Hip dysplasia in infants, symptoms and treatment

Hip dysplasia - a congenital inferiority of the joint that can lead to damage. Dysplasia in newborns is the direct cause of congenital dislocation of the hip. This pathology, in turn, may lead to a change in gait, chronic pain syndrome, and significantly limit the mobility of the future.

Of neonatal (newborn - is a child in the first 28 days of life) dysplasia is not concerned; parents and doctors identify the disease by external symptoms and not on the basis of the baby crying or anxiety. If the pathology is not treated in time - it leads to deformation of the musculoskeletal system, violation of the formation of the locomotor system and disability. The disease can affect one leg (usually), or both. Boys suffer hip dysplasia in 7 times less often than girls.

What it is?

To date, hip dysplasia is considered to be the most common disorders of the musculoskeletal system in newborns and infants. "Dysplasia" means "abnormal growth", in this case, one or both hip joints.

The development of disease is associated with impaired formation in utero basic structures of the joint:

• ligamentous apparatus;
• bone structures and cartilage;
• muscle;
• change of joint innervation.

More often than hip dysplasia in infants and treatment of this pathology is associated with changes in the femoral head position in relation to the bone of the pelvic ring. Therefore, medicine is a disease called congenital hip dislocation.

Treatment should begin from the moment of diagnosis of disease, the sooner the better, and before the baby starts to walk - from this moment appear irreversible complications. They are associated with increasing load on the joint head and bone outlet from the acetabulum fully offset upwards or sideways.

The child is formed changes in walking, "duck" gait, significant shortening of the limbs, compensatory curvature of the spine. Correct these violations only by surgery. When expressed changes in the joint baby for a lifetime can remain disabled.

Statistics

Hip dysplasia is common in all countries (2 - 3%), but there are racial and ethnic features of its propagation. For example, the incidence of congenital underdevelopment of the hip joints in newborns up to 4% in the Nordic countries, Germany - 2%, in the US it is higher among whites than blacks, and is 1 - 2%, among the American Indians dislocation hip occurs in 25-50 per 1000, whereas congenital hip dislocation hardly occurs in the South American Indians, the Chinese and the southern Africans.

Us incidence seen with ecological trouble. The incidence in Russia is approximately 2 - 3%, and in environmentally sensitive regions up to 12%. Statistics dysplasia is controversial. For example, in Ukraine (2004), congenital dysplasia, subluxation and dislocation of the hip occur from 50 to 200 cases per 1000 (5 - 20%) neonates, ie significantly (5-10 times) higher than in the same territory in the Soviet period.

It noted a direct correlation of increased morbidity and tradition of tight swaddling baby straightened legs. The peoples living in the tropics, not swaddled newborn, not to restrict their freedom of movement, wear them on the back (the child's feet are in a state of flexion and abduction) incidence below. For example, in Japan, in the framework of the national project national tradition of tight swaddling babies straightened legs was changed in 1975. The training program was aimed at grandparents, to avoid the traditional swaddling infants. The result was a reduction of congenital dislocation of the hip with 1.1-3.5 to 0.2%.

Most often, this pathology occurs in girls (80% of diagnosed cases), family history of the disease is approximately one-third. Hip dysplasia is 10 times more common in those children whose parents had signs of congenital hip dislocation. Congenital hip dislocation is detected 10 times more frequently in born breech fetus, usually during the first delivery. dysplasia is detected frequently at the medical correction of pregnancy, pregnancy complicated by toxicosis. Most affected left hip joint (60%), at least the right (20%) or both (20%).

Until the first half of the last century considered only severe form of dysplasia, congenital dislocation of the hip (3-4 cases per 1000 births). In those years, "light form" of dysplasia is not detected and treated. From 70 - 90 years. used the term "hip dysplasia", meaning thereby not only dislocated, but predvyvih and subluxation of the hip joint. incidence figures have increased ten-fold.

It should be noted that no clear standards and concern skip heavy orthopedic pathology is the cause of over-diagnosis (20-30% on predvyviha step). Dilemma "immature hip joint and predvyvih" usually resolved in favor of dysplasia, which increases the incidence figures.

Reasons dysplasia

Hypoplasia and malformation of the hip occur in violation of pre-natal development of the child in connection with violations bookmarks, development and differentiation of the musculoskeletal baby unit (4-5 weeks of fetal development before becoming a full-fledged walk).

