How to eliminate congenital dislocation of the hip
If newborns are diagnosed with a hip dislocation, this indicates that the other joint elements are not sufficiently developed.
There are three forms of such a dislocation, they can pass into each other:
- congenital dysplasia;
Congenital dislocation is characterized by the fact that the ratio of the head and cavity is broken in the hip joint. Most often there is a one-sided dislocation, and in girls it occurs almost 5 times more often than in boys.
Causes and symptoms of the development of the disease
The reasons for the development of the anomaly of the hip joint may be several:
- during embryogenesis, the primary development of the child and his motor apparatus is disrupted;
- lack of vitamin B2;
- toxicosis and changes in normal hormonal background;
- if the mother had nephropathy, impaired protein and water-salt balance;
- hereditary predisposition.
Development of hip dislocation is preceded by joint dysplasia and its subluxation.
If a newborn has hip dysplasia, it is necessary to begin treatment immediately. Otherwise, after the child begins to walk, he can develop a dislocation of the joint. To detect this abnormality in the hospital the child must be examined by an orthopedist.
If the mother, when swaddling a baby, finds limited mobility of his hip joint, immediately consult a doctor. But do not panic at once, as a complete dilution of legs in children is impossible: this is due to the fact that muscle tone is increased. One of the bright symptoms of the presence of abnormal development of the hip joint is the mismatch of the gluteal folds and folds on the hips. An indication of this disease is the appearance of a click if the thigh head moves over the edge of the hollow. This occurs when the legs are bent and retracted. It is worth noting that such a symptom may not be a sign of violations in the joint. It occurs with hypotension of the muscles, which is often found in children at the first stage of their life. But if you turn the leg outward, it is slightly shortened, this indicates an abnormal development of the joint.
When a child starts walking alone, new symptoms of the disease appear:
- is a limited ability to withdraw the leg;
- muscles of the front inner surface of the thigh are constantly strained;
- a large thimbus of the hip is shifted upwards;
- if the child becomes on a sick leg and lifts a healthy one, the pelvic axis will shift towards the healthy leg;
- if one side is damaged, then the baby will limp while walking, and if the development of both joints is broken, then he will have a duck's gait.
- although the absolute length of the leg remains constant, its relative length decreases;
- excess circular movements that are performed by the thigh;
- if you put the child on your back and push on the heel of the sick leg, it will shift upwards.
One of the signs that dysplasia is developing will be the sloping of the joint cavity, while the ossification of the nucleus slows down. On the side affected by the disease, the femoral head is flattened, and the thigh is shifted outward and upward in its upper part.
Degree of dislocation and diagnosis of
Disease Depending on how pronounced the dislocation and subluxation of the hip joint in newborns, 5 degrees of disease are distinguished:
- lateral head position and chamfer;
- displacement of the head up to the edge of the cavity - this is a subluxation;
- the head is displaced above the cavity;
- the wing of the ilium is completely covered by the shadow of the head;
- the head is at the upper edge of the ilium.
Degrees of joint dislocation of the newborn
Although X-rays can be performed only at 4 months of age, in the presence of symptoms of abnormal development of the hip joint in children, it is necessary to do it as soon as possible. The roentgen is held in the supine position, with the legs straightened. The peculiarity of the study of the hip of the child is that in the picture the cartilaginous tissue that covers the joint bones is not displayed and there are no nuclei of ossification of the thigh.
Since it is not possible to conduct an X-ray study at an early age, it is not possible to identify an abnormality of the hip joint as early as possible and begin treatment, the child is referred for ultrasound. Such a survey does not hurt the baby if he was at least 2 weeks old.
Methods of conservative treatment of
Such treatment should be started as soon as the child is diagnosed in the hospital. Assign the performance of special exercises: it is necessary not to flex, rotate, withdraw legs in the hip joint. It is necessary to do up to 10 such charge per day and each time to perform up to 20 movements.
Parents should learn how to swaddle a child correctly, use a wide swaddle where the legs are raised with a diaper. For the treatment use the tires CITO or Cough, as well as the pillow of Freik. These devices allow centering of the femoral head and cavity. Only after 4 months the child can do x-rays, according to her results, corrections can be made to the treatment tactics. The therapy lasts until the child is one year old, and the orthopedist should periodically observe up to 5 years.
CITO tire for newborns will fix the consequences of injury
The use of special tires with a subluxation of the hip joint in children makes it possible to gradually stretch the muscles that are responsible for the hip to the side. But do not rely only on the orthosis - you need to do a massage, apply physiotherapy. The tire can not be used if a dislocated dislocation is established during arthrography with contrast.
