The physiological immaturity of the hip joints is dangerousPhysiological immaturity of the hip joint is a common problem that many mothers of newborn babies face. Very scary mother terrible word "underdevelopment", which sounds like a sentence. Do not be upset! This pathology is quite serious, but is amenable to correction. Timely diagnosis and corrective measures help, in most cases, to reduce the consequences of underdevelopment to a minimum. In order to help the baby recover, it is necessary to understand the cause of the problem with the joints. First of all, it is worth noting that the term "physiological immaturity" means that this process occurred due to a number of "natural" causes and the severity of the course of pregnancy in the mother. Some physiological features of the hip joints in newborns arise from violations of motor activity of the embryo and fetus even before birth. The organism of the child as a whole and its separate organs in particular can be considered mature when their physiological functions correspond to the calendar age.
Physiological immaturity of the hip joints is more common in premature infants. Such babies differ from donors not so much anthropometric data, as physiological characteristics. It should be noted that even in normal hip joints in newborns are immature structure.
The immaturity of the joint does not allow the thigh bone to fix in the nest of the pelvis
Thus, among the predisposing factors of the development of joint pathology, the following can be distinguished:
- genetic predisposition;
- pelvic fetal presentation;
- Pregnant Toxicosis;
- during pregnancy of certain medications;
- gynecological diseases of a pregnant woman;
- large fetus;
- multiple pregnancies, etc.
Underdevelopment of hip joints in newborns often leads to the emergence of various forms of dysplasia, as well as dislocation or subluxation of the head of the femur.
The main symptoms of the pathology and diagnostic methods
Preliminary diagnosis of "immaturity of the hip joints" can be delivered to the baby even in the hospital. If this happens, then the baby's parents are sent for examination of the pediatric orthopedist. Do not delay the trip to the doctor! The most effective treatment is the children of the first year of life. The fact is that the ossification of the femoral head takes place at the age of 7-9 months, and this process is faster for girls than for boys.
The differential diagnosis is determined by the orthopedist on the basis of examination, a survey of parents and visualizing methods of research. The most accurate diagnostic data is given by ultrasound of the hip joint in newborns or ultrasonography. After 3 months, fluoroscopic examination is possible, which is also quite informative. There is a definite ultrasonic classification, which allows to determine the degree of maturity of the joints( according to the graph).
According to this classification, type 2a according to the Earl in premature infants and children up to 3 months of age indicates an immature dysplastic joint, and this condition requires observation in dynamics. If a similar pattern is observed in children over the age of 3 months, the child needs appropriate treatment.
Explicit symptoms of pathology are most pronounced in children aged 2-3 months. Some signs in children of the first month of life can be considered a variant of the norm. Among other things, it is common to identify the main symptoms of immaturity of the hip joints:
- shortening of the hip on the affected side;
- muscular hypotension;
- asymmetry of skin folds;
- limitation in the lead of the joint;
- is a symptom of a "click"( or Marx-Ortholani).
An accurate diagnosis can be made only if there are several diagnostic signs, since some of them may be false. Asymmetry of skin folds in babies of the first month of life can go to 3 months by itself, shortening of the thigh may be absent in bilateral lesions, and the symptom of Marx-Ortholani is found in half of the newborns, but by 3 months it passes without any outside interference.
Correction of dysplasia with immature hip joints
There are many methods of treatment and correction of this pathology. The most common method of conservative treatment is to hold the baby's legs in a certain position( bending and retracting).To this end, use:
- overlapping tires;
- orthopedic devices;
- of the Pavlik stirrup;
- special cushions;
- wide swaddling.
When treating infants, it is necessary to pay attention to the next moment. Attachments for holding the limbs in the desired position should not cause the baby discomfort and completely limit his movements. This is very important for the child's well-being.
Of great importance in the process of recovery are massage and physiotherapy. For each kid, the specialists select an individual complex of exercises and a specific massage technique aimed at strengthening the muscles. Such procedures are carried out, as a rule, in specialized offices at polyclinics. However, the orthopedist can show parents a series of exercises that they can do themselves at home.
If conservative therapy is ineffective, then a decision is made to correct the dislocation, followed by fixation with a plaster bandage. Such treatment is used in children aged 2 to 5 years. After 5 years, such treatment is not possible. In particularly severe cases, surgical intervention is possible. During the operation, an open dislocation of the dislocation is performed.