Reasons for negative effects on the fetus and violate organogenesis:

• gene mutations, resulting in developing orthopedic abnormalities violations primary tab and the formation of defects in the hip joints of the embryo;
• the negative impact of physical and chemical agents directly on the fetus (ionizing radiation, toxic chemicals, the use of drugs);
• large fruit or breech presentation, causing the displacement of the joints due to violations of the norms of the anatomical location of the baby in the womb;
• disruption of water and salt exchange in the fetus during renal disease, intrauterine infections.

Factors that adversely affect the development of the fetus and cause the formation of dysplasia of the mother are:

• severe somatic diseases during pregnancy - heart dysfunction and vascular disease, severe kidney and liver, heart defects;
• vitamin deficiency, anemia;
• metabolic disorders;
• transferred severe infectious and viral diseases during pregnancy;
• unhealthy lifestyle, poor diet and bad habits (smoking, drug abuse, use of alcohol);
• early or late toxicosis.

The risk of developing this disease, promote early diagnosis of dysplasia in infants. While still in the maternity hospital neonatologist and pediatrician at the site watching the baby more active.

Included in this group are primarily preterm babies, big kids, in breech presentation, pathologically proceeding pregnancy and family history. It should be noted that the girls realized this pathology more often than boys.

Also, except for the true dysplasia in infants (violation of joint development) can manifest immaturity joint (of a slowdown), which is considered borderline state of hip dislocation joint.

symptoms dysplasia

When viewed grudnichka pay attention to the following features (see. Photo):

• the position and the size of the lower extremities;
• skinfold position in the hips (symmetrical or asymmetrical);
• muscle tone;
• volume of active and passive movements.

Hip dysplasia in infants manifested characteristic symptoms.

1. Limitation of hip abduction. Children's hip dysplasia evident presence retraction limit and 80 degrees or less. The symptom is more characteristic of a unilateral lesion.
2. Symptom slipping (synonym: click symptom). Child laid on his back, bending the legs in knee and hip joints at an angle of 90 degrees (Thumbs are placed on exploring the inner thighs, the other fingers - on the outside surface). When hip abduction carried pressing on the greater trochanter, resulting in reduction of the femoral head. The process is accompanied by the characteristic click.
3. External rotation of the lower limbs - sign, characterized by rotating the hip on the affected side outwards. It can occur in healthy children.
4. The relative shortening of the limbs. The symptom occurs in newborns is rare, there is a high dislocation.
5. Asymmetric position femoral and gluteal folds - is detected during the visual inspection.

Secondary (auxiliary) signs of hip dysplasia in the newborn:

• soft tissue atrophy (muscle) on the affected side;
• pulsation of the femoral artery is reduced by the joint dysplasia.

Rare cases of asymptomatic congenital hip dislocation.

The degree of severity of the TPA

1. Grade I - predvyvih. Deviation of development in which the muscles and ligaments are not changed, the head is inside a beveled joint cavity.
2. Grade II - subluxation. only a portion of the femoral head is inside the joint cavity, as seen it move up. Ligaments are stretched and lose their strength.
3. III degree - dislocation. The femoral head completely out of the basin and is located above. Ligament in tension and stretched and cartilage rim enters into the joint.

Diagnosing

The child signs of hip dysplasia in the form of dislocation can be diagnosed even in the nursing home. Neonatologist should carefully examine the child for the presence of such deviations in certain pregnancy complications.

The risk group includes children who are classified as major, kids with deformed feet and aggravated on the basis of heredity. In addition, attention is paid to toxaemia of pregnancy for the mother and the child's sex. Newborn girls are subject to mandatory inspection.

Survey Methods:

1. Ultrasound diagnosis - it is an effective method for detecting abnormalities in the structure of joints in children during the first three months of life. SPL can be carried out repeatedly and is subject to the examination of the newborn. Expert drew attention to the condition of cartilage, bones, joints, calculates the angle of the deepening of the hip joint.
2. Arthroscopy, arthrography held in harsh, severe cases of dysplasia. These invasive procedures require general anesthesia for more information about the joint.
3. CT and MRI provides a complete picture of pathological changes in the joints in different projections. The need for such a survey will appear in the planning of surgery.
4. Radiographs are not inferior to the reliability of ultrasound diagnosis, but has some significant limitations. Hip joint in children under the age of seven months is viewed poorly due to the low level of ossification of these tissues. Children first year of life is not recommended irradiation. Moreover, the baby bed movable under the machine in compliance with the rules of symmetry problematic.
5. Visual inspection and palpation conducted to identify the characteristic symptoms. In infants hip dysplasia has featured as dislocation and subluxation, which are clinically difficult to identify. Any deviations symptoms require more detailed tool inspection.