Basic principles of treatment:
- up to 3 months of age, a wide swaddling should be used;
- closed-circuit control with the use of a bus is carried out up to 10 months;
- if conservative treatment does not bring results, surgery is necessary.
Previously, some specialists performed a dislocation correction, while plaster casts were used. Now this method of treatment is not used, as this often leads to necrosis of the head, the development of arthrosis and the appearance of repeated dislocations.
If the conservative treatment has not yielded positive results, the doctor can prescribe the operation. Indication for surgical intervention is a large inconsistency of the components of the joint. The operation is performed, and if soft tissues have blocked the acetabulum. Contraindication to this method of treatment is a severe obscheomatic state.
Operative methods used to treat:
- conservative methods with low intervention;
- open joint repositioning;
- conducting open repositioning and deepening of the cavity;
- palliative operations;
- extraarticular reconstructive interventions.
During the operation, the following principles must be observed: interventions in soft tissues and cartilage are minimal, restoration of the ratio of surfaces in the joint, increase in the area of contact. When choosing the method of surgical treatment, the age of the child is necessarily taken into account. Up to 2 years, only simple open reduction and minimal arthrotomy are performed. If the baby is not yet 7, in addition can apply corrective osteotomy of the thigh and restoration of its cavity.
With a simple correction, the articular bag and cartilage of the cavity are excised, which is wrapped. If a deepening of the acetabulum is performed, the joint is opened, after which the altered tissues are excised and the cartilage is deepened. In the course of reconstructive operations, a hollow is formed at the expense of the joint capsule. Palliative methods of treatment are associated with osteotomy.
After the child reaches 8 years of operation, it is difficult to perform the operations, therefore, mainly palliative intervention is used, in which the correction of the ability to work is carried out. In order for the pelvic asymmetry to decrease, the center of the femoral head must be performed. Otherwise, the disease will constantly return.
During rehabilitation after surgery, it is necessary to stop pain and improve wound healing. It is necessary to prevent the occurrence of circulatory disorders in the joint, to remove contractures, to restore joint function. Activities are carried out that promote the splicing of bone fragments, and the child is prepared for walking.
To implement these tasks, we use physical therapy, massage, paraffin therapy, electrostimulation of the buttocks muscles, electrophoresis with the use of angioprotectors. As a means of drug treatment, vitamins, chondro- and osteoprotectors are used. After carrying out an operative intervention, a full load on the joint can be given only after a year.
If the diagnosis was carried out correctly and the treatment is started on time, it is possible to get rid of the dislocation of the hip joint. In this case, the anatomy of the joint is fully restored and the probability of dysplastic arthrosis is eliminated.
Causes and signs of hip dysplasia in newbornsPerhaps all moms and dads are eagerly awaiting the birth of their baby. With the birth of the child appears more trouble, but these efforts are very pleasant. Parents try to give the child a caress and attention, but do not forget about his health.
Hip dysplasia in newborns is a fairly common disease, implying a congenital hip dislocation. It is caused by abnormal development or underdevelopment of joints. The disease is quite dangerous, since it can significantly slow down the development of the musculoskeletal system of the child.
If you start and do not treat dysplasia in newborns or even untimely detect it, the consequences can be very deplorable. There may be a shortening of the limbs, a violation of the walking process and permanent severe pain in the joints. That is why it is important as soon as possible to diagnose the disease in infants.
Symptoms of dysplasia of pelvic joints
Especially pronounced contractures of dislocation, doctors will notice already in the hospital. Restriction of normal mobility in the hip joint is a sign of dysplasia. But in some cases, hypoplasia of the hip joint is less pronounced, as a result of which the problem can be identified only 2-3 weeks after the birth of the child.
Symptom of abnormal development of the hip joints is the asymmetry of the folds on the toes of the baby
Young mothers can independently detect signs of dysplasia while doing gymnastics with the baby. The following signs will help to identify the presence of joint underdevelopment:
- at gymnastics a limited hip extraction is detected( normally the angle of tap reaches 170 degrees);
- legs in elongated state have different lengths;
- asymmetry of inguinal or gluteus folds;
- characteristic click in the hip joints when the legs are spread apart;
- at a later stage - later getting up on the legs or breaking when walking.
If you find any of the symptoms of dysplasia, you need to show your child as soon as possible to an orthopedic doctor. Upon examination, he will confirm or refute the suspicions of the parents and, if necessary, immediately prescribe the necessary treatment.