It is necessary to treat the recommendations of specialists with all responsibility. The consequences of untreated dysplasia can manifest themselves in childhood and adolescence, and at an older age. Dysplasia of the hip joints is the cause of the development of dysplastic coxarthrosis of the hip joint in people aged 25-55 years.
It is important to realize that the earlier treatment is started and pathological changes in immature hip joints are eliminated, the more favorable is the prognosis.
Treatment of immaturity of the hip joints in infantsVery often from moms one can hear that the crumb was diagnosed as "immature hip joint".This refers to the slow development of the articulation, as well as the incorrect formation of the joint. There is also a disease like hip dysplasia in newborns, and many mothers often confuse these two ailments.
The difference between these two diseases is significant. Dysplasia is a congenital hip dislocation, and immaturity is a hypoplasia in the hip joint of the so-called ossification nuclei. Dysplasia is immediately detected in a newborn, whereas immaturity can only be said from the age of three months when the formation of joints occurs.
Causes and signs of the development of the disease
There are a number of reasons for the development of the disease, which every mother needs to know about. If a woman wants to give birth to a healthy child, she should take care of her health and the health of the baby already during pregnancy. The reasons for immaturity or dysplasia are as follows:
- inadequate and unbalanced nutrition of a woman during pregnancy;
- lack in the body of pregnant calcium and vitamins;
- bearing of a child at a later age;
- threat of miscarriage;
- infectious diseases during pregnancy;
- incorrect fetal position in the womb;
- hereditary predisposition to the disease;
- difficult delivery.
It is desirable for young parents to know in advance which main signs can be used to judge the presence of the disease. Periodically inspect the legs of babies. If the legs can be sideways by 170 °, then the child is all right. But if the angle of the tap is smaller, there is an occasion to turn to the orthopedist. Remember: the legs should be sideways to the same distance.
You need to worry if there is a difference between the length of the baby's legs, asymmetrical creases in the buttocks and groin. If during the movement of the legs of your child parents hear a sound that looks like a click, it is necessary to visit the orthopedist urgently to identify or eliminate immaturity.
The earlier the immaturity of the hip is revealed in the baby, the more likely it is that the disease will be treated successfully.
How to cure a toddler
footrest If your child is diagnosed with hip joint immaturity, do not rush to despair, and immediately get treatment. In the early stages of the disease with the help of special tires, the legs are bred to the sides. This method of treatment is not suitable for children who are more than six months old, that is why it is desirable to identify the disease at an earlier date. The method is very effective and stimulates the correct development of the joint.
You must take vitamins. Orthopedist will prescribe you vitamin therapy, course and dosage. Treatment of this ailment is not without a special kind of massage, which will be done by specialists at your clinic.
Also an experienced doctor will show you how to do daily therapeutic exercises at home. The complex of exercises includes:
- "bicycle"( flexing and unbending legs);
- dilution of the legs in the hip joint and bringing them to their original position;
- rotational foot movements.
The complex of exercises must be performed with each change of diaper. Each exercise is done 15-20 times during one lesson. The complex should be carried out by placing the child on a firm and level surface. A bed or a sofa is not suitable for this. The orthopedist can prescribe electrophoresis with phosphorus or calcium or magnetotherapy. All these procedures significantly improve blood circulation in the hip joints.
Wide diaper fixes the legs in the correct position.
. Excellent prevention in the fight against immaturity and dysplasia is a wide swaddling. Young mothers, of course, heard about this method, but do not have a clue how this is done. All will tell and will show on an example of the orthopedist. There is nothing complicated. A dense flannel diaper is folded in a triangle. This triangle is laid down by a right angle. Then the baby wears a diaper. The baby is laid on a diaper and the legs are bent at 80-90 °.One end of the diaper wraps one foot of the baby, and the other - the second. The lower corner of the diaper is fixed on the abdomen. Then with one more diaper swaddle the baby, as usual.
The child's recovery depends on the parents. Timely visit to an orthopedic doctor, adherence to his recommendations and a daily set of exercises will help your child to recover as soon as possible and enjoy life with you.
Hip dysplasia in children
Hip dysplasia is an innate hypoplasia of the hip joint with a violation of its functions.
It is found in about 3 out of 100 newborns. Girls suffer from it 5 times more often than boys. Dysplasia of the hip joints is found on all continents of the globe, and the frequency of its appearance does not depend on nationality and race.
