Dysplasia in infants how to treat a mild degree. Hip dysplasia in infants

The abnormal structure and improper functioning of the pelvic bones are the first signs of hip dysplasia in infants. This is the most common type of pathology of the musculoskeletal system in children in early childhood.

According to statistics, this disease develops in 2.5% of newborns. In regions where poor environmental conditions are observed, the indicator can increase significantly. In addition, experts note that the disease affects girls more often than boys.

Joint dysplasia - what is it?

According to medical terminology, hip dysplasia is called a pathology in which unformed parts of the joint are observed:

ligaments;
cartilage tissues;
bones;
muscle tissues;
nerves.

Some experts call this disease - congenital dislocation of the hip. Doctors distinguish three stages in the development of pathology in children:

Stage 1 - bone and cartilage tissues are not formed, muscles and ligaments are developed normally. Deviation of the femoral head is not observed;
Stage 2 - against the background of the abnormal structure of the bone and cartilage segments, a displacement of the head of the bone is formed upward and outward.
Stage 3 is the most severe type of pathology. There is no contact between the femoral head and the acetabulum.

Depending on the clinical picture of the disease, experts distinguish several forms of pathology in newborns:

acetabular - there is an irregular structure of the acetabulum. The head of the femur presses on the cartilage and deforms it. There is ossification of cartilaginous tissue and displacement of the femoral head;
epiphyseal - diagnosed in violation of the mobility of the pelvic joints and the appearance of pain;
rotational - there is an incorrect arrangement of the pelvic bones. The child has a clubfoot.

Incorrect formation of the hip joints in infants occurs against the background of violations of the intrauterine development of the embryo. Most often, the development of this pathology begins at 4-5 weeks of pregnancy. Experts identify several factors that have a negative impact on the formation of the musculoskeletal system in the fetus:

a genetic mutation caused by a violation in the primary laying of the pelvic joints;
the impact of negative substances on the embryo (chemicals, poisons, toxins, some groups of medications, etc.);
large size of the fetus;
breech presentation, provoking damage to the pelvic bones during delivery.
intrauterine infections or kidney failure in the fetus. Against the background of such deviations, a violation of water-salt metabolism is observed.

Factors in the development of dysplasia, on the part of the expectant mother, are:

chronic pathologies in which there is a dysfunction of the internal organs of a woman (heart, kidneys, liver, stomach, etc.);
lack of vitamins;
nervous shocks 1-2 weeks before childbirth;
taking hormonal drugs;
sedentary and inactive lifestyle;
metabolic disease;
first birth;
narrow pelvis of a woman;
childbirth before the due date;
risk of miscarriage;
the development of infectious pathologies in the process of bearing a child;
toxicosis and gestosis;
unhealthy lifestyle (drinking alcohol, cigarettes and drugs);
unbalanced diet.

In addition, experts note the relationship between the development of pathology and tight swaddling. In areas where doctors recommend not to restrict the movement of the child, this disease is less common.

As a rule, this pathology can be noticed by a specialist (neonatologist, surgeon, pediatrician) during the initial examination of the newborn. But many parents are interested in: “how to diagnose the disease on their own and what to do if the development of the pathology is still confirmed?” Most often, the first 2-3 weeks the disease is latent, and then it can manifest itself with one or more symptoms:

asymmetrical arrangement of folds in the gluteal zone, they can be seen if you turn the baby on his stomach;
the difference in the length of the lower limbs, usually the leg on the side of the unformed joint is shorter than in the healthy area;
stiffness of movement, when breeding the child's legs, this can be seen in the process of doing gymnastics to the baby;
incorrect posture;
constant tilt of the head to one side;
asymmetrical arrangement of the feet, they can be turned in different directions;
the appearance of a click when breeding the child's hips.

In the absence of proper treatment, the disease passes into a more severe stage and is accompanied by more pronounced symptoms:

pain on movement;
increased tone or complete atrophy of the pelvic muscles;
thinning of muscle tissue in the area of development of the pathological process;
frequent falls when trying to step;
swaying when walking;
joint stiffness.

If you do not start timely treatment of dysplasia, then this can lead to the development of various complications, ranging from poor posture to disability.

According to statistics, children suffering from this disease begin to walk much later than healthy ones. They have an unsteady gait, accompanied by swaying. This becomes especially noticeable in children at 1.5-2 years. In addition, there are other deviations in babies:

the occurrence of arthrosis of the hip joint at an older age;
violation of posture;
flat feet;
disorders in the mobility of the joints and spine;
death of joint tissues;
osteochondrosis.

Diagnostic measures

Many parents are interested in: “how to treat dysplasia in children?” To choose a method of treatment, it is necessary to make an accurate diagnosis and establish the stage of pathology. To do this, the doctor will examine the baby and prescribe additional examinations, according to the results of which he will decide how to cure the pathology and avoid the consequences.

X-ray examination.
Arthrography.
Arthroscopy.
KLA and OAM.
Blood chemistry.

In order to have an idea of what dysplasia looks like in infants, you can see the photo, which shows the diseased joint.

Treatment

The choice of treatment for this pathology depends on the stage of the inflammatory process. If the baby is diagnosed with pre-dislocation, then it is enough to massage the joint. At more advanced stages, the child requires complex treatment, which includes the use of several methods:

orthopedic;
physiotherapy;
surgical.

