Causes of joint dysplasia in an infant. Hip dysplasia in newborns and infants

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

What is hidden under the diagnosis of “dysplasia”?

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

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

• Pelvic diligence of the fetus. If the child spent the second half of pregnancy sitting on his butt and did not turn around, then it is more difficult for him to go through birth canal. Normal births are those when the baby is born with the head. It’s hard for a baby to push her butt. Therefore, the pelvic bones suffer and dislocations occur, which lead to dysplasia.

• Large fruit(about 4000 grams). The more a child weighs, the more difficult it is for him to be born. Pelvic bones experience strong pressure, and the head falls out of its place. Then it may be impossible to return to the place on your own.

• Heredity. Relatives or the mother herself had problems with the development of the hip joint or brittle bones. Then the risk of pathology increases.

• Gender of the child. Most often, girls are susceptible to dysplasia. Experts explain this feature by referring to the action of the hormone relaxin, which softens the hip bones of the pregnant woman and the fetus before childbirth. Girls are more susceptible to this process than boys. Therefore, the hip joints suffer more.

• You are expecting your first child. In first-time mothers, relaxin is released more than during all subsequent births. Therefore, softening of the fetal bones occurs more, which leads to the risk of joint dislocation in the infant.

• Negligent attitude of doctors. It also happens that obstetricians themselves, through their actions, lead to dislocation hip bones if the baby is being pulled too hard. But in such a situation, complications will arise not only in the pelvic, but also in the cervical and lumbar regions.

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

Symptoms indicating pathology

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

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

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

Contact your doctor without delay if:

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

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

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

Professional diagnosis of dysplasia in newborns

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

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

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

Treatment methods for dysplasia in newborns

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

What will help the baby and parents?

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

Wide swaddling of baby

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

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

Specialist massage, physiotherapy

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

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

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

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

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

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

Often the orthopedist also prescribes physiotherapy:

• calcium electrophoresis;
• heating with wax.

Special orthopedic gadgets

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

Operative method of treatment

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

The hip joints connect the largest parts of the human skeleton. They must be mobile and withstand heavy loads. Hip dysplasia in newborns disrupts the development of the musculoskeletal system due to incorrect position of the femoral head. Early detection of pathology and properly selected treatment will lead to the child’s absolute recovery.

Pathology is registered in an average of 3 percent of children. The disease is rare in southern countries, where it is not customary to swaddle babies tightly. Thus, in Japan, artificial restrictions on the mobility of newborns were abandoned, and the number of children with dysplasia decreased tenfold.

Hip dysplasia in newborns affects girls 4 times more often.

More than half of sick children suffer from a defect in one joint – the left one. In other cases, the right or both joints are weakened.

The causes of hip dysplasia in newborns include: hereditary predisposition– the disease can be transmitted through the maternal line.

In addition to genetics, there are other risk factors:

• Restriction of mobility in the mother's belly or in the baby using diapers;
• Excess progesterone in the last trimester of gestation;
• Severe toxicosis at the beginning of pregnancy and uterine tone throughout its entire length;
• Intoxication, including alcohol, drugs, pharmaceuticals;
• Incorrect position of the fetus (usually breech presentation) or its large size;
• Deficiency of valuable elements (especially calcium, phosphorus, vitamin E);
• Congenital defect of the acetabulum;
• Diseases of the expectant mother - chronic or infectious.

It is believed that joint problems can arise due to unfavorable environmental conditions in the place of birth.

What types and degrees of the disease exist?

In an infant, the ligaments are overly elastic and are not always able to hold the femoral head in the glenoid cavity. Under unfavorable circumstances, she takes an unnatural position. Depending on this, four main types of hip joints are determined in a child with several subtypes:

1. Normal joint
2. There are minor violations.
3. Subluxation of the hip.
4. Severe dislocation.

Most babies have type 2a. This is a mild degree of the disease, pre-luxation. The muscles and ligaments have not yet changed, but if treatment is not started, the disease will progress to more serious stages. With subluxation, the ligaments lose tension and the head begins to move upward. A dislocation will cause it to come out of the cavity, and the treatment will be lengthy, possibly even surgical.

The form of the disease also influences the therapeutic course:

• Acetabular, when due to the irregular structure of the cotyloid cavity, inversion of the joint, cartilaginous ossification and displacement of the femoral head occurs.
• Epiphyseal, characterized by poor joint mobility and severe pain;
• Rotational – with incorrect placement of bones in the plane, leading to clubfoot.

Each form can appear on either joint or both.

How to detect pathological changes?