Causes, forms and treatment of the disease
Doctors agree that the main cause of dysplasia lies in the genetic predisposition. If in a family someone had problems with the musculoskeletal system, the chance of having a baby with such a disease increases. Also, the cause may be infectious and endocrine diseases, which the woman suffered during the bearing of the child. In this case, the maturation of the locomotor system is impaired.
Hip dysplasia in the baby can develop due to inadequate fetal positioning of the fetus. This is a pelvic, gluteal or transverse presentation. This disease of the hip joints can be a consequence of severe toxicosis. Threats of miscarriage during pregnancy can also cause the development of this disease in infants.
There are several forms of the disease:
- incorrect development of the hips of the proximal part.
Rotational dysplasia of the hip joints is less common than other forms. This change in the configuration of the pelvic bones, which leads to a violation of the interaction of the hip and knee joints. There is rotational dysplasia in the form of clubfoot in a child.
The acetabular shape of the disease is characterized by acetabular dysfunction. There are three types of such violations. The first is the pre-hip of the hip, the second - the subluxation, and the third - the dislocation. In the first case, there is a slight deviation in the development of the hip apparatus, the acetabulum is oblique. With subluxation of the femur, a partial displacement of the cervix and femoral head occurs. If a dislocation is diagnosed, then the femoral head is completely displaced upwards. If the proximal part develops improperly, the neck-diaphyseal angle can have a normal, enlarged or reduced shape.
For the correction of the legs, special stirrups are used.
Treatment largely depends on the form of the disease. If the disease is detected in a timely manner, it can be cured within a month. Therapy usually consists of a wide swaddling of newborns or the imposition of tires, but only if the disease was detected immediately after birth. The orthopedist can also advise wearing the stirrups.
Hip dysplasia requires an integrated approach to treatment. Every day it will be necessary to visit the children's polyclinic, where the child will be given a massage and exercise therapy. Physiotherapy is also indicated.
Orthopedist can show mother infants gymnastic exercises that are easy to perform with the baby at home. Such charging will speed up the recovery of the baby.
Subluxation of the hip joint in children
Statistically, dysplasia is found in 3-5% of infants annually, and has varying degrees of development. Most often it is necessary to talk about the subluxation of the hip joint in children, which can be of four types - iliac( most frequent), sciatic, obturating or lumbar( the rarest).But the symptomatic picture is similar in all cases, and the treatment should be taken as early as possible.
Causes and process of congenital subluxation of
The growth of an abnormal anatomical structure results from the appearance of any defects in healthy tissues. According to statistics, women of low stature, giving birth to the first time, are more likely to have a baby with a subluxation of the hip. This is due to lack of space in the womb, and, as a result, excessive pressing of the legs of the baby to the stomach.
The subluxation of the hip joint needs urgent correction, as the degeneration of healthy tissues may occur, as a result of their eating disorders.
Unfortunately, about 23% of babies with congenital dysplasia have not received proper treatment at birth for various reasons, but the main thing is the lack of a modern diagnostic base in medical institutions of specific states. Absence of treatment of pathology leads to the fact that the subluxation of the hip joint in adults becomes the main cause of secondary ailments - arthritis, arthrosis, osteoporosis, etc. This indicates the importance of timely diagnosis and treatment of dysplasia.
What are the symptoms of subluxation of the hip in a baby?
In this pathology, the baby does not experience pain, and there are no pronounced external deformities, but typical signs of subluxation of the hip are:
- on the hips and buttocks, asymmetry of the folds is observed;
- limited passive homing of the affected thigh;
- in the future, dysplasia manifests itself as a "smoothly swaying" gait and curvature of the spine in the lumbar region.
This symptom, like shortening of the affected limb, is more typical for dislocation, but even in case of subluxation, it is observed in a healthy person in the absence of treatment.
Signs of a severe form of the disease are the outwardly or inwardly turned fingers of the affected limb.
General therapeutic basis
Before the appointment of a doctor, the doctor conducts a diagnosis and determines the degree of the disease - pre-infection, subluxation or dislocation, and then chooses the main and additional therapeutic agents. Mostly, these are orthopedic adaptations, as well as special gymnastics and massage of the femoral and gluteal muscles. If the subluxation of the hip joint is detected early, doctors prescribe a wide swaddling and Pavlik's stirrups. They are prescribed to babies from 1-9 months, and are the most sparing and effective remedy,promote the breeding of legs in the knee and hip joints with an angle of flexion up to 90 degrees.
In case of late diagnosis, a special tire is applied, which is worn for 1.5 to 3 months. In this case, adjustment of the tire is necessary weekly, as the bones of the babies develop rather quickly and grow.