In order to get rid of dysplasia at an early age, it is necessary to fix the hip joint in the correct position. To do this, experts prescribe the wearing of special devices. The duration of such treatment depends on the degree of deformation of the hip joint.

Pavlik's stirrups. This is a special device that was invented in the last century by a Czech scientist. It is made of soft fabric that does not irritate the skin of the baby and is a device made of straps and a chest brace. Thanks to him, it is possible to fix the normal position of the femoral head and gradually the hip joint takes the correct shape. It does not restrict the movement of the baby at all and the child can take a comfortable position for him.
Freyka pillow. This is a special device that is placed between the legs of the baby and strengthened with the help of special belts. In this case, the legs of the child are fixed in a divorced state and are in a bent state.
Tire Vilensky. Another name for this device is a strut. It consists of a pipe and a special cuff with lacing. This device is worn daily for 4-6 months and is removed only before taking water procedures.
Sheena Volkova. This design is made of plastic and has several parts. The legs of the child are fixed in a fixed position with the help of a special corset.

Physiotherapy treatment

If the baby has acetabular dysplasia, then the baby is prescribed physiotherapy:

therapeutic gymnastics - consists of a set of exercises that parents can even carry out for a child on their own;
massage - for the procedure, the child is first laid out on the stomach, and then on the back and knead not only the hip joint, but also other parts of the body (stomach, back, arms, etc.);
thermal procedures - the inflamed joint is affected with the help of ozocerite or paraffin;
electrophoresis - for the procedure, a solution with calcium and chlorine is used.

Do not try to carry out these procedures at home, as you can aggravate the condition of the child. The procedure should be carried out by a highly qualified specialist, taking into account the form of the disease and all possible contraindications.

Surgery

This method of therapy is used only in extreme cases, if an advanced stage of pathology (dislocation) is diagnosed, or in the case when the treatment has not brought the desired result. There are several ways to perform surgery in young children:

osteotomy of the hip joint - the femur is divided into two parts and its proper fusion is ensured;
palliative surgery - with the help of the operation, specialists align the asymmetric limbs of the child;
arthroplasty - the inflamed joint is replaced with a plastic implant.

After the operation, the lower limbs of the child are fixed in a fixed position with a splint. This equipment will cause discomfort to the baby, but it is necessary in order to ensure proper fusion of the joint. After some time, the splint can be replaced with more convenient devices: stirrups or Freik's orthopedic pillow. The duration of wearing these devices is determined by the attending physician.

Preventive actions

If a mild stage of pathology is diagnosed, then in order to get rid of hip dysplasia, it is enough to do regular massage. In addition, Dr. Komarovsky advises following some recommendations that will be useful for caring for children with any stage of dysplasia.

It is not recommended to use tight swaddling of the lower extremities of the child. It is better if the baby's legs are in a free state.
The transfer of a child must be carried out according to a certain rule. Give the baby a vertical pose and press it to your body, while spreading his legs.
Daily exercise of the lower extremities. A very good exercise is considered to be “bicycle”, because in the process of its implementation the baby’s legs are in motion.
It is better to lay the baby in such a way that his lower limbs partially hang down. This will reduce the load on the area of inflammation and give a little rest to the sore joint.
You should not put a baby with dysplasia on the legs, because even a minimal load can provoke a curvature of the joint.
When transporting a baby in a car, you must have a special chair. It will not only protect the child in the event of a collision, but also prevent the legs from collapsing.
If the child eats in a special highchair for feeding, then between the legs he should put a roller twisted from a towel.

With late diagnosis of pathology, the duration of treatment is delayed, and the risk of complications increases significantly. If therapy was started in the 2nd week of life, then the chance of complete recovery is 100%. In the treatment of dysplasia in children under one year old, it is sufficient to use conservative methods of therapy: orthopedic, physiotherapeutic. At an older age, more serious treatment is required and surgical intervention is possible.

The development of a child up to a year is rapid: every day brings something new. The kid sits down, starts to crawl, stands on his legs ... finally, takes the first step. There is no limit to the delight and tenderness of parents. However, sometimes soon after this joyful event, it becomes clear that not everything is in order with the gait: the child strangely puts his legs, or limps, or rolls over when walking. What is this? And this is most likely a manifestation of hip dysplasia.

Hip dysplasia (DTS), or congenital subluxation of the hip joint, is the underdevelopment (or abnormal development) of the joint itself or its components: the acetabulum of the pelvic bone, cartilage, ligaments and muscles that hold the femur in the correct position.

With underdevelopment of the joint, the correct contact between the head of the femur and the recess for it (the acetabulum in the pelvic bone) is disturbed or absent. Manifestations of such a pathology are sometimes difficult to identify by parents at an early age of the child. The initial diagnosis of this congenital pathology is carried out immediately after the birth of the baby, which makes it possible to prevent its serious consequences that develop with late detection.

In the absence of contact between the femur and pelvic bones, the femur can move freely outside the joint. This condition is called joint dislocation, or dislocation. There are 2 subspecies of dislocation: teratological and typical.