Symptoms of the disease can be noticed even in the maternity hospital, in the first days of the baby’s life. A neonatologist examines the baby, taking into account risk factors and the severity of the pregnancy. Girls and large boys should be subjected to especially thorough inspection. But more often, hip dysplasia in children is detected by an orthopedist who conducts the first examination.

Symptoms of hip dysplasia in a newborn

The main signs of the disease that are easy for parents to detect:

Additional signs include a disorder of the searching and sucking reflex, abnormal pulse and flaccid muscles in the hips and pelvis, and torticollis. In older children, illness may be indicated by late standing on their feet, a “duck” gait, or problems with coordination of movements. If such symptoms appear, you should make an appointment with an orthopedist.

Hardware Research

The diagnosis is never made based on external examination and palpation. If a disease is suspected, it is necessary to conduct hardware tests.

The most effective diagnostic techniques include:

1. Ultrasound diagnostics. Allows you to identify pathological changes in children in the first months of life.
2. X-ray. It also gives an accurate result: deviations from the norm are visible on x-ray photos. But this procedure is not recommended for children under 1 year of age due to harmful radiation exposure.
3. Computed and magnetic resonance imaging. If necessary, operations are performed to obtain a complete picture of the condition of the joints in several projections.

Arthrography and arthroscopy allow us to judge the condition of bone surfaces, ligaments, and cartilage. Due to the complexity of their implementation, they are used only in the most unclear cases.

Very important differential diagnosis, because there are diseases with similar symptoms, but requiring other therapeutic techniques. These include paralytic hip dislocation, arthrogryposis, rickets, metaphyseal fracture, and epiphyseal osteodysplasia.

Treatment methods for the diagnosis of hip dysplasia in infants

Even if the joint defect is not too significant, therapy should be started immediately. Pre-dislocation can turn into dislocation.

In addition, treatment for a baby up to six months will be quick and effective; for the youngest, it is enough to undergo therapy for two months. The disease in children takes much longer to treat after a year.

Therapy

The therapeutic technique depends on the degree of neglect of the dysplastic process.

Methods for treating dysplasia in the first year of life include:

Method of therapy	How is it carried out?	At what age is it effective?
Wide swaddling	A folded diaper 16–21 cm wide is placed between the legs, bent at an angle of 90 degrees.	From birth to three months.
Pillow (feather) Freyka	A special roller, secured to the baby’s body with straps, secures the hips in an extended position. Like the previous method, it helps only in the mildest cases.	From birth to three months.
Becker's pants	Panties with a felt or metal insert in the gusset prevent the legs from being pulled together. They come in different sizes.	From one to nine months.
Pavlik stirrups	Bandage from soft fabric, also secured with straps, provides a therapeutic effect on the problem area without limiting the baby’s movements.	From the second month to a year.
Sling and ergo backpack	They allow the baby to be in the correct and comfortable position.	A sling - from birth, an ergo backpack - from five months.

Pavlik stirrups

In serious cases, fixing spacer splints are used. These can be elastic Vilensky and Volkov splints or plaster analogues with a distraction system. This therapy is intended for children under 3 years of age. Individual options are also used for older children, but usually as a safety net after surgery.

Closed reduction of a dislocation in the pelvic joint is performed in difficult cases in children under 6 years of age. For those who are older, such therapy will only do harm. Skeletal traction can help with severe pathologies in preschool children up to 7 years old.

The most advanced options, if it is impossible to solve the problem therapeutic methods, are treated surgically.

Surgical treatment

The operation can be open or endoscopic - it depends on the severity of the disease. Usually, if treatment for dysplasia is started on time, it is possible to manage with conservative methods.

The risks associated with surgery (bleeding, infection, and those associated with anesthesia) are minimal. However, at the time of the operation children, orthopedists should indeed take special careto avoid a condition called aseptic necrosis, atwhich head femur(hip ball) doesn't get enoughblood, condition,which could lead to improper growth bones.

Physiotherapy, exercises for hip dysplasia, massage

Gymnastics for hip dysplasia is aimed at flexion-extension, adduction-extension of the legs. Exercises can be performed at home, but exercise therapy should be recommended by an orthopedist, based on age and severity of the pathology.

Physiotherapy will reduce inflammation and pain, improve cell regeneration in tissues. To the most effective procedures of this kind include:

• Electrophoresis;
• Paraffin applications;
• Amplipulse therapy;
• Ultrasound;
• Magnetotherapy;
• Hyperbaric oxygenation;
• Acupuncture;
• Mud therapy.