For a long time it was believed that congenital disorders in the structure of the hip joint are less common in the peoples of Africa and Asia than in Europe. In fact, this is not the case, the frequency of pathology formation in the prenatal period is the same, but the number of newborns that have persistent violations in the hip joint as they grow up, in countries with warm climates is actually less. This is due to the traditional way of wearing the child on the back or thigh with the legs apart and the absence of tight swaddling and cramped cradles.
Symptoms of hip dysplasia
All symptoms of hip dysplasia can be divided into 2 large groups:
observed in newborns( 0 to 12 months);
characteristic for children older than 1 year.
Symptoms of the disease in newborns
Underdevelopment and prelux of the hip joints is very meager. And more often it is found out casually at preventive survey at the pediatrist or the orthopedist. With careful observation of the newborn, mild asymmetry of the gluteus and popliteal folds, stiffness and discontent of the child can be noted when trying to spread the legs bent in the hip and knee joints, to the sides. When ultrasound is observed later the formation of nuclei of ossification in the head of the femur. On X-ray images, you can detect a slight flattening of the roof of the acetabulum, slanting of the outer margin.
Subluxation and dislocation of the hip joint is characterized by a richer clinical picture.
It is characterized by the following symptoms:
a "click" symptom;
limitation of the legs;
is a symptom of Erlacher;
asymmetry of popliteal and submagodular folds;
relative shortening of the foot on the affected side;
turning the leg outward.
The best time for diagnosis is the first week of a newborn's life. During this period, the physiological hypotension of the muscles of the lower limbs predominates, therefore it is quite easy to determine all the pathological symptoms. After the 7th day of life neurologically healthy babies develop physiological hypertonia and some manifestations of subluxation and dislocation can be overlooked.
The "click" symptom of is determined at the moment when the doctor or parent attempts to dilute the child's bent knees in the sides in the hip joints. The head of the femur that has emerged from the joint cavity with a characteristic crunch enters back into the joint. When the legs are brought back, a click is heard again, which means that the hip is again outside the joint.
Limited dilution of legs helps to determine subluxation and dislocation of the hip joint in almost 100% of cases, when studying this symptom in children without pathology of the nervous system on the 5th-7th day of life. If the legs are divorced by 50-60%, this is a sure sign of trouble in the hip joint.
The Erlacher symptom is checked as follows: the straight leg of the child in whom a subluxation or dislocation is suspected leads slowly to the opposite healthy leg. And then they also gradually bring a sick leg to a healthy leg. Normally, the leg crosses the opposite limb in the lower or middle third of the thigh, with severe forms of hip dysplasia that occurs in its upper third.
Asymmetry of the skin folds of the should be checked both in the position of the child lying on the back and on the abdomen. Attention is not drawn to the number of skin folds, which can normally differ on both extremities, but to the depth and height of their location.
The relative shortening of the of the leg is detected as follows: the newborn is laid on the back, the legs are bent at the knee and hip joints, the feet are pressed against the couch. The level at which the knees are in relation to each other is assessed. Normally they should be at the same level. If one of them is lower, this indicates a relative shortening of the leg.
With a congenital dislocation of the thigh, the diseased leg is unnaturally turned outward, this is determined when the leg is straightened in the hip and knee joint in the supine position.
Symptoms in children after 1 year
In children after 1 year, dysplasia of the hip joints is easy to detect, because at this point, difficult to diagnose mild forms of the disease disappear or become more severe.
There is a limping on the aching leg, and with a bilateral dislocation of the thigh - a duck walk. There is a significant decrease in the size of the gluteus muscles on the diseased side. At the pressure on the heel bone in the position of the child, lying on the back with straightened legs determines the mobility of the limb axis from the foot to the very femoral joint.
Causes of development of hip dysplasia
Three theories of development of hip dysplasia can be distinguished:
infringement of a bookmark of fabrics at an embryo;
exposure to hormones.
Disturbance of laying of tissues in the embryo
For the first time the rudiment of the hip joint appears in the human embryo for 6 weeks of intrauterine development. Movement in this joint is possible already with the 10th week of pregnancy. Under the influence of external and internal damaging factors, the formation of joint elements is disrupted.
For external reasons, the following may be referred:
chemicals, including some medicines;
The most important internal damaging factor is the virus diseases transferred by the mother in the first trimester of pregnancy, including influenza, rotavirus infection.
