A common symptom for all types of injuries is complaints of severe pain in the place where the hip joint is located.

With a posterior dislocation, the leg is turned inside out with the knee in a bent position. If the deflection is strong, a sciatic posterior dislocation may occur. With a slight deflection, the dislocation is usually of the iliac type.

With an anterior dislocation, the leg turns to the outside and is retracted to the side. It bends not only in the hip joint, but also in the knee joint.

There are several common signs of hip dislocation in a child. Among them:

• joint deformity, which can be easily identified visually;
• shortening of the limb on the injured side, both strong and not very;
• pain and discomfort, limitation of joint mobility.

During the lower posterior femoral dislocation, the sciatic nerve is often injured, and if the dislocation is anterior, the vessels are compressed. During the anterior lower dislocation, strong pressure is applied to the nerve endings, as a result of which there is an almost unbearable, acute painful sensation.

Hip dislocations are often accompanied by fractures, so a thorough examination is prescribed to establish an accurate diagnosis.

Diagnostics of the hip dislocation in a child

A dislocated hip in a child is determined without any difficulties. Diagnostics is carried out solely as directed by a doctor using special methods. In order to clarify the position of the femur, as well as to exclude possible bone damage, including fractures, X-ray is taken, preferably in two projections. If the diagnosis is in doubt, MRI of the hip joint is used as an additional diagnostic method.

Complications

If the child has an uncomplicated femoral dislocation, the prognosis for cure is quite favorable. Full recovery will occur immediately after the treatment of the disease and the recovery period. If the treatment of complicated dislocation was performed in a timely manner and correctly, complete recovery may also occur. But in this case, the likelihood of developing degenerative joint diseases in the future may arise. For example, arthritis or arthrosis.

Treatment

What can you do

Treatment of a dislocated hip in a child should not be done by a parent. Self-medication leads to serious consequences, including rupture of tendons and ligaments, damage to cartilaginous joints. If the dislocation is adjusted independently, and the person does not have the proper qualifications for such manipulations, during the period of the child's rehabilitation one leg may become shorter than the other.

All that parents should do in case of a dislocated hip in a child is to urgently call a medical ambulance and try to immobilize the victim before the doctors arrive.

What the doctor does

In the course of treatment, the doctor sets and fixes the hip joint, and then prescribes various additional procedures for the child, as well as a set of exercises from physiotherapy exercises.

Since during dislocation, as a result of a reflex, the large gluteal and femoral muscles are reduced, they are relaxed as much as possible before reduction. That is why the dislocation is reduced exclusively in stationary conditions and under anesthesia - this is considered mandatory.

Anterior, inferior, as well as posterior superior and posterior inferior dislocations are always adjusted according to the Janelidze method. It is considered one of the least traumatic, although quite painful. If old dislocations or fresh anterior and superior dislocations are repaired, the Kocher method is used. In this case, the Janelidze method becomes irrelevant, since when using it, there is a possibility of inflicting even more trauma on the child, namely, breaking the top of the femur.

In addition to dislocations that have occurred in a child due to indirect trauma, there are also congenital dislocations of the hip. This pathology is treated in two main ways: operative and conservative. If a child is diagnosed accurately and in a timely manner, only conservative therapy methods are used. During therapy, the child is fitted with a splint that supports the limbs in the required position. Conservative treatment of congenital dislocation must be performed until the child turns one year old, that is, until the dislocation is completely formed. If the diagnosis is not made on time, an operation is performed.

The femur should adjust smoothly and slowly. Abrupt movements can cause additional trauma to the child.

During the rehabilitation period after treatment, the child should use fortifying drugs prescribed by the doctor and perform various exercises, which are also made by a specialist in exercise therapy. The damaged area of ​​the thigh should be treated carefully and carefully. Physical activity during this period is prohibited, as it can adversely affect the recovery period of the child's body.