Massage for hip dysplasia in newborns will strengthen the muscles and joint capsules. It must be done regularly six times a day before feeding. The newborn lies on his back, and the adult spreads his legs bent at the knees as far as possible and alternately straightens and bends them eight times.

What is the prognosis for recovery?

With timely initiation of orthopedic therapy full recovery absolutely real. But if you ignore the problem, the disease leads to severe complications and disability.

Without treatment, these children face high risk development of osteoarthritis in adulthood, with associated degenerative changes that cause chronic and progressive joint pain and stiffness.

Although the numbers are difficult to determine, some members medical community It is estimated that up to 50% of adults whose health conditions ultimately require hip replacement due to osteoarthritis have the disease as a result of an undiagnosed childhood, problems with the hip joint. In most cases, in adult patients, upon examination, hip dysplasia is also diagnosed.

Consequences of hip dysplasia in newborns:

• Dysplastic coxarthrosis;
• Neoarthrosis;
• Musculoskeletal dysfunctions;
• Problems with posture;
• Scoliosis;
• Flat feet;
• Osteochondrosis;
• Necrotic changes in the femoral head.

To prevent this from happening, the disease must be treated as early as possible. Better yet, ensure that the baby is born healthy. For the expectant mother You should avoid negative effects on the fetus and eat right. You need to swaddle the baby freely, so that nothing interferes with movement, and the diapers do not put pressure on the pelvic area.

As already noted, the earlier the disease is diagnosed and treatment begins, the higher the chances of a successful outcome: complete reduction of the hip dislocation, which is confirmed by x-rays and during physical examination. Children who have been treated for hip dysplasia should be seen by an orthopedist on a regular basis (the frequency is determined by the doctor, but most often every 3-6 months) until the skeleton is fully strengthened (until the child has finished growing) to ensure that normal development of the hip joint continues. In some cases, a hip dislocation that has been successfully corrected may still develop into dysplasia in subsequent years, requiring additional treatment.

Identify the problem on early stages A pediatric orthopedist will help and should examine the baby up to three months. He will advise you on what to do for any joint problems.

Remember that only a doctor can make a correct diagnosis; do not self-medicate without consultation and diagnosis by a qualified doctor. Be healthy!

Fixators for leg dysplasia in children Various different techniques treatment of dysplasia in children

Among congenital diseases The musculoskeletal system is distinguished by underdevelopment or incorrect arrangement of the components of the joints and cartilage. This is how hip dysplasia in infants is characterized.

Causes of dysplasia in children

There are many factors that provoke the development of dysplasia in newborns. Most of them appear during fetal development and are congenital. It has been proven that the predisposition to pathology is higher in infant girls.

In the first two months of pregnancy, the structure of the musculoskeletal system is formed, and if during this period the mother’s body is influenced by negative factors, then the likelihood of dysplasia in the baby increases.

Main reasons congenital dysplasia in infants:

• Genetic predisposition. If someone in the family has had cases of pathological development of the hip joint, then the likelihood of developing the disease in a non-congenital person increases by 40%;
• Hormonal imbalances during pregnancy. High level progesterone in the last trimester can worsen the condition of the baby’s ligamentous apparatus;
• Unbalanced maternal nutrition. Children's body cannot fully develop fully if there is a deficiency of vitamins and minerals;
• Hypertonicity of the uterus has negative impact on the formation of bones, ligaments and cartilage;
• Poisonous factors. Taking medications, bad habits, previous diseases and toxicosis of the mother affect intrauterine development;
• Often diseases musculoskeletal system appear in premature babies;
• The weight of the newborn at birth is more than 4 kg;
• The expectant mother is over 35 years old;
• Breech presentation of the fetus.

Infants can develop hip dysplasia if they are swaddled incorrectly or too tightly.

Symptoms of dysplasia in newborns

Already in the first months after birth, joint defects become noticeable. If you suspect dysplasia in a baby, you should immediately consult an orthopedist to clarify the diagnosis. Depending on the age of the baby, symptoms may vary:

• The femoral and gluteal skin folds are not symmetrical, which is especially noticeable when the baby lies on his stomach. With bilateral joint damage, this sign is not so noticeable;
• One leg is shorter than the other;
• The knee and foot turn outward when relaxing;
• A characteristic sound appears - a click when the bent legs are pulled apart;
• Limited movement of the joint, abduction of the leg to the side with a small amplitude;
• There may be muscle weakness on the side of the affected leg.

Attention!

Signs of dysplasia in newborns usually appear at the age of 3 months. But sometimes the disease becomes obvious at birth.

Main forms of dysplasia

In infants, the ligaments are very soft and elastic, which is why they cannot always hold the hip joint in place; then they take an incorrect position, which is dysplasia.