Teratological develops in utero due to genetic diseases or anomalies in the development of muscle tissue. She is rare. A typical dislocation is characterized by an existing contact between two bones, but it is incomplete, unstable. This developmental pathology is most common and can occur both in utero and after birth in healthy newborns.

Subluxation is a less severe condition: the contact between the bones is within the normal range, but the joint is unstable and the femur is easily separated from the acetabulum.

Causes

The true cause of the pathological development or underdevelopment of the joint is not fully known.

Predisposing factors are:

genetic predisposition (often along the female line);
female infant (80% of all cases of dysplasia);
hormonal background: an excess of progesterone in a woman before childbirth can contribute to the underdevelopment of the ligamentous-muscular system;
incorrect position of the fetus in the uterine cavity, limiting the normal mobility of the child;
the large size of the fetus, which restrict its movement and prevent the development of the joint;
harmful factors, especially in the early stages of pregnancy (ecology, toxicosis, maternal illness, etc.);
prematurity: fetal tissues do not have time to mature.

Symptoms

The pathology of the development of the joints in the normal position of the legs does not cause any discomfort or pain in the baby. Because of this, it is difficult for parents to notice the underdevelopment of the joints in the early stages.

The first manifestations of pathology may appear when the child begins to walk. With DTS, swaying when walking or the so-called "duck gait" is noted on both sides. With underdevelopment of one or both joints, the child may limp, walk "on tiptoe" (do not step on his heels).

At the slightest suspicion, you should consult a doctor who can determine the diagnosis not only through examination, but also through special manipulations. With DTS, the following symptoms are detected:

different lengths of the lower extremities, shortening of the thigh;
asymmetry of folds on the inner surface of the thighs (non-specific symptom, can also be observed in healthy children);
pain (the child reacts by crying) or restriction of movement when trying to spread half-bent legs to the sides (normally, in infants, the legs are bred up to 90 °);
the head of the femur easily (with a click) moves forward from the acetabulum and returns to it: this indicates an increased elasticity of the joint;
excessive mobility in the hip joints: the baby may unnaturally turn the legs outward or inward.

Diagnostics

To confirm the diagnosis suspected by the doctor when examining the child, the following are used:

Ultrasound (in the first half of the baby's life);
x-ray examination (after 6 months, since at an earlier age the skeletal system is underdeveloped, it consists of cartilage, which is difficult to fix on a radiograph).

An additional examination is necessary to detect DTS, since sometimes even an experienced doctor can make a mistake. So, according to statistics, pediatricians suspect this pathology of the joints in 8.6 cases out of 1000, orthopedists - in 11.6 cases, and ultrasound reveals violations of the structure of the joints in 25 children out of 1000.

Ultrasound is the prevailing method for diagnosing the pathology of the hip joint in the first months of a baby's life: it is more informative than a simple medical examination, painless, and does not give radiation. The study makes it possible to see a clear shape of the cavity of the pelvic bone, which is of great importance in the development of dysplasia.

It makes no sense to conduct an ultrasound scan before 4 weeks of a newborn's life, because some changes in the structure of the hip joint disappear on their own, without treatment, during the first month of life.

Symptoms of DTS, which can be detected using additional examination methods:

flattening or deformation of the acetabulum of the pelvic bone;
underdevelopment of the femoral head or cartilage;
excessive stretching of the joint capsule or ligamentous apparatus;
incorrect angle of the femur;
partial (or complete) protrusion of the femur from the acetabulum.

Treatment

Therapeutic exercise and massage are part of the therapeutic measures for hip dysplasia.

The goals of therapeutic measures for DTS:

ensure a fixed position of the femoral head in the acetabulum;
strengthening of cartilaginous tissue and the ligamentous-muscular apparatus of the joint in order to exclude excessive mobility of bones and ligaments.

Treatment after examination and diagnosis should be carried out immediately. The duration and complexity of therapeutic measures depends on the severity of dysplasia, on the age of the child. A pediatric orthopedic doctor prescribes treatment.

Depending on the severity and timing of diagnosis, DTS can be treated conservatively or surgically.

Conservative treatment includes the following types of treatments:

orthopedic means;
physiotherapy procedures;
physiotherapy;
massage;
closed reduction of dislocation.

There is a wide range orthopedic aids , the main purpose of which is to maintain the baby's legs in a divorced and bent position without restricting the child's movements (which is very important). Orthopedics keep the femoral head in the correct position, which ensures the normal formation of the joint.

The most popular of these is Pavlik's stirrups . They are usually used in children under 6 months of age. The effectiveness of the remedy is about 85%, therefore, during their use, medical supervision is necessary.

Orthopedic splinter fixes the baby's legs in a divorced position with the help of metal devices, which contributes to the proper development of the joint.

However, there is no convincing data on the effectiveness of such swaddling. Some doctors still recommend it today.

Under no circumstances should you swaddle your baby tightly! With this fixation of the legs, the underdeveloped mobile and elastic joint turns inward and fuses in this unnatural position. It is better not to swaddle children at all, but to put them on small sliders.

From physiotherapy methods treatments are used: electrophoresis with calcium chloride, applications of ozocerite, mud therapy. Procedures help strengthen underdeveloped joints.