Prevention

In order to prevent hip dislocation in a child, it is necessary to monitor his safety, both in everyday life and when playing sports. Also, in order to prevent the occurrence of dislocations, it is necessary to develop the physical condition of the child, dress him in comfortable shoes that prevent falls, use special fixing protective equipment when playing sports. It is not recommended to travel in cars on ice.

Congenital hip dislocation is a fairly common disorder that, for a variety of reasons, is difficult to diagnose in the early stages. Nevertheless, the sooner it is determined, the sooner treatment is prescribed, the easier it will be to eliminate the pathology and reduce the risk of further changes. But disorders in the skeletal system are always very serious.

It is known that hip dislocation is up to ten times more common among girls than among boys. Perhaps this is due to differences in the structure of the hip joint. The joints in the pelvic region in women are, by definition, more mobile. Dislocation of the hip can be unilateral or bilateral. In the second case, both joints will be affected. Fortunately, bilateral lesions are less common. However, the treatment in both cases is no different.

For a long time it was believed that congenital dislocation of the hip joint is a consequence of injuries during the birth period, which means that the doctor's wrong actions. Less often talked about various inflammatory processes. However, recent studies of pathology have shown that its cause lies in the violation of the intrauterine development of the child - dysplasia.

Various factors can provoke a deviation, for example, infectious diseases of the mother during gestation, abuse of drug treatment, unfavorable environmental conditions in the place where the expectant mother lives or in the place of her work. All this negatively affects the process of fetal development, in particular, it can cause disorders in the development of the musculoskeletal system.

Dysplasia is a primary developmental disorder that inevitably leads to others. Underdevelopment of the pelvic bones leads to partial or complete dissociation of the joint surfaces, and the head gradually leaves the glenoid cavity. In addition, dysplasia significantly affects the rate of ossification, reducing it.

There are three degrees of dysplasia:

1. Disorders can affect only the glenoid cavity, while the neck and head of the femur are completely normal. In this case, it is too early to talk about dislocation.
2. Dysplasia plus congenital subluxation of the hip, when the head is somewhat displaced relative to the glenoid cavity, but has not yet fully emerged from it.
3. Congenital dislocation of the hip, when the articular surfaces are separated, and the head of the femur has come out of the glenoid cavity completely.

Possible complications

If congenital dislocation is not cured in time, then there is a risk of facing very serious complications both in childhood and in adulthood. First of all, children with this pathology, as a rule, begin to walk much later. At the same time, their gait is changed. With unilateral dislocation, the child limps on the sore leg, and with bilateral dislocation, his gait begins to resemble a duck.

Due to constant lameness and tilting of the body to one side, the child may develop scoliosis - rachiocampsis.

Naturally, an untreated hip dislocation causes a gradual deformation of the bone tissue, flattening of the joint bones, a decrease in the joint space, and further displacement of the joint head. In adults, such disorders are treated only by surgery and a complete replacement of the head of the joint with a metal analogue.

Symptoms and diagnosis of pathology

It is very important to diagnose a child's congenital dislocation of the hip joint in time. However, the diagnostic process is complicated by the fact that the hip joint lies deeper than any other. It is tightly covered with muscle and adipose tissue. This means that it is impossible to feel it with your hands. You have to rely on not the most accurate signs of the disease.

There are several symptoms by which one can suspect the presence of a dislocated hip already in the hospital, in the first days after birth. However, they are all very conditional, and, alas, are not at all obligatory. Therefore, newborns are examined very carefully. The first time it is done in the maternity hospital, the second time - in the first days after the mother and child return to their home, then at preventive examinations a month, six months and a year.

As a rule, after the child begins to walk, the presence of a dislocated hip becomes evident. But alas, this is already quite late. Bone changes have already begun, and it is problematic to correct the hip without consequences, this process is long and difficult.

The first thing an orthopedist does when examining a newborn is to put it on the back, bend the legs at the knee and hip joints and gently, without effort, spread it to the side. Normally, a child's legs in this position are divorced by 160-180 degrees. Dislocation of the hip significantly narrows this angle ... Especially if the defeat is bilateral.