There are several forms of the disease, the treatment of which differs from each other:

• Acetabular. The structure of the main elements of the hip joint is disrupted, most often the marginal surface and limbus are affected, due to which the position of the joint changes significantly. This form of dysplasia limits the usual movements of the joint;
• Epiphyseal. This disorder is characterized by impaired mobility in the joint and severe pain;
• Rotary. Anatomical structure The joint turns out to be incorrect, which is why gait is disrupted and flat feet appear.

Also, the pathology can be of varying severity, the severity of the signs of dysplasia and, accordingly, its treatment depend on this. X-ray indicators of hip dysplasia, which are visible in the image:

• Pre-luxation is characterized by underdevelopment of the ligamentous apparatus, the femoral head is held in the acetabulum. This form of deformity rarely results in disability;
• Subluxation is a position in which the head of the femur is located in the socket, but partially protrudes from it. This is a borderline condition that develops against the background of signs of pre-dislocation;
• Dislocation is the last degree of deformation in which the head of the femur comes out of the socket, which leads to gradual curvature of the joint and negatively affects the mobility of the leg.

There are unilateral and bilateral hip dysplasia; in newborns, the latter option usually manifests itself - simultaneous damage to both femoral joints.

Interesting!

Hip dysplasia has an ICD-10 code - M24.8.

Diagnostics

To determine hip dysplasia in infants, it is necessary to show the child to an orthopedic surgeon a month after birth and at 3 months. If a joint pathology is suspected, an ultrasound examination is performed.

For children older than six months, an X-ray examination is allowed. Early diagnosis influences the choice of treatment and future prospects for recovery.

IN lately Computed tomography and magnetic resonance imaging began to be used. Such photos of hip dysplasia in newborns are absolutely safe.

Interesting!

Arthroscopy and arthrography are rarely used to diagnose hip dysplasia due to their difficulty in performing in infants.

The first signs of the disease in newborns can be noticed by doctors in the maternity hospital. Girls and large boys, as well as premature infants, are subject to especially thorough examination. Depending on the course of pregnancy and the collected medical history, the specialist must make a preliminary diagnosis.

To avoid mistakes, differential diagnostics is used, which will help determine current state human and distinguish dysplasia from other diseases with similar symptoms.

Treatment of dysplasia

Depending on the severity of the pathology and the age of the baby, different methods of treating hip dysplasia in newborns are used. You should not expect a quick recovery; the results of therapy will appear with careful and constant implementation of the specialist’s recommendations.

Treatment of hip dysplasia in children under one year of age is carried out using conservative methods without taking medications.

Wide swaddling

Doctors have found that tight swaddling has a negative impact on the condition of the musculoskeletal system of infants. With wide swaddling, the newborn's legs remain in the physiologically correct position, due to which the likelihood of dysplasia and its development becomes less.

Wide swaddling for hip dysplasia in newborns is used when affected mild degree from birth to 3 months. It is easy for parents to do at home. To do this, you need to place the newborn on the changing table with his back. IN groin area, between the legs bent in a natural position, you should put 2-3 diapers, rolled up with a roller, secure with a bandage, another diaper or panties.

This type of swaddling helps to form the correct position of the acetabulum and provokes independent reduction of the joint in the infant.

Use of fixing agents

The use of various splints for hip dysplasia allows you to fix the position of the baby's legs in an anatomically correct position - abducted to the sides and bent at a right angle at the ankle and femoral joints.

The spacers must fit the size of the newborn, so they should be adjusted as the baby grows.

The main types of fixing orthopedic devices for leg dysplasia:

• The Frejka pillow is used from birth until the age of three months. This is a special roller that keeps the hips apart. Used only for mild forms of the disease;
• The sling is used for both prevention and treatment. Carrying a baby in it is acceptable from birth; it allows him to be in a comfortable position;
• Becker's pants – orthopedic device, made in the form of panties with a metal or felt insert in the gusset that prevents the legs from being brought together. They differ in size, but are convenient to use. Can be worn from 1 to 9 months;
• Pavlik stirrups are a soft bandage with straps that do not interfere with the baby’s movement, but have a positive effect, returning the hip joint to its place. Used from 2 months of age to 1 year;
• An ergo backpack is used for the same purpose as a sling, but for children over 5 months.

Therapeutic gymnastics and massage

To improve blood circulation and strengthen the muscular-ligamentous system, massage and exercise therapy are used for hip dysplasia. They are carried out before feeding.