Physiotherapy used in the form of complexes of special exercises in accordance with the stage of treatment and the age of the child. Good effect gives swimming on the stomach. Exercise therapy helps to strengthen the muscular apparatus and restore range of motion.

The muscles of the thigh and gluteal region are well strengthened by a properly performed massage.

If the use of these methods of treatment from 3 months of age to 2 years did not give a result, then rigid fixation can be used to completely immobilize the hip joint in the form of a coxite bandage after reduction of dislocation in a closed way . Gypsum can be applied depending on the complexity of the case in one of 3 options: on the leg and half of the other leg, on two legs or on one leg.

Surgery It is usually used for advanced dysplasia and the ineffectiveness of previous treatments. More often this happens in those cases when DTS is detected in a child older than a year already at the stage of a formed dislocation of the hip. Although in some cases, even timely detection and treatment of the disease is ineffective.

Surgical intervention is achieved by the reconstruction of the hip joint. Operations can be carried out by different methods and are selected individually in each case. Sometimes only one operation is performed, and in another, more complex case, it may be necessary to carry out a multi-stage surgical intervention.

The following methods of surgical treatment are used:

Reduction of dislocation in an open way and gypsum fixation. The surgeon inserts the head of the femur into the socket of the pelvic bone during surgery. It is used in cases where reduction by a closed route was ineffective. The operation is possible when the bone nucleus has appeared, that is, the head of the femur has already turned from cartilage into bone.
Tenotomy, or surgical lengthening of the tendon to ensure proper insertion of the femoral head into the socket. After the operation, a plaster cast is also applied for 6 weeks. After that, an examination is carried out under anesthesia (to achieve complete relaxation), and an x-ray of the joint is taken. If it is unstable, reapply a plaster cast.

Such an examination (under anesthesia) can also be carried out after the ineffective use of the splinter method to decide on further treatment tactics (for example, to carry out reduction in a closed or open way).

Osteotomy of the pelvic or femur: an artificial fracture of the femur below its head is performed and the hip is rotated to the optimal position; or deepen the acetabulum in the pelvic bone. Bone fragments are fixed in the correct position using metal osteosynthesis (metal plates and bolts). A year later, when the bone grows together, an operation is performed to remove the metal plates. Such operations reduce pain in the joint when walking and improve joint function.
Palliative surgery: do not eliminate the defect in the joint, but improve the quality of life. One of the options for such an operation is to equalize the length of the legs using the Ilizarov apparatus.
Endoprosthetics: the affected joint is replaced with an artificial prosthesis.

After the operation, the child is in the hospital for several days. After surgery, it is necessary to carry out rehabilitation treatment for a long time, during which massage, physiotherapy exercises, and physiotherapy are used.

Forecast

With timely detection of pathology and treatment from the first month of a baby's life, the prognosis is quite favorable: conservative treatment is effective, and in 95% of children the diagnosis is removed by the year.

In case of ineffectiveness of the treatment or late diagnosis of DTS, the consequences can be very serious, and the child is likely to become disabled.

Childhood dysplasia is not as dangerous as the immaturity of the hip joints, these two conditions must be able to distinguish. If the symptoms are similar, only a doctor can distinguish one disease from another, so the newborn must be shown to an orthopedist in order to exclude pathology. Timely treatment allows you to completely get rid of the disease.

Causes of the disease

The very concept of "dysplasia" means a violation of the development of any part of the body. If this ailment struck precisely the hip joints, then this often manifests itself in:

improper development of the articular cavity;
immaturity of the femoral head;
impaired mobility of the hip joint.

These conditions can result in predislocation (predisposition to dislocation), subluxation and dislocation in newborns.

The reasons why the hip joints do not develop normally have not yet been elucidated. But some characteristic features of the disease have been found. Firstly, such an ailment is more common in girls than in boys. Secondly, the tendency to this pathology is genetically determined and is transmitted from generation to generation. And thirdly, improper swaddling of a newborn can provoke dysplasia.

It has been noticed that where it is customary to freely swaddle babies, this disease is much less common. For example, as soon as tight swaddling of babies was abandoned in Japan, the frequency of dislocations of the hip joints in babies decreased by 10 times.

So, in what cases are babies more vulnerable to dysplasia:

if the family has already had cases of congenital subluxation of the femoral articular joints;
if children are born in breech presentation;
in the presence of deformed feet;
with too much weight at the time of birth;
with pathologies of pregnancy.

Clinical symptoms

Signs of subluxation or dislocation of the hip in infants are visible upon visual examination. This:

asymmetrically located skin folds in the inguinal region, on the buttocks and knees;
shortened thigh;
limited hip mobility.

The best signs of the disease are visible in children aged 3 months. In any case, if you notice the symptoms of the disease, you should not panic, consult a doctor and start timely therapy. Examining the baby, the doctor pays special attention to the skin folds in the groin, gluteal area and under the knees - in the affected areas they are larger and deeper than usual. However, with bilateral dysplasia, the asymmetry may not be as obvious.

However, hip folds can be asymmetrical in healthy children, so you need to pay attention to a few more indicators.
Lay the baby on his back and gently bend his legs at the knees and at the hips. If you notice that the knees are at different levels, this is already a serious enough reason to take the newborn to the doctor.