However, it is important to remember that this position can be caused not only by a dislocation of the hip, but also by the temporary tone of the muscles of the child's legs. During the examination, this is quite natural, because the child is tense.

Another symptom of congenital hip dislocation is called Marx's symptom, or click symptom ... The doctor's actions will be similar to the previous option. However, in this case, more attention is paid not to how exactly the legs are bred, but to sounds. A dry click will be heard from the side of the dislocation. It is usually quite quiet, but can sometimes be heard from a distance.

If you put the child on his tummy and stretch his legs, then in the event of a dislocation of the hip, it will be possible to observe some asymmetry of skin folds on the buttocks. On the affected side, the fold can be located lower and have a greater depth.

Another symptom is shortened legs ... However, in the first days after childbirth, this is quite difficult to notice, since the difference in the length of the legs will be insignificant. In order to determine this symptom, the child is again laid on the back, the legs are bent at the knees and at the hip joint and they look at the knees. If they are at different levels, then a dislocation can be assumed.

It often happens that congenital dislocation also affects adjacent joints. In this case, it can be determined by the so-called external rotation of the lower extremities: the foot is turned out slightly .

Unfortunately, these symptoms may not appear. And they can talk about completely different diseases. Therefore, at the slightest suspicion of congenital dislocation of the hip, the child is sent for ultrasound and X-ray. This is the only way to reliably diagnose and start treatment on time.

As already mentioned, at an older age, hip dislocation can also be determined by an altered gait. In addition, several other characteristic symptoms can be found in the child, named after the researchers who identified the connection between the symptom and the disease. These include the symptom of gluteal muscle insufficiency (it is called the Duchenne-Trendelenburg symptom), the symptom of a non-vanishing pulse, and a number of others. But pain in children with hip dislocation is usually not observed.

How can I help my child?

There are two possible methods of treating congenital dislocation of the hip joint - conservative and surgical. Fortunately, even in severe cases of bilateral dislocation, with a timely diagnosis, as a rule, it is possible to do with a conservative method.

That is why he is considered the leader and consists in individual selection special tire , which fixes the legs of the newborn in one position: bent at the knees and in the hip joints and slightly spread apart to the side.

Thus, the head of the femoral joint is gradually reset into place. It is important that this happens slowly, without haste and harshness. Otherwise, you can damage the bone tissue, which will lead to even more problems.

It is believed that in the year the dislocation has already been thoroughly neglected, but even in such a situation they are trying to correct it using conservative methods. Only in very old cases they resort to surgery.

What else can you advise parents who are faced with the problem of congenital dislocation of the hip joint in their little child? Above all, be careful. Nowadays, various gymnastics and massage for children are in vogue, but it is important to understand that not all exercises and massage techniques are suitable for babies with congenital dislocation.

For massage in the case of such a pathology, a more thorough and intensive treatment of the lumbar and gluteal region is characteristic. Also, attention is paid to the hip joints. However, it is important not to make jerky, jerky movements.

Separately, it should be said about swaddling children. For a long time, tight swaddling was encouraged when the baby's legs are pulled together. It was believed that in this case, the legs would be straighter. In fact, this position of the legs for newborns is unnatural. Over the long months in the womb, babies get used to the bent-legged position. Tight swaddling is especially harmful for children with dislocation of the hip joint, but it does not have a positive effect on healthy children either. Moreover, for development at such a young age, movements are of great importance. Therefore, the ideal option would be to dress the child in rompers. If you still prefer to swaddle, then do not try to twist the legs as tightly as possible, leave the child the opportunity to bend and move them at will. Swaddling tightly will only aggravate the dislocation of the hip joint, interfering with the process of repositioning the head into the glenoid cavity.

Gymnastics for children with congenital hip dislocation

Gymnastics will not interfere with kids with such ailment. Below are some simple and effective exercises. Remember that they should all be done without any extra effort.

Exercise 1. Place the baby on the tummy. Lightly rub your buttocks and outer thighs. Now gently move the bent leg of the child to the side and fix it in this position.