It is performed carefully and gently. Lightly stroking and rubbing the muscles of the thighs, lower back, and buttocks stimulates metabolic processes, 5 minutes of warming up the lower extremities.

Gymnastics for hip dysplasia in newborns is selected by the doctor, depending on the condition of the baby and the degree of damage to the joint. The main thing is to perform the movements slowly and smoothly; exercises can be done in water. The duration of such a workout is no more than 5 minutes.

Physiotherapeutic procedures

Physiotherapy improves the conduction of nerve impulses, relieves inflammatory process And pain syndrome, activates cellular metabolism. The following treatment methods are commonly used:

• Ultrasound therapy;
• Electrophoresis for hip dysplasia in infants delivers medications to the affected joint;
• Mud applications;
• Amplipulse (impact of simulated currents);
• Acupuncture.

Interesting!

Surgery in newborns is performed in in rare cases, usually in the absence of improvement with treatment. Due to the high risks and complexity of the operation, the operation is prescribed for children at least 3-5 years old.

Prognosis and complications

If treatment is not started immediately after the baby is diagnosed, then as the child grows older and begins to stand on his feet, the load on the joint will be distributed incorrectly. IN severe cases joint dislocation occurs, even if the baby initially had an initial degree of dysplasia.

In this case you will need surgery so that the patient’s condition improves and the joint regains mobility. The joint will no longer be completely healthy.

Interesting!

Some experts believe that about 50% of adults who experience osteoarthritis have suffered from undiagnosed hip dysplasia since childhood.

Lack of treatment for hip dysplasia in infants is dangerous; the following complications may occur:

• Scoliosis;
• Flat feet;
• Necrosis of the femoral head tissue;
• Osteochondrosis;
• Pathologies of the spine, legs and pelvis that prevent normal functioning musculoskeletal system.

Treatment of hip dysplasia in babies under 3 months is the most effective, more than 90% of cases full recovery articulation functions. If therapy is started after six months, the chances of recovery become much lower.

Preventive measures

Treating a disease is always more difficult than preventing it. Prevention of hip dysplasia in infants includes simple manipulations that will prevent the development of pathology.

Pregnant women should carefully consider their health status, plan their diet wisely and take vitamin preparations. After birth, the child should be examined by specialists in order to notice the disease at the earliest stages.

It is necessary to avoid tight swaddling, which can aggravate joint problems. For hip dysplasia in an infant, wear the baby in a sling facing the mother.

Be sure to follow special gymnastics and massage aimed at improving joint function. But you can’t “rush” the baby: put him on his feet early age, sit him down until he himself begins to assimilate these movements.

Having understood what hip dysplasia in newborns is, it becomes clear that it is serious pathology which requires immediate treatment. The first symptoms in a baby can be noticed by maternity hospital doctors or parents; the diagnosis is made at the age of 3-6 months. The therapy used helps prevent the deterioration of the young patient’s condition, improve the quality of life and prevent the development of complications in later life.

1. HIP DYSPLASIA IN NEWBORNS

Congenital dysplasia in a newborn baby is pathological change structures of the hip joint during intrauterine development of the fetus , which can lead to underdevelopment and improper functioning of the femoral head after the birth of the baby. There are dysplasia of 1, 2 and 3 degrees ( preluxation, subluxation and dislocation of the hip- see photo below).

Dysplasia refers to very serious deviations in the development of the child’s musculoskeletal system. Every minute after the birth of a baby with hip pathology is precious. It is important that an ultrasound of the joints be done while a baby with suspected congenital dislocation of the hip is in the maternity hospital. If you do not promptly refer the baby for examination to an orthopedist and do not start , then the child may become disabled!

IMPORTANT!

According to statistics, congenital hip dysplasia occurs 5 times more often in girls than in boys. This pathology is often observed in children with low weight at birth (less than 2400 g) and in babies who are born in breech position .


What typical signs of this disease in a newborn baby can a mother pay attention to:

The perineum is clearly visible if you bring the baby's legs together;

On one of the baby’s hips there is an extra fold of skin and one leg is slightly shorter than the other (with a unilateral dislocation);

If you bend the baby's legs towards the tummy, you can hear a characteristic click.

2. CONGENITAL PRELOSSATION OF THE HIP JOINT IN A CHILD

Preluxation is grade 1 dysplasia in a newborn, in which the hip joint is not fully formed, but the head is not displaced relative to the acetabulum.

Reasons for the development of pathology:

(1). Incorrect position of the fetus in the womb during pregnancy;

(2). Genetic predisposition;

(3). Hormonal imbalance a pregnant woman or a history of illness during pregnancy;

(4). Premature baby. Or the baby's birth weight is too low.