The orthopedist at the examination should check for symptoms of slipping and limited mobility of the hip joints. The presence of the latter feature is most important in making a correct diagnosis.

Diagnosis of the disease

For early detection of dysplasia, it is necessary to show the baby to an orthopedic surgeon almost immediately after birth - at 1 month. and at the age of a little older - at 3 months. Diagnosis is made by ultrasound and X-ray. X-ray is used for older children - from 6 months. The treatment itself, its methods and speed depend on how early the disease is detected.

So, if you suspected the presence of dysplasia in a newborn by external signs and went to the doctor, then an ultrasound scan will be required to clarify the diagnosis. The study will reveal the full picture of the disease.

Ultrasound is a painless and completely harmless procedure for babies, available in almost any clinic. The examination helps to determine the severity of the disease.

By degree, the disease is divided into:

light, when the muscles and ligaments do not fit well to the joint, because of this, the hip bone is incorrectly located in the articular fossa;
pre-dislocation - a borderline condition in which the head of the femur is partially located in the articular cavity, and partially goes out;
dislocation - in this state, the head of the bone is outside the articular cavity, in this position, not only a gradual deformation of the joint occurs, but also the mobility of the leg in the thigh is impaired.

The form of the disease can be unilateral and bilateral. The second option is hip dysplasia in a newborn.

After ultrasound, it is imperative to conduct an x-ray examination, this is done at an older age, when the baby is at least six months old.

Treatment of the disease

Dysplasia is treated for quite a long time, so you should not expect the first results immediately after the start of treatment. The disease is not treated with medication.

Firstly, the child's legs must be constantly fixed in a divorced position with bent knees, and secondly, the child must move in this position.

In order to keep the baby's legs in the right position, there are various devices - splints, bandages, Freik's pillow, Pavlik's stirrups, etc. At first, during the treatment of the disease, the baby must be in them all the time.

The child must stay in orthopedic devices for at least 3 months, but only the orthopedist sets the exact period. Further prognosis largely depends on how early treatment began. Diagnosis and treatment of the disease at the earliest possible date gives a 90-95% chance of recovery. If subluxations and dislocations of the hip joints are not treated in time, the baby may remain lame.

For very young children, soft pads and wide swaddling are used, while rigid orthopedic structures are used to treat older babies. Only in extreme cases is it possible to treat with surgical methods, usually a cure can be achieved with the devices listed above.

In addition to various devices for the treatment of the disease, therapeutic exercises are also shown. The doctor may also refer you to physical therapy, for example, or paraffin therapy.

How to massage and exercise

The treatment advised by Dr. Komarovsky is very simple. This is a massage that greatly increases the effectiveness of therapy, it is also useful for healthy children, and in the case of pathological development of the hip joints, it is 100% indicated. The procedure can be carried out by both a professional massage therapist and the parents themselves.

The process itself is quite simple, it is only important to consult with an orthopedist before it - he will tell you how to properly massage.

Step 1

Lay the newborn on his back and start the massage with light strokes on the arms, legs and abdomen, and then turn the baby face down. Make sure that in this position the legs are laid aside.

Gently stroke and rub the baby's hips from the inside, then work out the lower back of the newborn with similar movements. After that, you can move on to the buttocks, the massage is done with light tapping movements and gentle pinching.

Step 2

After you have massaged the back and buttocks, turn the child over again and continue the massage, develop the front surface of the thighs, gently bending and unbending the baby's legs. Do not make sudden movements and watch the reaction of the newborn - he should not be in pain. Otherwise, the baby will begin to act up during subsequent massage procedures.

Step 3

Then begin to rotate the baby's hip inward. Do this alternately with each leg - with one hand hold the baby's pelvis, and with the other hand slowly bring the knee closer to the body and gently rotate the thigh inward. Such a massage will contribute to the proper formation of the hip joint cavities. Let your child rest by gently stroking their entire body.

At the end, take care of your feet - put a small ball under them and roll it.

The final stage is chest massage.

Wellness gymnastics

The exercises are extremely simple and do not require any equipment. Gymnastics should be carried out often - at least 5 times a day before feeding. Within 3-4 months, you should do the exercises 15-20 times.

First exercise: rotate the leg of the newborn bent at the hip and knee in a circle along the axis of the thigh.
The second exercise: bend and unbend the legs at the hips and knees towards the stomach, while the hips should be in a horizontal position.

Together with physiotherapy, massage, gymnastics and orthopedic devices will give excellent results.

Disease prevention

All newborns for the purpose of early detection of the pathology of the development of the hip joints in the maternity hospital or in the clinic at 1 month. perform a pelvic ultrasound.

One of the preventive actions, according to Dr. Komarovsky, is to wear the baby in a sling facing the mother.

As a preventive measure, wide swaddling is popular, contrary to the old-fashioned method of tightly fixing the legs in a straight state. It was believed that such swaddling straightens the legs, but in fact it only harms the baby and, as it turned out, significantly increases the risk of developing hip dysplasia in a newborn.

In some countries, it is customary for babies not to be swaddled, but to be carried on their backs, when the child's legs wrap around the mother's back, being in the correct position.

For wide swaddling, use a soft but dense cloth. Fold it in several layers and lay it between the baby's spread legs so that the side edges are in the area of the knees, and the upper ones completely cover the pelvis. It turns out something like a diaper, but much wider and more stable shape.