Exercise 2. The baby is lying on its stomach. Take him by the ankles and bring your feet together, while your knees, on the contrary, should be divorced. Press the pelvis against the support.

Exercise 3. Place the baby on the ball with his tummy, so that he has to hold his legs in weight.

Exercise 4. Place the baby on the back. Gently and slowly bend and straighten your legs at the hip joints, and also spread them to the sides. This should be done carefully, in any case do not rush, do not tug on the child and do not press on the legs with force. Movements should be natural.

As you can see, this gymnastics is aimed at relaxing the muscles. It has a lot of static positions, fixations and slow, smooth movements. But fast and sharp ones are completely excluded. This is associated with the risk of further damage to the weakened joint.

Due to the deterioration of the environmental situation, the negligence of many women towards bearing a child, congenital dislocation of the hip is becoming more common. Doctors pay a lot of attention to the timely diagnosis of this problem in children. However, parents should fully rely not only on the opinion of doctors, but also on their own discretion.

Keep a close eye on your baby and if you suspect a congenital dislocation of the hip, contact your pediatrician right away. The doctor will examine the child and, if necessary, refer him to an orthopedist for examination. Only an attentive attitude towards the child from the first days of life guarantees the timely identification of the problem and the cure of the baby before the development of serious complications.

Fortunately, congenital hip dislocation is a common disorder, but it is quite easily corrected. Therefore, do not panic upon hearing this diagnosis. Just follow the doctor's prescriptions, and everything will be fine with your child very soon.

Consultation with a specialist about the signs of congenital hip dislocation in babies

Congenital dislocation of the hip in newborns is one of the most common malformations of the embryonic development of the musculoskeletal system. Pathology lends itself well to correction with early diagnosis: if the disease was detected no later than 3-4 months of life, conservative treatment is possible. With late diagnosis in children over a year old, only surgical correction is possible.

Dysplasia etiology

The exact causes of congenital hip dislocation remain unclear, however, most doctors identify a number of factors predisposing to the development of pathology, among which the most likely are:

• genetic predisposition;
• the consequences of infectious diseases suffered by the mother in the first and second trimesters;
• teratogenic effects of chemicals, radiation;
• breech presentation of the fetus;
• severe toxicosis, gestosis;
• intrauterine growth retardation;
• restriction of an intrauterine fetus as a result of an umbilical cord entanglement, a short umbilical cord, the presence of adhesions in the uterus, fibroids, or in case of large or multiple pregnancy;
• bad habits of the mother, as well as regular secondhand smoke;
• premature birth;
• fetal injuries sustained during labor or after childbirth.

Classification of pathology

Depending on the localization, unilateral or bilateral dislocation is distinguished: in the first case, one of the hip joints is involved in the pathological process, in the second case, both.

Depending on the severity of the pathology, the following types are distinguished:

• dysplasia of the hip joint - a change in the head, femoral neck and glenoid cavity while maintaining the position of the articular surfaces relative to each other;
• preluxation - pathological mobility of the femoral head, its free movement within the joint;
• congenital hip subluxation - in addition to the pathological mobility of the femoral head inside the joint, there is a violation of the location of the joint surfaces relative to each other;
• dislocation - the surfaces of the joint are completely separated, the head of the femoral bone is outside the acetabulum.

The main symptoms of congenital hip dislocation in children

Since newborns cannot yet perform voluntary movements, and the child begins to walk fully at the age of 1 year, it is rather difficult to assess the condition of the hip joints. Visual diagnosis of disorders is complicated by the fact that the hip joints lie deep and are covered with muscle tissue. Therefore, the primary diagnosis can be established on the basis of indirect signs:

• Max-Ortolani symptom (click symptom). You can determine the unstable position of the femoral head in the acetabulum by laying the child on his back and rotating the legs bent at the knees. When the legs are brought together and apart, the joint will fall out of the joint, and then return to its original position, while emitting characteristic clicks.
• Restriction of the possibility of abduction. As in the previous case, the baby is laid on the back, and the legs bent at the knees are bent neatly to the sides. The normal abduction angle of the limb is at least 80 degrees. If abduction is noticeably difficult, congenital dysplasia of the joint may be suspected. In some cases, abnormal abduction can be caused by increased muscle tone, so this symptom alone is not enough for a diagnosis.
• Shortening of the limb. You can check the asymmetry of the hip length by laying the baby on his back and bringing his legs bent at the knees to the stomach. Asymmetry of the knee joints may indicate a shortening of the hip due to the pathology of the hip joint. Visual asymmetry in the length of the legs extended and pressed against each other can also indicate a congenital dislocation.
• External rotation of the leg. When lying on the back in a relaxed state, for example, during sleep, there can be a large rotation of one of the limbs in relation to the axis of the body.
• Asymmetry of skin folds (primarily sub-gluteal folds). The developmental pathology can also be indicated by the Trendelenburg symptom - insufficiency of the muscles of the buttocks. If the infant has a pronounced asymmetry of the subgluteal folds, especially in combination with other symptoms, it can be assumed that there is a congenital joint pathology.

None of the above symptoms in themselves can be the basis for making this particular diagnosis.

In children over one year old who have begun to walk on their own, signs of pathology are already more eloquent: they include lameness, the so-called duck gait, visual shortening of one of the limbs.

Diagnostics

The success of the treatment of congenital hip dislocation directly depends on how early the defect was detected and its treatment started, therefore, it is necessary to undergo a scheduled examination by a pediatrician every month, as well as undergo an examination by an orthopedic surgeon at 1 and 3 months. In the presence of several symptoms, indirectly indicating the presence of pathology, instrumental diagnostic methods are prescribed:

• ultrasound examination of the hip joints,
• radiography of the femurs and pelvic bones.

Treatment of congenital hip dislocation in children

The earlier treatment is started, the higher the probability of complete elimination of the defect. Optimally, treatment should begin immediately after diagnosis and no later than 3 months of age. In other cases, treatment will be delayed, and the likelihood of a favorable outcome with conservative methods is significantly reduced.

Conservative treatment

It includes the constant wearing of a special individually fitted splint, which gives the legs a flexion at the knee and hip joints and a retracted forced position. The wearing period of such a tire is up to six months. Modern orthopedic splints are very lightweight, they lend themselves well to sanitary and hygienic processing. Physiotherapy is used as an auxiliary therapy:

• massage,
• paraffin therapy,
• electrophoresis.

Operative treatment

With a late diagnosis or in the absence of the desired effect from conservative methods, surgery may be prescribed for patients with congenital hip dislocation. It is believed that the best effect is achieved by an operation performed on a child under 5 years of age.

In children from one year old, the operation to reduce congenital dislocation is performed by the intra-articular method. The acetabulum deepens, and after surgery, a plaster cast is applied to the limb, the wearing period of which is determined individually and can reach 9 months.

In adolescents and adults, the operation is performed in an extra-articular way; during surgery, the roof of the acetabulum is formed from an auto- or allograft. There is also a less traumatic non-invasive method of correction - gradual skeletal traction.

Consequences of congenital hip dislocation in adults

If the pathology is not detected at an early age and adequate treatment is not carried out, in adolescence and adulthood, congenital hip dislocation can cause numerous complications:

• lameness,
• deterioration of limb functions,
• constant pain in the legs,
• formation of joint contractures,
• early arthrosis of the hip joint,
• aseptic necrosis of the femoral head.

Deterioration of the patient's condition can be observed during periods of hormonal changes: during puberty, during pregnancy and lactation.

Prevention and prognosis

The best prevention of congenital dislocation of the hip joint should be considered early diagnosis and regular monitoring by specialist doctors. If pathology is detected in the first weeks of a child's life and timely treatment, the probability of complete recovery reaches 100%. The later the defect is identified and the later measures are taken to eliminate it, the lower the likelihood of a favorable outcome.