Symptoms of grade 1 dysplasia in a newborn:

- the symptoms of the pathology are mild. There is no asymmetry of the folds on the buttocks and the baby’s legs do not differ in size from each other.

But there are signs that indicate pre-dislocation without special equipment. To identify underdevelopment of the joint, place the child on his back, lift his legs up and bend them at right angles at the knee joints, and then slowly move them apart. If the baby has a pre-dislocation of the hip joint, then you will feel a slight push with your hand - this is the femoral head entering the acetabulum. If such a symptom is detected, then an ultrasound should be done and x-ray examination baby's hip area.

Treatment for hip dislocation:

√ from the moment the pathology is identified, wide swaddling of the newborn baby is used . The hip joints are fixed using a diaper folded into a 20-centimeter rectangle;

√ if swaddling does not securely enough hold the femoral head in the acetabulum, then other methods of fixation are used - Freik's pillow, spacer splints;

√ therapeutic exercises, physiotherapy, therapeutic massage;

√ Fixation of the hip joint continues until grade 1 dysplasia is completely eliminated. As a rule, a child with preluxation begins to learn to walk later than their peers and only after complete recovery from the disease.

√ in rare cases, when a pre-dislocation threatens to develop into a dislocation of the hip joint, surgery is indicated.

3. SUBLUXATION OF THE HIP JOINT OF A NEWBORN

Subluxation of the hip joint in a child is called partial displacement of the femoral head relative to the acetabulum (grade 2 dysplasia)



Causes of grade 2 hip dysplasia in a newborn:

(1). genetic predisposition to pathology of the musculoskeletal system;

(2). delay in the formation of the joint in the fetus during the mother’s pregnancy;

(3). toxicosis and infectious diseases in a pregnant woman ;

(4). late age for the birth of a child from both parents;

(5). endocrinopathy in women;

(6). breech presentation of the developing fetus on later pregnancy;

(7). a mother's diet that does not contain the components necessary for the development of cartilage and connective tissue of the fetus.

Symptoms of hip subluxation:

- the inability to completely spread the legs of a baby lying on his back to the sides (if the joints are normal, then the child’s spread legs can touch the surface);

One of characteristic symptoms dysplasia of the 2nd degree in a newborn - the folds of skin on the thighs are asymmetrical. On a subluxated hip they are located higher. There are more folds there and they are deeper;

If you spread the baby's legs to the sides, you can feel a click with your hand on the side of the subluxation, as the femoral head is reduced into the acetabulum. At the moment of bringing the legs together, you can again feel a click and a slight wince from the pathology;

One leg may be slightly shorter than the other;

When the baby sleeps, you may notice an unnatural position of the foot (turned to the side).

Treatment of dysplasia 2 degrees:

√ is largely similar to the treatment of hip dislocation in a child. The sooner the pathology is detected, the more successfully methods for fixing the displaced femoral head will be implemented. Maybe the best option Pavlik stirrups will be used for fixation problem area hips.

√ After a period of joint fixation, the orthopedist will examine the condition of the baby’s hip area and prescribe course of therapeutic exercises and physiotherapy.

4. DISLOCATION OF THE HIP JOINT OF A NEWBORN

Congenital dysplasia of the 3rd degree is a complete displacement of the femoral head relative to the acetabulum of the underdeveloped hip joint in a child.

Causes of grade 3 dysplasia:

(1). hereditary predisposition;

(2). abnormal position of the fetus in late pregnancy ;

(3). disturbances in the development of joint tissues in the first trimester of pregnancy;

(4). infectious and gynecological diseases, exposure to toxic compounds on the fetus, uterine fibroids;

(5). effects of the hormone oxytocin on development joint tissue fetus and on the tone of the thigh muscles.

Symptoms of hip dislocation:

- the baby’s leg is shorter on the side of the dislocation;

The legs of a baby lying on his back are spread apart with a noticeable restriction. If you bring your legs together, you will feel a click on the side of the dislocation;

The folds on the hips of a newborn baby are not symmetrical relative to each other.

Treatment of pathology:

√ If you begin to treat grade 3 dysplasia promptly with the help of soft pads that abduct the hips, then in 3-4 months you can successfully reduce the dislocation. In any case, suitable devices for fixing the hip joints are prescribed by an orthopedist. Self-medication is unacceptable and can lead to serious disorders of the child’s musculoskeletal system;

√ after successful reduction of the dislocation , the doctor prescribes a course of treatment, including therapeutic massage, physiotherapy and a set of daily exercises to strengthen the joints in the hip area;

√ in some cases, surgery is indicated if conservative treatment of dysplasia is unsuccessful. It is necessary to do an ultrasound and x-ray of the problematic hip area. In any case, surgery to eliminate the dislocation is a last resort treatment option.