Effects

If left untreated, the early age it can threaten a child with serious troubles. Children develop limping while walking, it can be a barely noticeable and pronounced. Also, the baby can not take the leg to the side, or will do so with great difficulty. The child will disturb persistent pain in the knees and the pelvis with the possible misalignment of bones. Depending on the severity of dysplasia symptoms in children observed muscle atrophy varying degrees of severity.

Gradually, with the growth of the child, the consequences of untreated dysplasia will be compounded and expressed in the development of so-called "duck gait" when the baby rolls over from one foot to the other, sticking pelvis back. The motor activity of the child will be limited, which would entail the underdevelopment not only the rest of the joints, but also affect the work of all organs and overall physical development. In the future, the leg muscles are completely atrophied, man will begin to pursue the constant incessant pain. In adult patients the spine in the lumbar hyperlordosis. Also affects all organs located in the pelvis.

All this can be avoided if the time to begin treatment and comply with preventive measures.

Treatment of hip dysplasia in newborns

Modern conservative treatment of hip dysplasia in infants is performed on the following basic principles:

• give the final ideal to reposition the position (flexion and abduction);
• possible early start;
• preservation of active movements;
• Long-term continuous therapy;
• the use of additional exposure methods (physiotherapy, massage, physiotherapy).

It has long been seen by enough that the position of the child's legs in a retracted state, there samovpravlenie dislocation and centration of the femoral head. This feature is the basis of all the conservative treatment of existing techniques (wide diapering, pillow Frejka, Pavlik stirrups, etc.).

1. Without adequate treatment of hip dysplasia in adolescents and adults leads to early disability, and treatment outcome depends on the timing of the start of treatment. Therefore, the primary diagnosis is carried out still in the hospital in the first days of the infant's life.
2. Today, scientists and clinicians have come to a conclusion about the inadmissibility of the application in infants under six months age rigid fixation of prosthetic restricting movement in and bent aside joints. Saving mobility contributes to centering of the femoral head, and increases the chances of a cure.

Conservative treatment provides long-term therapy under ultrasound and X-ray examination.

Wide swaddling baby

Wide swaddling probably can be attributed not to the therapeutic and prophylactic measures in hip dysplasia.

Indications wide swaddling:

• children are at risk for hip dysplasia;
• during ultrasound newborn baby found immaturity of the hip joint;
• It has hip dysplasia, while other treatments are not possible for one reason or another.

Wide swaddling technique:

• child laid on his back;
• between the two legs paving diapers which will limit the reduction of legs together;
• these two diapers fixed to the belt of the third child.

Free swaddling allows to keep the baby's legs in a dilution of approximately 60 - and 80 °.

Massage and physical therapy

Exercise and massage is performed prior to feeding: these treatments stimulate blood circulation, improve nutrition of the hip joint structures. As a result of the processes of growth are stimulated cartilage and bone tissue, nerve conduction is enhanced - and the joint is formed correctly.

Massage movements performed smoothly and gently. Apply stroking, rubbing and kneading the thighs, buttocks and lower back. Newborn and spread to the back and stomach. Duration of massage - about 5 minutes. After the procedure, you can leave it to soak for some time in the stomach so that the legs hanging down on the sides. This further strengthens and hardens the body.

The complex of exercises exercise therapy or doctor chooses a pediatrician according to the degree of development of disease. Most often it is: allocating bent legs to the sides (contraindicated in sliding syndrome), flexion and extension in the hip and knee joints. Movements are performed very smoothly. The first time they are recommended to do in the water while swimming. Duration gymnastics - also about 5 minutes.

To deal with a newborn at home, parents have to attend courses of study massage and physical therapy at the clinic.