There is a high incidence of hip dysplasia in parents who have suffered from this disease. Among all cases of this pathology, the disorder of the structure of the hip joint, due to a variety of genetic factors, is approximately 25%.
Dysplasia of the hip joints is often found in conjunction with congenital myelodysplasia - a disease that is based on a violation of the formation of blood cells in the red bone marrow. Perhaps this is due to the fact that the red bone marrow located in the pelvic bones, undergoing a pathological process, disrupts the development of the acetabulum.
By the end of pregnancy in the female body, there is a high level of the hormone progesterone, which has a relaxing effect on ligaments, muscles and cartilaginous tissue. This is necessary for the mother's pelvis to prepare for childbirth. However, progesterone is able to penetrate the placental barrier and enter the fetal bloodstream. This leads to a softening of the ligamentous apparatus and capsule of the hip joint, which can cause its incorrect formation. The development of this condition can contribute to the anomalies of the fetal position, as well as heavy births in the leg and breech presentation.
Hip dysplasia is divided into 4 severity levels depending on the severity of changes in the joint components:
The mildest degree is the immaturity of the components of the joint tissues. It is defined as the state between the disease and the transient characteristic of a healthy joint. Most often observed in premature infants. Children born on time may also have immaturity of the hip joint. This is especially true for low birth weight infants whose mothers suffered from feto-placental insufficiency during pregnancy.
The next in severity is pre-exertion. It is based on a change in the shape of the acetabulum, but the femur does not leave the limits of the joint, in addition, its structure itself is not subject to change.
When subluxation can mark the change in the shape of the head of the femur, it moves inside the joint to its very border, but never goes beyond it.
Congenital dislocation is the most severe degree of hip dysplasia. The structure of the joint is grossly disrupted. There is a strong change not only in the shape of the articular cavity, but also in the femur, ligaments, muscles and articular sac. The head of the femur leaves the articular cavity and is located behind its anterior or posterior margin.
Detection of hip dysplasia at the stage of underdevelopment and pre-severity presents great difficulties.
In children who are not 3 months old, the following methods are used to diagnose:
a questioning of the mother of the child;
Survey of the mother helps to find out the course of pregnancy, the infections transferred in this period, the existing hereditary diseases. During the examination, attention is drawn to the presence or absence of characteristic symptoms.
For children up to 6 months old, the hip joint examination is performed using ultrasound. It includes 2 phases: static, during which the fixed joint is studied, and dynamic, performed with passive movements of the child's legs in the hip joint.
ultrasound can determine the degree of ossification of the head of the femur, the stability of the joint during movement. In a healthy child, the size of ossification nuclei in millimeters corresponds to the age in months, for example, 1 month to 1 mm, 2 months to 2 mm. If the diameter of the points of ossification does not correspond to physiological norms, this can talk about dysplasia.
At present, there is mandatory screening of hip joint ultrasound for all children aged 1.5 months.
X-ray examination is performed by newborns older than 6 months, as well as children at any age, with suspicion of subluxation and dislocation. X-ray images can accurately determine the structure of the bone components of the joint. The radiologist determines the angle of the acetabulum and, on the basis of additional lines, estimates the location of the femoral head.
Treatment of hip dysplasia in children
The choice of this or that technique in the treatment of hip dysplasia directly depends on how much the articular elements are changed.
Hemorrhage of the hip joints
If this pathology does not give any clinical manifestations, including, does not cause difficulty in breeding the legs of the child, then conservative methods are used:
wide swaddling without the use of orthopedic devices;
therapeutic gymnastics aimed at movements in the hip joint;
Treatment is carried out for a month, after which the child is sent for repeated ultrasound and x-rays. If the immaturity of the joints is accompanied by the restriction of the dilution of the legs, it is recommended to wear the tire-struts according to the type of the pillow of Freik with repeated control after 1 month.
In both cases, foot fixation is accompanied by a daily complex of physical therapy, a course of massage and physiotherapy( electrophoresis with calcium, paraffin baths, saline baths).
Treated conservatively. To keep the legs in a dilute state, orthopedic devices are used: Freik's pillow, abduction tires, Pavlik's stirrups. Massage, physiotherapy and physiotherapy are also used.
Subluxation and dislocation of
With this severity of hip dysplasia, the application of plaster casts is applied, which fix the legs in the desired position. The duration of wearing a cast is determined individually.