One thing is clear, an early call to a doctor is the key to a successful and speedy recovery, because lost time can lead to the fact that it will be impossible to restore the normal working capacity of the hip joint. More details about the problem of hip dysplasia in toddlers are described in the video.
Hip Dysplasia - Hashan Karimova's Center for Manual Medicine
Congenital dislocation of the hip( synovial hip dysplasia) is a congenital inferiority of the joint due to its abnormal development, which can lead to( or resulted in) subluxation or dislocation of the headfemur - to "congenital dislocation of the hip".The modern name of this pathology is dysplasia of the hip joint.
Hip dysplasia is common in all countries( 2 - 3%), but there are racial and ethnic characteristics of its distribution. For example, the incidence of congenital maldevelopment of hip joints in newborn children in the Scandinavian countries is 4%], in Germany - 2%, in the United States it is higher in the white population than in African Americans, and is 1-2%, among American Indians, dislocation of the hip occurs in 25-50 per 1000, whereas congenital dislocation of the hip almost never occurs in South American Indians, in southern Chinese and Negroes.
The connection of morbidity with ecological uneasiness is noted. Incidence in the Russian Federation is about 2 - 3%, and in ecologically unfavorable regions up to 12%. . Statistics of dysplasia is contradictory. For example, in Ukraine( 2004), congenital dysplasia, subluxation and dislocation of the hip meet from 50 to 200 cases per 1000( 5-20%) of newborns, that is, significantly( 5-10 times) higher than in the same territory in the Soviet period.
There is a direct link between increased morbidity and the tradition of tight swaddling of the straightened legs of the baby. Among the peoples living in the tropics, the newborns are not swaddled, do not restrict their freedom of movement, wear them on their backs( while the child's legs are in a state of flexion and diversion), the morbidity is lower. For example, in Japan, as part of a national project, the national tradition of tight swaddling of the straightened legs of infants was changed in 1975.Result: decreased congenital dislocation of the thigh from 1.1 - 3.5 to 0.2%
This pathology is more common in girls( 80% of cases detected), family cases are about a third. Dysplasia of the hip joint is 10 times more common in those children whose parents had signs of congenital dislocation of the hip. Congenital dislocation of the femur is detected 10 times more often in those born with pelvic fetal presentation, usually at the first birth. Often, dysplasia is detected with a medical correction of pregnancy, with pregnancy, complicated by toxicosis. The left hip joint is more often affected( 60%), less often the right hip( 20%) or both( 20%)
Until the first half of the last century, only the severe form of dysplasia, congenital dislocation of the hip( 3-4 cases per 1000 births) was taken into account. In those years, "light forms" of dysplasia were not detected and treated. From the 70's to the 90's.use the term "hip dysplasia", meaning by this not only the dislocation, but also the pre-exertion and subluxation of the hip joint. The figures of morbidity have increased tenfold.
Anatomical features of the hip joint for
dysplasia Hip dysplasia can manifest itself in a variety of forms. There are three main forms of dysplasia:
- acetabular dysplasia - acetabular dysplasia;
- dysplasia of the proximal femur;
- rotational dysplasia.
With dysplasia, the shape, interrelation and dimensions of the hip joint structures change significantly. The development of the hip joint occurs in the process of close interaction between the femoral head and the acetabulum. The distribution of the load on the bone structure determines the acceleration or deceleration of bone growth, determines in the end result the shape and the head of the femur and the acetabulum as well as the geometry of the joint as a whole.
The hip joint of a newborn is even normally immature biomechanical structure, its articular cavity is flattened, it is located more vertically, in comparison with the "adult joint", the ligaments of the joint are excessively elastic. The femoral head is held in the joint cavity due to the tension of the joint capsule, its own ligament( round ligament of the hip joint).The displacement of the femur is prevented by the cartilaginous plate of the acetabulum, which is called the "limbus"( acetabulum - labrum - lip, margin).
If the development of the joint( with dysplasia) is disturbed, we see( see figure) a flatter and oblique joint cavity;excessively elastic ligaments and articular capsule are not able to hold the head of the femur in the articular cavity, it shifts upwards and laterally( outwards).In this case, the limbus is turned( shifted upwards) and deformed, it loses its ability to retain the displacement of the head of the femur. With certain movements, the femoral head may extend beyond the acetabulum. This condition of the joint is called "subluxation".
With a severe form of hip dysplasia, the femoral head completely extends beyond the acetabulum, a condition called "hip dislocation".The head of the hip is located above the articular cavity, the limbus is screwed into the joint and is located below the head of the thigh, the articular cavity is filled with fat and connective tissue. This greatly complicates the direction of the dislocation.