At the first appointment with an orthopedist, the mother of a newborn may hear an alarming diagnosis: hip dysplasia. It should not be taken lightly, because in the future the child may be tormented by severe pain along with inflammatory processes.

But you shouldn't panic either. The sooner parents begin to act, the more effectively and quickly they will be able to help the baby. How does this most common orthopedic pathology of the infantile period manifest itself and what to do with it? Let's discuss.

A bit of anatomy

Hip dysplasia in newborns is a condition in which the joint is underdeveloped. Normally, it is formed by the head of the femur and the acetabulum of the pelvic bone. The acetabulum in appearance resembles a semicircular bowl, framed along the edge with a cartilaginous rim, which limits movement in the joint. The cavity itself is filled with synovial fluid (a sticky fluid that acts as a lubricant for the joint).

The head of the femur is ball-shaped, so it fits exactly into the acetabulum. It unites with the body of the bone with the help of a small so-called femoral neck. The neck and head of the femur are covered by the articular capsule. Inside, the joint is held on ligaments, due to which depreciation occurs during power loads. In the main ligament passes a vessel that carries nutrients for the head of the femur.

In the figure you can see how the norm and pathology of joint placement looks like.

The hip joint, which resembles a spherical joint, is much more stable than other joints in the body, and is very mobile. With its help, movements such as flexion and extension, turns, adduction and abduction are performed. Of course, ligaments and muscles make his mobility not unlimited.

Dysplasia in newborns is determined when there is an underdevelopment of the joint, its inferior development, or the ligaments are excessively elastic. There are the following forms of dysplasia:

preluxation. It occurs when the joint capsule is stretched, due to which the head of the femur moves slightly, but easily returns to the desired position.
Hip subluxation. The femoral head is partially displaced relative to the acetabulum, and the ligament is stretched and strained.
hip dislocation. Complete displacement of the head (it goes beyond the cavity).

Whatever the situation, remember that the immaturity of the joint bag is to some extent due to physiological reasons. On the one hand, this means that all newborns are at risk of developing pathology, on the other hand, the condition is not a disease as such, especially since it is successfully treated precisely in infancy, thanks to the active process of formation.

The most dangerous thing that can be is procrastination. If the problem was discovered at the beginning of life, in the first 6 months, up to a year, up to a maximum of one and a half years, you can correct the situation to absolutely normal. When dysplasia in newborns is diagnosed in the second half of the year, the situation becomes more complicated: the treatment will take several years, but it will be effective.

However, if irresponsibility and negligence in relation to the health of the baby on the part of parents or doctors was admitted, and the child “decided to save”, when he, limping, went on his own, you can help, but it is possible that the baby will feel the consequences of dysplasia throughout his life .

Factors contributing to the development of dysplasia

Why do some children develop hip dysplasia while others do not? Doctors identify a risk group, confirmed by statistical data and a well-founded theory.

It is believed that the main cause of the development of dyslasia is the hormone relaxin. It is produced in a woman during childbirth. Under its influence, the ligaments of the small pelvis relax, and the pelvic bones “soften”, becoming as elastic and soft as possible. All this in combination allows the newborn to pass through the birth canal.

But the hormone affects not only the mother, it also softens the bones and ligaments of babies, and for girls, whose bones are initially more plastic than men, the effect is stronger. If a woman gives birth for the first time, the body, experiencing stress, produces relaxin more than usual. Thus, it becomes clear why at risk are:

firstborn,
female babies.

Other factors are:

Pelvic presentation. When a baby is born bottom-first, it is not entirely physiological, and there is a risk of dislocating the hip joint.
hereditary predisposition. If there were problems with the hip joints in the family along the female line, it is quite possible that the child "inherits" such a gift from the mother.
Large fruit. A baby weighing more than 4 kg does not always easily overcome the birth canal. Increased pressure goes both on the pelvic bones of the mother and on the child himself, and the risk of injury increases. According to statistics, the left hip joint is damaged in 60% of cases, which is associated with the forced position of the fetus in the womb.
Low water. A small volume of amniotic fluid (less than 1 liter) complicates the mobility of the fetus, this situation is fraught with injuries and pathologies.
Tight swaddling. It has been observed that in African countries, where children are not swaddled, but carried on the back, the percentage of cases of dysplasia is minimal. And when in Japan in the 70s they began to abandon the traditional tight swaddling for their nation, congenital dislocation of the hip began to occur not in 3% of babies, but only in 0.2%. So the relationship is clear.

Why did we consider all these factors? To know how to minimize the risk of developing dysplasia. For example, if a woman has her first birth as a large girl, and besides, a breech presentation, there is every reason to perform a caesarean section. And this is not because it is easier and more money for aunts-midwives. First of all, this is taking care of the child, because the risk in this case is high.