Wearing different orthoses

Pillow Frejka stirrups Pavlik and others. All this also helps to keep the child's legs in breeding and bent position. This method of treatment of hip dysplasia in infants appears to many parents blasphemous, because they have to constantly see the "chained" to her baby in the orthopedic spacers.

It is worth remembering that this measure is necessary, but temporary, and should treat it with patience and understanding. The initial discomfort for the child goes for about a week, then he gets used and does not feel discomfort from wearing tires. The duration of these devices determined by the physician based on periodic inspections and ultrasound diagnostics.

physiotherapy

A variety of physical therapy, which eliminate the inflammatory response, improve trophism joints and reduce joint pain. The most frequently used such procedures:

electrophoresis	using this procedure may be administered antiinflammatory and analgesic agents in joint cavity.
mud therapy	During this procedure, dilate blood vessels, whereby Uluchay blood flow in the joints.
Ultrasound	such treatment also has anti-inflammatory and absorbing effect.

Features care of newborns with dysplasia

With the right approach to treatment and care dysplasia in newborns is surmountable. If your baby has abnormal development of the hip joints, then he needs daily care and constant compliance with the special rules for transporting, feeding, lying down to sleep.

1. Hip dysplasia in newborns eliminates vertical load on feet.
2. If the child is in a supine position, his feet should hang a little, in a way better off the voltage from the thigh muscle.
3. Transportation of the vehicle in a special child seat, does not interfere with a wide breeding legs.
4. The correct position while carrying on his hands: Hold your baby in front of the back, with his feet firmly should you bow back.
5. Make sure that when feeding and a sitting, the hips were divorced as far as possible.

Hip joint - an important support element of the human skeleton. He is constantly exposed to heavy loads when moving heavy weights, running, long walks. Monitor the proper full-fledged development of this joint need from infancy, or in adult life disease still will have an effect, but to cure it will be much harder than in dysplasia newborns.

Reduction of congenital hip dislocation

Indications for reposition of congenital dislocation of the hip:

1. Child's age 1 year. Before this is relatively easy to reduce a dislocation using functional techniques (tires and orthoses cm. above). But a single unambiguous algorithm does not exist. Sometimes dislocation after 3 months of age is not possible to straighten any means other than surgery.
2. The child's age is not more than 5 years. At an older age usually have to resort to surgery.
3. Having formed hip dislocation, which is determined during radiography and / or ultrasonography.

Contraindications for closed reduction of congenital dislocation of the hip:

1. Expressed underdevelopment of the acetabulum;
2. Strong shift of the femoral head, the inversion of the joint capsule into the joint cavity.

Closed reduction in congenital dislocation of the hip is performed under general anesthesia. The doctor, guided by X-ray and ultrasound data, carries out reduction - return of the femoral head in the correct position. Then 6 months imposed koksitnaya (in the pelvis and lower limbs) cast that captures the child's legs in the dissolved state. After removal of the dressing is carried out massage, physiotherapy, physiotherapy.

However, some children after closed reduction of congenital hip dislocation relapse. The older the child, the greater the likelihood that eventually still have to resort to surgery.

pathology Prevention

If you do not want your dysplasia appeared grudnichka, you must follow certain precautions:

1. Vitamins, nutrition, light exercise during pregnancy.
2. Continuous implementation of recommendations of the doctor during pregnancy. An important element of the survey is ultrasound, which can show health problems at an early stage of fetal development.
3. Postpartum orthopedic examination, as well as holding the hip ultrasound.
4. It is necessary to eliminate the causes that can lead to disease and cause dislocation.
5. The use of therapeutic exercises and regular physical activity, which will help to raise and fix the bone in place.
6. Wearing grudnichka in a sling, and the use of wide swaddling.
7. If the diagnosis of "dysplasia" still put, you can not put the baby on the legs to the moment when the doctor will not allow.

Modern methods of diagnosis and treatment of hip dysplasia are far from perfect. In outpatient facilities (clinics) still cases of underdiagnosis (diagnosis has spread is not put in the time with the existing pathology), and overdiagnosis (diagnosis is healthy children).

It prompted a lot of prosthetic and surgical treatment options. But none of them was not entirely perfect. There is always a certain risk of recurrence and complications. The different clinics practiced different approaches to the diagnosis and treatment of disease. At present, we continue to actively conduct research.