Hip dysplasia in a newborn - serious problem, requiring qualified and integrated approach. Early detection of the disease increases the effectiveness of therapy many times. What does the effectiveness of treatment depend on? Swaddling: benefit or harm? The role of parents at the stage of diagnosis and therapy. You will find answers to these questions in the article.

A bit of geometry

First, let's deal with the main question - a diagnosis of hip dysplasia in children has been made, what is it?

The shape of the hip joint is spherical. Movements are carried out in 3 planes (sagittal, frontal, vertical). The joint consists of:

• Articular head. This is the head of the femur.
• Acetabulum. Has a crescent shape.
• Vertabular lip. A cartilaginous plate that serves protective barrier from displacement of the head upward outside the joint.
• Joint capsule. Connective tissue, forms a hermetic cavity due to the weaving of its fibers into the structures of the joint.
• Ligaments and muscles. Keep all elements of the joint in the correct position.

Normally, the articular head occupies a mid-position in the capsule. The angle formed by 2 lines (1 line along the femur, 2 parallel to the socket) is 90º. This ensures even pressure distribution.

In the picture on the left is normal, on the right is dysplasia (dislocation) of the hip joint in a child

With the correct development of the components of this complex system, functional problems do not arise. But if something goes beyond the norm, hip dysplasia develops in the newborn.

In other words, dysplasia is the inferiority of structures.

If untimely and inadequate therapy occurs, serious complications in the form of subluxation, dislocation of the joint. Treatment is complex and not always 100% successful.

First symptoms: what to look for?

Everyone looks at their sleeping baby with tenderness. But often a child’s sleeping position can tell a lot. When the baby sleeps, his muscles are relaxed, he lies on his back with his legs spread wide apart. In some cases, with pronounced muscle tone () or problems with the joint, the child’s arms and legs are compressed.

Parents often wonder and worry that their baby has uneven legs. However, we hasten to reassure them and note that this shape of the legs at this age is necessary conditions For proper development joint

How to determine hip dysplasia in newborns? For this purpose orthopedist conducts mandatory routine examinations of children. The first time in the maternity hospital, then every month, at 3 months, at six months and a year.

Signs and diagnosis of hip dysplasia in children

The folds on the legs are located asymmetrically

To do this, the child is placed on the table, first on his back. The inguinal folds are examined, their severity (depth) is noted by the symmetry of the level of placement on both legs.

Next they turn over onto their stomach. The gluteal and popliteal folds are assessed. On the leg where the problem is fixed, there are more folds and they are deeper. When diagnosing hip dysplasia in a newborn, the photo shows a clear picture of the location of the folds. This method is informative from 2 months of age.

Take this test not worth a panacea. Because there are cases of completely healthy children with asymmetry of the folds. If bilateral hip dysplasia is diagnosed in an infant, the folds, on the contrary, are symmetrical.

One leg is shorter than the other

The child is placed on his back. The doctor bends the legs at the hip and knee joint. If the level of one kneecap is lower - this is a bad prognostic sign. Occurs when a dislocation occurs.

Clicking symptom

Diagnostic symptom of dislocation. The baby lies on his back, the legs are flexed at the hip and knee joints and taken to the sides.

This is done without pressure! At a certain moment, the doctor feels a characteristic click. The reason is that the head goes beyond the socket. This test is additional, since in 4 out of 10 newborns examined it will be positive, although the children are completely healthy. Information content decreases with age.

Legs abducted to the sides

The baby lies on his back, legs are bent in the same way as described in the previous test, and moved to the sides. Normally, the outer side of the leg should touch the table. This may not be the case with muscle hypertonicity.

You can detect dysplasia in a child up to one year old on your own at home. But To 100% confirm the diagnosis, you must conscientiously visit a pediatric orthopedist within the time allotted for scheduled inspection.

X-ray examination hip joint of a child is more indicative after a year

If symptoms of hip dysplasia in children are detected, in this case, additional examination is carried out to clarify the diagnosis.

For these purposes, ultrasound and radiography are used. Ultrasound is prescribed more often in children under one year of age, because At this age, cartilage is not yet visible.

Reasons: good information content at an early age, nothing threatens the child’s health, unlike radiation exposure during radiography.

In more complex clinical situations, X-ray diagnostics are performed. To decipher it, certain lines are drawn and angles are measured.

What are the causes of hip dysplasia in newborns?