Hip dysplasia can manifest not only in the form of acetabular dysplasia( acetabular dysplasia), but also in the form of an abnormal development of the proximal femur. The shape of the proximal femur is most often described by the cervico-diaphyseal angle( SHDU), which is formed by the median line of the diaphysis and the line drawn through the centers of the head and neck of the femur. These measurements are carried out on the frontal radiograph. Depending on the size of this angle, depending on how much it corresponds to the age norm, distinguish the normal form of the proximal femur, dysplasia with an increase in this angle - coxa valga, dysplasia with decreasing this angle - coxa vara. The relationship between the acetabulum and the femoral head is very important. To assess the geometry of the hip joint, many methods are used, one of which is shown in the figure. An important indicator is the centralization of the head of the femur and the acetabulum. If you draw a line through the edges of the acetabulum( AB) and the line through the middle of the head and neck of the femur( CF), then the line CF must pass through the middle( point O) of the line AB.
And the angle formed by these lines should approach the straight line. This is a great biomechanical meaning: a uniform load on the head and acetabulum and the normal development of these structures. The angle of centering is closely related to the shape of the cervico-diaphyseal section. The lower part of the figure shows some forms of hip dysplasia associated with a violation of the neck-diaphyseal angle and the angle of the acetabular tilt. Figure A is the norm. The acetabular slope and median line of the head and neck constitute a right angle, the SHDU and the angle of the acetabulum are not changed. Figure B - varus deformity of the proximal femur with dysregulation. Figure B shows the form of dysplasia with an increase in CRS at a normal angle of inclination of the acetabulum. Figure D - dysplasia, in which excess SHDU and excessive angle of inclination of the acetabulum
are combined. Rotational dysplasia of is a violation of the development of bones with violation of their geometry in the horizontal plane.
Normally, the joints of the lower extremities in a person are not aligned. The axis of motion of each joint does not coincide with the axis of the upper and lower joint. The axis of the hip joint( axis of the joint in the horizontal plane) is at an angle to the knee axis. This is due to the shape of the femur, which is twisted in such a way that the femoral head is turned forward. As shown in the figure( top view), the axis of the knee joint, drawn through the condyles of the thigh, forms an angle with the axis of the hip joint, a line drawn through the middle of the neck and the head of the femur. This angle is called the "corner of the antecessor".The angle of femoral antterussia at birth is 15-57 °( mean 32 °), 20-50 °( 34 °) in 1-3 years old children, 12-38 °( 25 °) in 4-6 year oldschildren and 25-37 °( 12 °) in adults. The phenomenon of decrease with age of the angle of anthortia is explained by the beginning of walking and the verticalization of the body. In most cases, this hip antitussia is the constitutional norm. Excess antetoria is accompanied by a violation of the center of the femoral head in relation to the acetabulum and is manifested by the gait of the child - a gait with an internal rotation of the leg, a variation of the gait of the foot.
Diagnosis and diagnosis of
Factors such as "the presence of joint dysplasia in the parents", "pelvic presentation", "large fetus", "deformity stop", "toxicosis of pregnancy," especially in girls, should be alarming in terms of possible congenital pathology of the joints. The risk of congenital pathology of the hip joint in these cases increases tenfold. Therefore, such children, even if orthopedic symptoms are absent, are considered to be at risk for congenital dislocation of the hip.
Most orthopedists and related specialists under dysplasia in a broad sense mean congenital inferiority of the joint, which is due to its underdevelopment and can lead to subluxation or dislocation of the femoral head. With dislocation of the femur, the head completely loses contact with the acetabulum, with subluxation - only partially. Dysplasia in a narrow sense, or pre-bleeding, is characterized by a developmental disorder of the hip joint without a shift in the articulating elements of the joint. However, many orthopedists and surgeons use the term "dysplasia" in the collective concept, including all the anomalies in it - from the radiological barely perceptible underdevelopment of the joint's roof, without the hip head shifting to the true dislocation.
Thus, the classification of the degrees of hip joint pathology in these cases should be based on clinical and radiological indices:
Classification of hip dysplasia. A: Norm. B: Pre-exertion. C: Subluxation. D: Congenital dislocation of
Anterior hip joint is a clinically and radiologically defined developmental disorder of the joint without a hip displacement( B).This condition is most often observed in newborns. It is also revealed on the so-called healthy side in adolescents and adults with unilateral dislocations.
Subluxation of the femoral head - its displacement due to anteversion and valgus within the articular cavity: a) primary, b) residual( after repositioning the femoral head)( C).