Asymmetric folds will tell you about problems with the joints

Symptoms

There are signs that should alert the mother and encourage her to visit the orthopedist unscheduled. These include:

Fold asymmetry. Babies are placed on their tummy and their legs are straightened. Normally, all folds (gluteal, inguinal, popliteal) should be mirrored. The depth of the folds is also assessed. However, this method in itself is not very reliable, since asymmetry will not be noticeable with bilateral dysplasia. In addition, up to 3 months uneven folds may be normal.
Hip abduction incomplete. In practice, it looks like this: the baby is placed on the table on his back and, holding his knees, spread his legs to the sides. Normally, the exercise is done without much effort, so that the knees touch the table. But if resistance is felt in the legs when trying to spread them, or one leg fits well and the other does not, this is an alarm signal.
Click when spreading the legs to the sides(symptom of slipping). It is also checked when breeding the hips to the sides. At some point, the doctor feels that the hip is no longer retracted, after which the hand “hears” a characteristic click. This is a reliable diagnostic method, but only in the first three weeks.
The situation when one leg shorter than the other. The limbs of the baby are pulled out and they look to see if the kneecaps are at the same level. Shortening indicates a severe form of dysplasia, when a dislocation of the hip is formed.

If you find a manifestation of one of the symptoms in your little one, this does not mean that he has dysplasia. It only means that you need to consult a doctor for advice.

Diagnostics

Dysplasia in newborns, as well as subluxation, is determined at a routine examination by an orthopedist. Such a survey is carried out at birth, a month, 3 months, six months and a year. Then, as a preventive measure, it is recommended to visit a doctor annually.

On the right side of the X-ray, you can see a dislocation

The trouble is that about 18% of diseases occur without visible symptoms. Therefore, ultrasound and X-ray methods are used for accurate diagnosis.

And if not treated?

If the immaturity or underdevelopment of the joint is small, they speak of mild dysplasia. In half the cases, it will go away on its own. But only half!

When children are diagnosed with dislocation, subluxation of the hip or severe hip dysplasia, treatment is necessary, otherwise, as mentioned earlier, the baby will complain of pain in the limbs, fatigue when walking, and the gait will resemble a duck.

Methods of treatment

plastering

The essence of therapeutic measures to correct the condition is to fix the joint in the correct position. It takes enough time for the ligaments to get stronger and hold the joint securely. For these purposes, gypsum is used when the legs are fixed in a parted half-bent position with a plaster cast. The minus of gypsum is its hygroscopicity and very heavy weight.

Orthopedic devices

There are many orthopedic devices that allow you to correct the deviations that have arisen.

Unlike rigid structures that led to complications (in particular, to necrosis), Pavlik's stirrups allow the baby to move more or less freely. The design includes a chest brace and overlays on the tops, united by straps. A pair of thongs in the front helps to bend the knees, and a pair in the back spreads the shins to the sides. Stirrups are made from soft fabrics.

Frejka pillow

It looks like panties, made of a dense material that helps keep the legs in a state of dilution at 90 OC. Wear a bandage if subluxation or dysplasia without dislocation is diagnosed.

Tire Vilensky

A device of two leather straps with laces connected by a metal spacer. They come in three types, oriented to the age of the baby. The orthopedic doctor regulates the length of the spacer, he also shows parents how to put it on correctly. So that the child, while playing, does not accidentally move the adjusting wheel, it is fixed with electrical tape. The straps are laced tighter, otherwise they will slip off. The tire is worn up to six months. You can only take it off to buy. A variation of this design is the CITO bus.

It consists of saddle-shaped leg struts with a metal rod inserted between them, shoulder pads, threads connecting the struts and regulating the length of the product, and Velcro fixing the orthosis.

Sheena Volkova

Now it is almost never used, since it practically immobilizes the child, it is difficult to select the size and is quite expensive.

Gymnastics and massage techniques

Massage and gymnastics are another tool that accelerates the process of joint development. All manipulations are carried out only as prescribed by the doctor and only by a good specialist. Usually the course is divided into 10 sessions with repetition in a month. In addition to therapeutic massage, parents can do daily relaxing exercises at home, including stroking and rubbing.

With the help of therapeutic exercises it is possible:

strengthen the thigh muscles;
return the original configuration to the joint;
maintain good blood circulation and trophism of articular tissues, prevent complications such as necrosis;
develop the physical activity of the baby.

Children under one year old are shown passive gymnastics as elements of a complex massage.

Physiotherapy

Electrophoresis with calcium and phosphorus. Electrodes with a solution are applied to the joint area. Thus, the elements, entering the body, strengthen the joints.
Warm bath. Water with sea salt has a relaxing effect on the body, improving blood circulation and accelerating regeneration processes.
Applications with ozocerite. They also affect the nutrition of tissues, contributing to the speedy recovery.
UFO. The treatment regimen with the use of ultraviolet rays is selected individually. Its purpose is to stimulate the immune system and accelerate regeneration.

Congenital dislocation - how it is reduced

If x-ray or ultrasound indicates hip dislocation in a child aged 1 to 5 years, closed reduction is indicated unless the displacement is severe (otherwise surgery is needed). What is this method?

Under anesthesia, based on ultrasound data, the doctor returns the femoral head to the correct position, after which a plaster cast is applied for six months, fixing the legs in a divorced state. When the bandage is removed, the rehabilitation period begins, including massages, physiotherapy, etc.

Surgery

Sometimes the displacement is so strong that it cannot be eliminated by a closed method. The situation can be complicated by infringement of the joint capsule, underdevelopment of the femur, or late diagnosis. Then resort to open surgery.