Let us note the main cases.

• Antenatal (intrauterine) period. Toxicoses. Taking medications.
• Childbirth. Breech presentation. This position of the fetus is challenging task, requires skilled labor management. Often, in order to avoid complications during breech presentation of the fetus, C-section. A large fetus (more than 4 kg) is also at risk.
• Genetic predisposition. In 30% of cases, this disease is hereditary.
• Tight swaddling. The baby is swaddled, arms and legs are tightly wrapped in diapers. The legs are aligned - this is highly undesirable!

With this swaddling method, the necessary conditions for normal development joint structures are reduced to zero, which is fraught with consequences. Hands can be swaddled, but legs - under no circumstances.

What will the statistics say?

• Hip dysplasia in a newborn occurs more often in girls. In this case, there are several hypotheses. The main one among them: “it’s about the hormone relaxin, which is produced in the mother’s body during childbirth. Its task is to soften the ligaments and bones necessary for the baby to pass through the birth canal. It is believed that girls’ bodies are also sensitive to the influence of the hormone.”
• The right joint is most often affected.
• Residents of the tropics have a low incidence rate, while Scandinavians, on the contrary, have the highest.
• If parents are diagnosed with the disease, the risk of developing the disease in children increases 10 times.

Main forms of the disease

• Impaired development of the acetabulum. It takes on a flattened, beveled appearance. Accordingly, the head of the femur, due to the altered anatomy, cannot be maintained in the median position (which is the norm). In addition, in infants, the ligaments are very elastic. This leads to the formation of subluxation and even more dangerous complication such as a dislocation.
• Problems associated with developmental disorders proximal part femur. To diagnose this form, the neck-diaphyseal angle is determined, the value of which varies depending on age.
• Dysplasia due to changes in bone geometry in the horizontal plane.

Treatment

Examination and therapy (when the first symptoms are detected) are carried out by a pediatric orthopedic surgeon.

Massage for hip dysplasia in newborns is performed to improve blood circulation and eliminate muscle hypertonicity.

The course consists of 10-15 procedures. Repeat after 1-1.5 months.

Execution technique

• The baby is lying on his back. Stroking outer surface thighs and shins, then proceed to rubbing these areas. Make it the main one and index finger spiral kneading movements. Without much pressure, but you should press deeper to improve trophism in the muscles and ligaments.
• The baby is turned over on his stomach. Stroking lumbar region, outer thigh. Rub these areas with spiral movements.
• Next, the buttocks are massaged. Local massage is performed on the dysplastic area. The joint is fixed with one hand, and the leg is abducted with the other, rotating the thigh inward.

After carrying out the stroking, rubbing, kneading movements described above, 3 main exercises are performed for hip dysplasia in newborns.

Execution technique

1. The child lies on his back. Alternately bend and unbend each leg.
2. Move the leg bent at the knee to the side (without pressure). Up to 10-15 repetitions at a time and up to 300 repetitions/day.
3. "Bike". Use your feet to imitate a child riding a bicycle.

Note that Exercise therapy for hip dysplasia in children is important and an effective element of treatment. Electrophoresis helps saturate bones with calcium ions. The procedure lasts up to 5 minutes. Carry out under the supervision of a doctor.

To treat hip dysplasia in newborns, by holding the legs apart, Pavlik stirrups, Becker panties, and Freik's pillow are most often used.

Pavlik stirrups are most often used for up to 3 months, then in combination with Volkov splints.

In case of a serious form of the disease, the method of hip reduction with overlay is used. plaster cast(performed for children aged 2 to 5 years).

Devices for conservative treatment hip dysplasia

After 5 years, use open surgical method reduction.

Consequences of hip dysplasia in children

1. Limitation of mobility in the joint.
2. Severe inflammatory process.
3. Severe pain syndrome.
4. Lameness.

In the absence of adequate diagnosis and rational treatment, dysplasia can cause disability.

5 steps to prevent the development of the disease

1. Complete refusal of swaddling. The baby is dressed in ordinary clothes.
2. Using diapers. When Evgeniy Olegovich was asked what is a preventive measure for hip dysplasia in a newborn, Komarovsky replied that wearing a diaper every day is not only helping parents, but also good prevention diseases.
3. Use of kangaroo backpacks and slings.
4. Proper carrying of the baby. When the little one begins to hold his head confidently, parents can carry him in vertical position"Push". One hand holds the little one at chest level, the other holds the feet with knees bent and legs apart.
5. Swimming on your tummy. Hydro procedures are very useful. The baby, overcoming the resistance of water, develops different groups muscles.