In case of ineffectiveness of conservative methods, severe acetabular lesions, as well as in late diagnosis, operative treatment with restoration of the normal shape of the hip joint and fixation of the elements entering into it is indicated.
Author of the article: Polyakova Elena Anatolievna, pediatrician, specially for the site ayzdorov.ru
Hip joint immaturity in newborns
Hip dysplasia in newborns is a disease of the musculoskeletal system manifested by congenital dislocation of the hip. At the same time, if there is a delay in the appearance of sites of ossification in the articulation, then we are talking about the physiological immaturity of the hip joint.
Both these pathologies must be identified as early as possible, when conservative treatment methods are still effective.
Causes of Underdevelopment
Why does physiological immaturity and hip dysplasia develop? Most experts believe that dysplasia of the hip arises due to a violation of the primary tissue bookmarking in the early stages of intrauterine development.
Nevertheless, there are also many causal factors that can lead to physiological immaturity( underdevelopment) or hip dysplasia in newborns:
- Insufficient nutrition of the expectant mother during pregnancy.
- Various diseases during pregnancy( especially in the early stages).
- Breech presentation.
- Complicated delivery.
- Hereditary predisposition.
Special attention should be paid to the balanced nutrition of the mother. Lack of intake of vitamins of group D, B and E, and also such microcells, as calcium, phosphorus and iron, can adversely affect the health of the baby.
Clinical picture and diagnosis
A clinical examination helps to identify the immaturity or hip dysplasia in a newborn. First of all, in addition to regular consultations with the supervising pediatrician, it is necessary for the parent to closely monitor his child. Characteristic clinical signs that allow one to suspect this pathology:
- Impossibility of withdrawing the child's legs by 170 °.
- Asymmetric folds on hips and buttocks.
- Some shortening of the leg on the side of the lesion.
By severity of clinical symptoms, one can judge the severity of the disease. Timely detection of immature hip joints in newborns significantly increases the chances of recovery.
If the symptoms persist during treatment, then at the age of 1.5 months it is recommended to perform ultrasound. At an older age, the use of additional instrumental examination methods, including radiography and magnetic resonance imaging, is not ruled out.
After the diagnosis is made, a choice is made for a method of treatment that directly depends on the nature of the pathological changes and the severity of the disease. When using dressings, tires, orthopedic devices are guided by the following principles:
- Ensure a gradual adjustment of the dislocation of the hip.
- Hold the child's legs in the retracted position.
- Mobility in all joints should be preserved.
- Avoid ghosting and unbending legs.
- Have the opportunity to change the position of the legs in the process of treatment and provide adequate care for the child.
As a rule, with underdevelopment or dysplasia of the hip joint, the newborn begins treatment with a "wide swaddling", the principle of which should be explained and shown by the doctor. Children over the age of 1.5 months go to special tires, stirrups and other orthopedic structures.
Also can be prescribed massage, physiotherapy and physiotherapy( electrophoresis, paraffin).To correct this pathology, paraffin has proven itself.
Paraffin wax can be applied at home. Only in this case it is necessary to use a special medical paraffin, purchased at the pharmacy. The pediatrician should tell how correctly and without damage to the health of the child to make applications with paraffin.
Independently without prior consultation with the attending physician to apply paraffin for dysplasia or underdevelopment of the hip joint in a newborn is strictly not recommended.
The regime of a child with dysplasia, who started treatment in the first 2 months of life, usually does not differ much from healthy babies. Nevertheless, there are some recommendations:
- It is better to wear a child with divorced legs.
- Do not forget about doing gymnastic exercises.
- It is not necessary to teach early walking, let alone use additional devices( wigs, walkers, etc.).
Children who started treatment at an older age, after taking off the tire, continue to exercise LFK, go for massage and physiotherapy( electrophoresis, paraffin).
Surgical treatment of congenital dislocation of the hip is resorted when it is impossible to perform a closed approach and if the conservative approach is ineffective. Often, late diagnosis of underdevelopment or hip dysplasia becomes the main cause of surgical intervention.
Significantly reduce the risk of development of immaturity or hip dysplasia in newborns will help correct management of pregnancy and childbirth. First of all, it is necessary to exclude the effect of harmful factors on the fetus.
In addition, an essential role is played by the balanced nutrition of the expectant mother. Among other important preventive measures it should be noted:
- Conducting an optimal examination of newborns, identifying children from risk groups and further supervising them in polyclinics.
- Recommend a wide open swaddling.
