Treatment of immaturity of the hip joints in infantsVery often, it is possible to hear from moms 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 that 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 in later life;
- 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 the successful treatment of the disease.
How to cure a baby
footrest tire If your child has an immature hip joint, do not be in a hurry 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 have to 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 gymnastics 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.
A set of exercises should 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.
Anatomy of the pathology of
Even in absolutely healthy children who have just appeared, the structure of TBS is not a fully formed structure( immaturity), and this poses possible problems.
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 system of ligaments 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 pathology of the acetabulum).
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 condition of the cartilaginous 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.
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;
Preparation and conduct of the
procedure The procedure is absolutely harmless, even if the baby is only 1 month old. Before the ultrasound of the hip joints of the child, it is recommended to feed and soothe. During the study, you should carefully listen to the explanations of the doctor-diagnostician and put the baby right on the couch. From this depends the diagnosis, its accuracy and decoding.
Ultrasound of hip joints in children up to 6 months of age is the most informative, harmless and accurate method of diagnosis.
During the examination period, the baby should not move, therefore, if possible, all likely causes of increased motor activity of children should be eliminated:
- infants should be healthy( no pain and colic);
- to avoid regurgitation feed for 30-40 minutes before the study.
Grudnichkov in ultrasound is laid on the couch, hypoallergenic gel is applied to the area under investigation. The doctor neatly drives the sensor in the infant's groin, looking at the condition of both the hips, adjacent bones and soft tissues.
The decipherment of ultrasound of the hip joints is performed by an orthopedic physician by constructing special geometric figures on the printout of the result and measuring certain angles in the resulting scheme. For ultrasound of the hip joints in children, there is a certain norm of angles, with the help of which the presence and severity of development of the joint in infants is determined. The main line is studied, which is carried through the base of the gluteus gluteus and the surface of the ilium, as well as the angles denoted by the letters alpha and beta. The alpha angle is measured to evaluate the development of the acetabular bones of the acetabulum. On the corner of beta judge the development of the cartilaginous zone of the acetabulum. The figures obtained during the measurement of angles and their ratio make it possible to classify the joints according to certain types and to make a diagnosis. These data are compared with the table, which indicates the norms of angles for newborns.
To exclude or confirm dysplasia, the child is prescribed an ultrasound examination of the hip joints
. According to the received data, ultrasound of the hip joints calculates the required angles. Then, in accordance with the figures obtained, the type of joint and the corresponding disorders( or their absence) are determined. We give the classification and norms of angles for newborns.
- Type 1a( represents a pointed bony protuberance) and 1b( bony protuberance is smoothened).Angle values: alpha is more than 60 degrees, beta is less than 55. This is the norm of angles for newborn babies, if the baby has such values in 1 month, he is healthy.
- Type 2a and 2b( after 3 months) - immature hip joint. Angle values: alpha from 50 to 59 degrees, beta - more than 55. Bone prominence is rounded, the head is centered, the cartilaginous part of the roof is wide, the bone part of the roof is sloping. When examined in preterm infants and newborns before 3 months of this type is considered physiologically immature, requires observation. The fourth month has gone - treatment may be required.
- Type 2c is regarded as a pre-exertion( the head is centered, but the cartilage does not cover it sufficiently, the bone part of the roof is rounded).Angles: Alpha from 43 to 49 degrees, beta - from 70 to 77. These are indicators outside the norm of angles, treatment is required.
- Type 3 - subluxation. Angle values: the alpha is more than 43, the beta is greater than 77. The head of the joint is located eccentrically, the cartilaginous part of the roof is not determined. After 3 months of age, degenerative processes may begin, which will provoke coxarthrosis. Treatment is necessary.
- Type 4 - hip dislocation. The alpha angle is 43, the beta is greater than 77, that is, far beyond the norm of angles. The head is located outside the joint cavity, a symptom of the "empty acetabular hollow" is noted. Treatment of such children should begin immediately.
It should be borne in mind that these indicators are suitable only for newborns and infants up to 6 months. If ultrasound of the hip joints is done on schedule in 1 month, these figures can be guided. For older children, the norms of angles will be different.