The disadvantage of surgical interventions is that they are fraught with complications: large blood loss, inflammatory processes, suppuration or tissue necrosis. Therefore, it is important to pass the recommended examinations on time and follow all the doctor's instructions.

Get your child checked out by an orthopedist

Prevention

To minimize the possibility of developing such a problem, follow these recommendations:

Do not practice tight swaddling. Instead, fix the handles with a diaper, and let the legs remain free. If the baby is at risk, master the technique of wide swaddling: laying the baby on his back, lay two diapers between his legs and fix them with the third one on the baby’s belt.
Slings. Use slings, carriers and kangaroo-style backpacks according to age. In African countries, where this method of transporting children is a tradition, the problem under discussion practically does not exist.
Use diapers one size larger. In addition to being just convenient, filled diapers spread the legs apart - an excellent prevention.
Massage and gymnastics. Physical exercise strengthens muscles, so general massage is done daily for prevention.

Summarize. We looked at the causes of hip dysplasia and how to treat it. Wearing restraint devices seems to be exhausting. Of course, it’s a pity for the baby, especially when his peers begin to stomp. But in this situation, as they say, time heals, and treatment cannot be interrupted, otherwise all your efforts will be nullified.

Untreated hip subluxation entails severe chronic diseases. Therefore, follow all the recommendations of the doctor and do not try to put the child on legs if the orthopedist has not given the go-ahead.

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

What is hidden under the diagnosis of "dysplasia"?

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

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

Pelvic diligence of the fetus. If the child spent the second half of pregnancy sitting on the priest and did not turn around, then it is more difficult for him to go through the birth canal. Those births are normal when the baby was born with a head. It's hard for a baby to break through. Therefore, the pelvic bones suffer and dislocations occur, which lead to dysplasia.

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

Heredity. Problems with the development of the hip joint or fragility of the bones were in relatives or the mother herself. Then the risk of pathology increases.

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

You are expecting your first child. In primiparous mothers, relaxin is released more than in all subsequent births. Therefore, the softening of the bones of the fetus occurs more, which leads to the risk of dislocation of the joint in the baby.

Negligent attitude of physicians. It also happens that obstetricians themselves, by their actions, lead to dislocation of the hip bones if they pull the baby strongly. But in such a situation, complications will arise not only in the pelvic, but also in the cervical and lumbar regions.

If any item is directly related to you, then you need to conduct a full examination for the presence of dysplasia.

Symptoms indicating pathology

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

The first examination of a newborn is carried out within the walls of the maternity hospital and all pathologies should be identified at the initial stage. This will help to cope with the underdevelopment of the joints earlier and easier.

But it also happens that dysplasia in a newborn begins to appear after being discharged home. Therefore, be careful and watch the crumbs yourself.

Contact your doctor without delay if:

Noticed the asymmetry of the gluteal, inguinal, femoral folds. To do this, undress the child and lay on a flat surface. First, straighten both legs, and then bend at the knees, trying to combine them at the same level. All folds in the groin, priests and hips should be the same.
The knees of the legs should be at the same level. If one is higher than the other, then there is a deviation in the development of the joint. But if the dislocation was on both sides, then the knees may not differ in level.
different amplitude. Lay the baby on the back. First, bend the legs at the knees, and then spread them from this position in different directions. Ideally, the knees should touch the surface. But don't overdo it. Don't put too much pressure on your feet. This can lead to dire consequences. If without effort the legs do not fall to the sides, or have a different angle of inclination, then there is a suspicion of dysplasia.

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

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

Professional diagnosis of dysplasia in newborns

A planned visit to an orthopedic doctor is prescribed by a pediatrician every month. But do not wait a month if there are suspicions. The orthopedist will accept the baby and prescribe all the necessary studies:

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

All stages of the survey are completed. The diagnosis is confirmed. What to do next?

Treatment methods for dysplasia in newborns

Hip dysplasia is not a death sentence. Stock up on patience and love. The process of returning the head of the joint to the acetabulum and fouling with elastic ligaments is long. It can take from six months to one and a half years. You can overcome everything, you just need to do it on time. Don't stop in the middle of your treatment.

What will help the baby and parents?

So, the cause of dysplasia is the displacement of the head from its place. It is necessary to return the joint to its original position. This can be achieved if you bring the baby's legs to a certain position: bend and spread apart. This position is comfortable for the child. You may have noticed that children without pathology themselves try to raise their legs to the tummy. If the dislocation is not very strong, then even diapers and proper swaddling will allow you to correct slight deformation.

wide baby swaddle

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

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

Specialist massage, physiotherapy

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

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

- Bend the child's knees to the maximum possible position and straighten them completely.

- We bend the legs at a right angle and try to spread them apart. After that, we begin to smoothly rotate the hips in a circle.

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

Exercises are performed lying on your back without fanaticism, when the baby is in a good mood. We repeat up to ten times. During the day, you need to do three to four approaches and follow the doctor's recommendations.

Often the orthopedist also prescribes physiotherapy:

electrophoresis with calcium;
heating with wax.

Special orthopedic gadgets

The treatment of dysplasia cannot be dispensed with without special devices that have passed all clinical trials and have benefited many patients.

Operational treatment method

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