- From 1.5-2 months of age, wear a baby on the abdomen with dilated legs.
- Do not ignore planned medical examinations.
Many experts unanimously hold the view that tight swaddling only contributes to the aggravation of orthopedic pathology.
As practice shows, a double examination of the baby( in the maternity hospital and in the children's polyclinic) makes it possible to reveal the physiological immaturity or hip dysplasia in most cases.
Anatomy of the pathology of
Even in absolutely healthy children who have just appeared, the structure of TBS is a not fully formed structure( immaturity), and there are possible problems associated with it.
For reference. The immaturity of the hip joint in the infant( type 2a) is a physiological component, a concept that includes delayed development of the joint due to various causes. Dysplasia - initially wrong formation of TBS.Both of these concepts were previously united into one, and the treatment was the same. However, it should be remembered that the line between the two diseases is very thin and if you do not start to observe the newborn with the diagnosis of "hip joint development( type 2a)" in time, you can get all the "delights" of dysplasia with all the ensuing consequences.
The ligament system in children has such differences from adult TBS:
- Newborns have a large vertical articulation in the joint.
- Newborn ligaments are more elastic.
- In the newborn, the acetabulum has a more flattened structure.
The femur does not move upwards due to the limbus( cartilaginous plate of the articular cavity).If there are congenital disorders in the development of the joint( underdevelopment), the hollow becomes flatter. Excessive elasticity prevents the bundles from holding the TBS head in one position. In case of violations in its development, the shape, size, and overall geometry of the bones may change.
If the time does not begin treatment and do not correct the congenital dysplasia( immaturity) in children, the limbus turns out with a shift up. Strongly deforming, it is no longer able to hold the head inside the acetabulum. The slightest careless movement of the baby can lead to subluxation and even dislocation.
Forms of the disease
The immaturity of TBS in newborns has several varieties:
- Acetabular( congenital abdominal pathology).
Immature dysplastic joint of newborns( type 2a according to the Earl) - a fairly common phenomenon. If the elasticity of the ligaments and the changes in the centralization of the head in the acetabulum have slight deviations, the usual therapeutic massage plus charging quickly corrects this deviation. Practically all children in the first month of life can have this or that degree( more often they put type 2a) underdevelopment( immaturity) of the hip joint. Therefore, the examination of babies starts from the second month, when the tendency of cartilaginous strengthening of TBS is already visible. If serious anxiety occurs earlier, an unscheduled ultrasound is performed( according to Graf - an underdeveloped dysplastic joint of newborns - type 2a).
- Femoral dysplasia in the proximal part.
Congenital disorders of bone development in the proximal part( underdevelopment) are changes in the neck-diaphyseal angle. The indicator is calculated along the line connecting the centers of the neck and the head of the femur, and along the line of the diaphysis. Detecting the pathology in children can have a frontal X-ray.
- Rotational dysplasia( immaturity).
In girls, hypoplasia of the hip joints is 5 times more common than in boys
This developmental disorder, which changes the angle between the TBS axis and the knee axis( in the horizontal plane).Geometric anatomical measurements in a healthy person have the following indicators: in infants - about 35 °, in children by three years - 25 °, in an adult - 15 °.With age, the angle decreases due to the vertical position of the body. With excessive antithesis( a change in the degree of angle), the centering of TBS in the acetabulum is impaired.
Congenital malformations of the joints in children can be a consequence of how the mother's pregnancy has progressed, so the following factors affect the occurrence of pathologies:
- Treatment with potent drugs during pregnancy.
- Acute leaking toxicosis.
- Presence of chronic diseases in pregnant women.
- Family predisposition.
Underdevelopment of hip joints in newborns: treatment( photo)
When a married couple becomes parents, their happiness is no limit. But, sometimes it is eclipsed by some diseases that are often found in newborns. Let's take a closer look at the immaturity of the hip joints, why it arises, how to define it, and what treatment to take to make the baby healthy.Table of contents: back to contents ↑
What is a hip joint?
The hip joint is the largest and strongest joint in the human body. It consists of a head of the femur and a large part of the neck of the femur. Underdevelopment of the hip joint in newborns develops due to the fact that the articular cavity is flattened, is located vertically, and the ligaments are excessively elastic. Since during the growth of the child the articular apparatus experiences great loads, very often serious and not very pathologies develop. An important fact! Based on statistical data, it can be said that birth defects of hip joints in newborns are most often found in girls. Pathology occurs in babies born with a small weight - less than 2400 grams, as well as in crumbs, which were born in pelvic presentation.