Congenital dislocation of hip( D): a) lateral or anterolateral, b) nadacetabular, c) ileal high.
It is advisable to distinguish the concepts of "disruption of the development of the joint"( this actually is dysplasia) and a slowdown in development( immature joint - borderline condition, risk group).Hip dysplasia is indicated by weighed heredity, pregnancy pathology, clinical signs of hip joint instability( that is, signs of pre-exertion), or, especially, signs of displacement of the femoral head in relation to the acetabulum( that is, signs of subluxation or dislocation of the joint).Clinically established diagnosis should be confirmed by ultrasound data, and at the age of more than 3 months by X-ray examination.
The diagnosis of "hip dysplasia" is primarily based on clinical signs, ultrasound results and X-ray diagnostics. Ultrasound and radiographic examination, informative and extremely important diagnostic methods, but are secondary to clinical methods. The diagnosis of "hip dysplasia" always involves the likelihood of developing a hip dislocation and the need for urgent treatment.
A doctor or an orthopedic surgeon should be suspected or diagnosed promptly when examining newborns in a maternity hospital. Further, sick children and children at risk are observed by the orthopedist at the place of residence. All sick children and the newborn from the risk group are prescribed orthopedic treatment, which continues until the final diagnosis is clarified.
All these children should be observed by an orthopedist and should be examined using ultrasound, and at the age of 3 months using the X-ray method. The diagnosis is definitively formulated by the orthopedic physician at the place of residence on the basis of the examination, the results of the instrumental methods and on the basis of the dynamic observation of the child.
The study of the child has features depending on the age of the child and on the degree of disruption of the functional condition of the hip joint. The child is examined in a quiet and calm environment, in a warm room, after feeding, in the state of maximum relaxation of the muscles. We can distinguish 4 groups of clinical tests that may indicate dysplasia of the hip joint in children of the first year of life: 1. asymmetry of skin folds 3. a symptom of the slipping of Marx-Ortholani 4. limitation of the hip
First of all, pay attention to the symmetry of the skin folds of the thigh, havingthat in the case of bilateral pathology this sign may not be visible. Asymmetry of skin folds is more informative in children older than 2-3 months of age. Skin folds with congenital dislocation of the femur are located at different levels, differ in depth and shape. Diagnostic value are: gluteal, popliteal and inguinal folds. On the side of subluxation or dislocation, they are deeper and larger. This symptom is observed in half of the sick children and "in itself" has no diagnostic value.
The often observed asymmetry of skin folds on the thigh, especially in newborns, is of no diagnostic importance, it occurs in perfectly healthy infants.
A reliable diagnostic criterion is the phenomenon of shortening of the hip due to posterior displacement of the head of the femur with respect to the acetabulum. He points to the most severe form of hip dysplasia - on a congenital hip dislocation. The test is considered positive if the knee lying on the back of the child with knees bent in the knee and hip joints is lower.
The gold standard for the early diagnosis of hip dysplasia is the symptom of Marx-Ortholani( see figure).The symptom of slipping was described by the Soviet orthopedist VO Marx in 1934 and independently by the Italian pediatrician Marino Ortolani in 1936 as a symptom of a "click".Vasily Oskarovich Marx describes the symptom of slippage proposed by him:
"The child is laid on his back, and his face is turned to the doctor. The latter bends both legs of the patient in the hip and knee joints and grasps the hips with the hands so that the thumbs are located on the inside, and the others - on the outer surfaces of the thighs. The doctor slowly, avoiding forced movements, withdraws the hips evenly in both directions. Efforts to obtain leads are not required, since in this position the child loses the ability to resist. With normal relations in the joints, both hips in the position of the outermost lead are almost touching the outer surfaces of the table plane. When dislocated, the femoral head slips into the acetabulum at the time of withdrawal, which is accompanied by a characteristic tremor. If, after this adjustment, the femur is left in the retracted position, it begins to be driven and, having reached a certain degree of reduction, produces a rapid jerky movement in the direction of reduction, corresponding to the moment of dislocation of the head from the acetabulum. This movement is easy to see if you follow closely the resulting hip "
Since then, this simple and informative test has changed little and is successfully used to diagnose instability and congenital dislocation of hip joints in children of the first year of life. Of course, some practical skill is required to perform this test, and most importantly the proper interpretation of its results, comparing it with other symptoms and research results.