Degeneration of joints in newborns can be detected by the following symptoms:
- One leg may be shorter than the second;
- There is one more fold in the hip area;
- Buttocks and buttock folds asymmetric;
- Asymmetric skin folds when the legs are withdrawn;
- A doctor or parents can not completely remove the knees bent in the knees;
- When the legs are bent in the joints, clicks are heard.
At detection of at least one of the above-described symptom in newborns, babies should be examined at the orthopedist, since the disease can develop very quickly and progress.
If suspected of hip dysplasia, an ultrasound examination should be performed to show the state of the cartilage protrusion, the joint head, and the cavity. To babies over half a year the doctor can appoint or nominate a roentgen of joints.
The most important thing is to timely detect hypoplasia of the hip joints in order to start treatment as early as possible. If defects are detected immediately after the birth of the baby, with adequate and correct treatment by six months, you can completely cope with them. If dysplasia was found after six months of the baby, it would take at least five years to pass the course of treatment. If the disease is found after a year, when the baby does its first little steps, it will be almost completely rid of the disease. But, you can try.
This disease is treated with conservative and surgical methods. Treatment with conservative methods:
- With the help of the pillow of Freik;
The pediatric neurologist or orthopedist should determine the treatment and the timing. A massage should be performed only by a highly qualified specialist. Thanks to massage movements, it is possible to prevent secondary dystrophy of the muscles, as well as blood supply in the joint improves and the pathological phenomenon is eliminated. When you massage, you need to stroke the entire body of the baby with sliding movements. It is also useful to rub the skin with a shift. The massage should last at least ten minutes.
It is useful to carry out a newborn medical gymnastics. Treatment with the help of exercise therapy will help strengthen the muscles of the joints, as well as help the baby physically and mentally develop well. In a complex with gymnastics it is recommended to perform physiotherapeutic procedures, for example, the use of warm baths, mud treatment, paraffin applications, underwater massage.
Treatment using Pavlik's stirrups is as follows. These structures allow you to hold the feet and shins. The belt should fit tightly on the body, but it is important that it does not squeeze the skin.
Treatment with a Freik cushion occurs by using special medical plastic panties that should support the hip joints in the "frog" position.
With a wide swaddling, the flannel diaper is folded with a rectangle 16 cm wide, which is placed between the side legs and bent legs.to table of contents ↑
When are surgical interventions for dysplasia performed?
For severe defects in the hip joints, operations are indicated. Since any conservative methods will not be effective, and the disease will progress with more force. Operational interventions can be different. In some situations, it is enough to make small incisions, in some cases plastic surgery can not be avoided.
Varieties of operations with hypoplasia of hip joints in newborns:
- Performing an open reposition of congenital hip dislocation;
- Treatment of dysplasia with endoscopy.
Before the operation in newborns and after it it is important to do massage, therapeutic gymnastics and physiotherapy. In addition, the doctor will prescribe special drugs that will improve the baby's condition and help him recover as soon as possible.to the table of contents ↑
Important notes for parents
When finishing the treatment for defects in the hip joints, it is important for children to observe a certain regimen. Doctors strongly recommend continuing to perform gymnastics .It is forbidden to teach babies too early to walk! Under strict prohibition the use of walkers and other similar devices that force walking. When the baby grows a little, it is recommended to wear shoes that will fix the ankle joints.
After the performed operation with immaturity of the hip joints in newborns it is important that the kids undergo a full rehabilitation course. These measures should strengthen the muscles;activate recovery processes;and also to adapt the joint to new conditions of dynamics and statics.
Rehabilitation is performed through the use of physical therapy, physiotherapy and medications.to table of contents ↑
The prefusion is a first-degree dysplasia in a newborn. With this pathology, the hip joint was not completely able to form, but the head is in its place. The treatment is the following - it is important for the baby to swaddle wide. If this is not enough, you need to resort for help to the pillow of Freik or tire-strut. It is highly recommended to perform to the child therapeutic gymnastics, physiotherapy, massage. Fix the hip joint until the dysplasia of the first degree is completely eliminated. If the prelumed hip has not been cured, the doctors will have to undergo an operation.to table of contents ↑
We treat the subluxation of the hip joint
With the subluxation of the hip joint in the newborn, the femoral head is partially displaced relative to the acetabulum. Treatment of dysplasia of the second degree consists in using the Pavlik stirrup, which will reliably fix the problematic part of the thigh. When the stirrups are removed, the toddler should be examined by an orthopedist who assesses the condition of the disease and prescribes a course of special exercises and physiotherapy.to table of contents ↑
Treatment of hip joint
The dislocation of the hip joint is the third degree of dysplasia. With this disease, the femoral head is completely displaced from its location. Treatment consists in operative intervention. After the operation, after a couple of months, you can completely fix the joint in place. The most important thing is not to self-medicate! Act only with the orthopedist. After the dislocation is successfully adjusted, the baby needs to undergo a comprehensive rehabilitation, which consists of massage, physiotherapy and exercises that strengthen the joints in the hip area.
Measures for the prevention of defects in the hip joint
To prevent the development of hip joint disease in newborns it is important:
- Systematically show the baby to a neurologist and orthopedist;
- Perform an ultrasound examination of the joints;
Hip Dysplasia in Children |
THE BROAD The most common dysplasia is found in the first month of a child's life. In this case, treatment usually quickly gives a positive effect.
But sometimes at first, dysplasia does not appear, and it happens later, under certain circumstances. So, often dysplasia makes itself felt in three or six months. Provoke its manifestation may be improper care - for example, a tight swaddling or the fact that the child did not do gymnastics for newborns. By the way, the consequences of the tightly swaddling that was widely used in previous years are now manifested in the form of arthrosis in adults.
It happens that the dysplasia becomes noticeable only in a year, when the child takes the first steps and sees abnormalities of the gait. This is the most undesirable option - because in this case, most likely, without surgical intervention can not do.
Treatment of dysplasia
With timely diagnosis and treatment for 5-7 months, the function of the joint is almost completely restored, even with a serious deviation from the norm. When dysplasia is detected in the early stages, the orthopedist usually applies special tires and spacers. With their help, the legs are bred in different directions, and this stimulates the correct development of the joint. Also, vitamin therapy is prescribed, professional massage with elements of therapeutic physical training, sometimes magnetotherapy and electrophoresis with calcium and phosphorus - that is, those procedures that improve blood circulation in the region of the hip joints.
There are not many osteopath specialists in Russia yet, but their help is also desirable for a child who has dysplasia. The osteopath is able to restore the balance of the bone structure by soft manual effects. The main thing is to find a really experienced specialist.
For prevention and in the case of immaturity of the hip joints, a wide swaddling helps - the diaper needs to be laid between the legs, the child in this position of the "frog" needs to stay up to 2-4 hours a day. Also, parents should perform the exercises recommended by the orthopedist with the child. Special skills for performing such gymnastics does not require, but it is desirable that parents at first made it under the guidance of a specialist. Tight swaddling in any case should be avoided.
Swaddling the child
Take a tight flannel diaper, fold it in a triangle and place it on the table so that the right angle is at the bottom and the sharp ones are on the sides. Put a disposable diaper on the baby and put the baby on top of the diaper, bend his legs in the hip and knee joints( so that the legs are sideways about 60-80 degrees).One end of the diaper wraps one leg of the baby, and the other - the second. Lower the nape of the diaper and fix it on the abdomen. From the top you can swaddle the child as usual, so that the wide diaper is better kept.
- If the diagnosis of "dysplasia" is delivered late enough, the child is treated with functional gypsum dressings applied to the lower limbs in a certain position. Thus, the formation of bones in the correct position.
- If you can not fix the dislocation with spacers and plaster bandages, apply stretching to the crib with orthopedic frames in the hospital. If this conservative method does not have a significant effect, then surgery is required.
But even if the treatment of dysplasia was timely and successful, the child should remain under the orthopedist's supervision for a long time. After recovery the child should be shown to the orthopedist twice a year to five years. Then the orthopedist will need to visit once a year. Do not forget to show the orthopedist also in adulthood, telling the doctor about dysplasia and the applied methods of treatment. The main thing is to remember that the key to successful treatment of hip dysplasia is not only the highly professional work of doctors, but also the patience and endurance of the child's parents when they implement all the expert's recommendations.
Limited thigh guidance
Limited hip withdrawal is a sign of dysplasia. The figure shows that the left hip of the child is diluted normally - by 80 °, and the right thigh - not completely, but only by 40 °, which can speak of a hip dislocation.