However, in itself the fact of a positive symptom of Marx-Ortholani in children of the first two weeks of life does not at all indicate a disease of the hip joint. This symptom can also occur in completely healthy newborns. The ratio of patients and healthy newborns, who were detected by the symptom of slipping, is 60 and 40%, respectively.60% of newborns "recover" in the first week of life, and 88% in the first 2 months. The remaining 12% actually constitute the various stages of true hip dysplasia. This symptom loses its value with the age of the sick child, it is detected only in 25% of children older than 2-3 weeks. Limitation of the hip abduction on the side of dysplasia is a characteristic sign of dysplasia of the hip joints.
"If the symptom of slippage is not caused in the infant when a congenital dislocation of the hip is detected because the baby has already disappeared, then with the remaining dislocation, the symptom of slipping appears as a symptom of the restriction of hip withdrawal. In a healthy newborn, it is possible to dilute the legs in the hip joints by 80-90 ° each, and arrange the divorced thighs with the outer surfaces on the bed. If each leg can only be withdrawn to an angle of 50-60 °, then the newborn, apparently, has a congenital dislocation of the hip. In a healthy seven-eight-month-old baby, each leg can be withdrawn by 60-70 °.If you manage to withdraw each leg only to 40-50 °, then there is probably a congenital dislocation of the hip. The legs in the hip joints are bred, grabbing them in the same way as when the symptom of slipping is revealed( quoted according to VO Marks) »
The x-ray image is on the left and the sonographic image on the right. You can see the head of the hip, the upper-external part of the acetabulum, the wing of the ilium, the abduction muscles and the limbus.
Ultrasonography of the hip joints of children of the first year of life is the diagnostic standard. The main indication for the use of this method is the risk factors and clinical signs of joint dysplasia in children up to 3 months. This is a worthy alternative to X-ray examination in children up to 6 months of age. The ultrasonic method is accurate enough and is practically safe for the child.
The main principles of treatment are: early onset, the use of orthopedic means for prolonged retention of the legs in the position of retraction and flexion, active movements in the hip joint within the permissible range.
"Various types of pillows, panties, stirrups, tires, apparatuses and other devices are proposed for the treatment of hip dysplasia without bias and with a shift of the femoral head. They are all designed to keep the baby's legs in the breeding position and provide them with a function. In children the first 2-3 months.if there is a suspicion of hip dysplasia or the presence of clinical symptoms of dislocation, there is no need for radiologic confirmation of the diagnosis, because in any case it is necessary to use the same therapeutic and prophylactic measures - the raising of the legs with the help of soft pads( wide swaddling, Freik's pillow, etc.), gymnasticswith the use of retractive-circular movements in the joint, a massage of the gluteal muscles. For the treatment of children with dysplasia, the method of breeding the legs is suitable for diapers, Becker's "panties", Freik's pillows, Pavlik's stirrups, and elastic tires. At this age, it is absolutely unacceptable to use rigid structures, that is, tires that impede movements of the extremities made by the baby. "
Widespread swaddling is used in children" at risk ", in newborns with ultrasound signs of" immature joint ", and in those cases,full-fledged treatment for any reason can not be carried out. This is the main method of preventing hip dysplasia. The diapering technique is simple: two diapers are laid between the legs of the baby, giving the position of bending and retraction in the hip joints, and the third fixing the legs. Wide diapering allows keeping the position of breeding and bending 60-80 °.
Massage and therapeutic gymnastics
The task of exercise therapy is strengthening the muscles of the hip joint and organizing the motor activity of the child, sufficient for full physical development. The goal is to stabilize the hip joint, restore normal volume of movements and raise the level of a healthy child. Medical gymnastics is used at all stages of conservative treatment and has its own peculiarities at the stage of leg breeding, at the stage of retention and at the stage of rehabilitation after removal of orthopedic products.
Direction of dislocation and treatment with a coaxial dressing
A child in a cockslide bandage after restoring a congenital dislocation of the hip.
In some cases, the control of high hip dislocations is possible by skeletal traction in children aged 1.5 to 6-8 years. The greater the age of the child, the greater the likelihood of the need for completion of treatment by surgical means.
For the treatment of congenital dislocation of the hip, a large number of surgical methods are used that can be divided into groups:
Open dislocation: 1. Operations on the proximal femur( corrective varizating and degrotation osteotomy) 2. Operations on the pelvic component( osteotomy of the pelvisby Chiari) 3. Palliative surgery( Shanz, König)
Prognosis, hip dysplasia in adults
Dysplasia of hip joint biomechanicsRivest serious violations of lower limb function, to disability, both directly from the first steps of the child, and in adult life.
Non-congruence of the dysplastic hip joint
The dysplastic hip joint is primarily characterized by incongruence, that is, a mismatch between the articular surfaces of the globular head of the femur and the acetabulum. With dysplasia, the radius of the acetabulum is greater than the radius of the head of the femur, the area of contact of the joint surfaces is smaller, the load on the joint cavity is much higher. This on the one hand provides greater freedom of movement, and on the other hand reduces the stability of the joint to physical stress.
Hip dysplasia, most often acetabular dysplasia, up to a certain age, is a problem of pediatric orthopedics. If the biomechanical disorders resulting from dysplasia do not exceed the critical level( stage of subluxation or dislocation of the hip joint), there are no deviations in the physical development of children, adolescents and young people.
On the contrary, it is noticed that people with acetabular dysplasia have a high need for motor activity, good motor skills, they are more often engaged in physical culture, sports, dancing, often have successes in this kind of activity. This is promoted by congenital hypermobility of joints, high elasticity of ligaments and constitutional type of physical development.
Most of them are women who make up the risk of having a baby with a congenital hip dislocation. In half of the patients, bilateral dysplasia with a predominant lesion of the hip joints is detected. Often dysplasia of the hip joint is an x-ray finding, after which only half "recalls" the history of "congenital dislocation of the hip" in infancy.
Pathological dislocation of the hip and neoarthrosis with congenital dislocation of the thigh
Neoarthrosis. Congenital dislocation of the hip.
If the dislocation of the femur is not eliminated, then following the known biological law "function determines the shape", the growing pelvic bones and femur change, adapting to the new loading conditions. The head of the femur loses its usual spherical shape and flattenes. The empty acetabulum diminishes in size, and in the place of the new location of the head of the femur( in the region of the iliac wing) a new articular cavity is formed. The newly formed joint is called "neoarthrosis".This is an inferior joint, however, it has been "serving" for dozens of years for those patients who, for various reasons, have not been confronted with congenital hip dislocation.
In case of incorrect treatment of congenital dislocation of the hip in childhood, the femur is displaced upwards beyond the acetabulum and rests against the pelvic bone.
Subluxation of the hip joints
Lord. What are the manuals? If it was a traumatic subluxation, it would be corrected in a minute. Is this innate? The ligament improperly supports the large femur with respect to the acetabulum. With the help of braces the ligaments will get used to keep in the right position. Do not condemn the child to subsequent arthrosis and lameness. I understand, with the child in the spacers it's hard. But it's half a year old, and yet not very heavy. He stays in bed for a year and will not be different from other children, because they start walking about a year later. Do not get yourself into trouble in the future. Carrying a five-year-old is much harder. Just in case, contact the pictures and the child with another orthopedist, and if he confirms, do not hesitate to put the spacers.
from friends this was-the child was in the struts.
as in a different way to treat, I do not know.
consult the specialists.
are you in Moscow?
call in children.orthopedic hospital, sign up for a reception-it's free!
Children's City Hospital № 19 named. TS Zatsepina.107061, B. Cherkizovskaya Str., Vlad.12. 168-86-33( informative), 168-86-69( reception)
Xenia, try this. When bathing try to connect the left knee of the daughter with the right elbow and, conversely, the right knee - with the left. If freely connected - then the problems with the pelvis are not great. And you can do without struts, and just between the legs to put more to the knees did not close. My cousin doctors also put a subluxation, but my grandmother and aunt checked with this "grandfather" method and did not put stirrups. Now she is 37 - everything is in order. My oldest son's wrinkles were asymmetrical up to 9 months. Constantly went to the orthopedist for examination, checked elbows-knees, now everything is normal( thank God).It just happens sometimes, torture a child for nothing, but you could not do it. ..Good luck to you anyway!
Do what the orthopedist advises, Congenital dislocation of the hip is treated by immobilization, fixing the hip joint in a physiologically correct position. Congenital dislocation of the hip has its own symptom complex( with a click of a pricket), as well as the state of the nucleus of ossification of the head of the femur. The orthopedist is not a fool, he advises you against complications( coxa vara, etc.), which usually lead to a shortening of the limb and restriction of the hip joint function, whose treatment is mostly operational. You think this is not necessary. ..
Mandatory tires Vilensky.no chiropractors and charlots.why so late diagnosed?
do what the doctor says, I also had these braces for more than a year and could not walk.congenital subluxation of both thighs, I was diagnosed with such a diagnosis in six years.and on the hood lay and corset at night dressed.then like everything fell into place.but not for long. Now I'm 27. And I have already been replaced with one joint and I am preparing to replace the second.like this, you can get a bunch of tips, but it's better to listen to your doctor, if you do not believe one, refer to the other.but the disease is very seryoznoe, do not run, the pain is hellish, limp and limp in motion-that's what can be.