Ultrasound of the hip joints in children of the first year of life

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Ultrasound of the hip joints is a painless and accessible method of assessing the condition and identifying pathologies of the joints themselves and the tissues surrounding them. In adult patients, this ultrasound examination is more likely to be an additional diagnostic method: it is rarely performed independently, more often as an addition to or MRI. However, ultrasound is recommended for patients with an artificial heart pacemaker or metal dental implants, since MRI is contraindicated for such people.

You can get an ultrasound of the hip joints at the clinics of JSC Family Doctor.

Why is ultrasound of the hip joints performed in newborns?

Ultrasound scanning of the TSB allows us to identify any abnormalities in newborns. It is a highly informative method that provides accurate results and allows you to identify such a serious deviation that can have a negative impact on the child’s quality of life, such as TBD dysplasia. This is a disease that is characterized by incorrect orientation of the femoral head in relation to the acetabulum. The result may be a violation of the supporting function of the leg. In order to eliminate the risk of such pathologies, ultrasound of the hip joints in infants is mandatory. It is carried out as part of a routine examination, highlighting the following stages of the disease:

Ultrasound diagnostics allows you to promptly identify any of the abnormalities and carry out the necessary treatment to prevent the child from lameness in the future. The attending physician prescribes special exercises, selecting them individually based on the stage of deviation.

It is important for parents to know that correct and timely diagnosis allows an accurate diagnosis and treatment to begin when it produces the desired results. Lack of treatment will lead to the development of serious complications in the form of lameness and arthrosis.

Detectable diseases

High-quality ultrasound of the hip joint in Yekaterinburg determines intra-articular pathologies and their presence in adjacent tissues. Problems inside a joint are often determined by fluid or blood accumulated in its cavity.

In medicine this is called effusion. The procedure detects the following diseases:

• arthritis and arthrosis;
• inflammation in the synovial area;
• tissue death of the femoral head;
• bone tuberculosis;
• displacement of elements of the joint capsule;
• developmental pathologies – dysplasia;
• coxarthrosis.

Extra-articular pathologies determined by ultrasound of the hip joint are negative changes in the periarticular tissues. They can be triggered by injuries - in an accident, at work or in sports. Examination of the soft tissues of the thigh reveals:

• hematomas, bruises;
• muscle micro-tears;
• swelling;
• bursitis – the presence of excess fluid in the joint capsule;
• various tumors and metastases.

Indications for ultrasound of the hip joints in newborns

As already mentioned, an ultrasound of a child’s legs is performed between the ages of one and three months as part of a routine examination. Outside diagnosis is prescribed if the baby shows signs indicating the presence of dysplasia:

• Asymmetry of the gluteal folds and buttocks, differences in depth;
• Clicking and crunching of joints when bending the baby’s lower extremities at the knees and TZB;
• Different lengths of the lower limbs;
• The presence of an additional fold on the thigh;
• Increased muscle tone in the legs;
• Inability to completely move the baby’s legs to the sides, bent at the knees;
• Presence of signs of embryonic development disorder.

In addition, the study is prescribed in the following cases:

• The child was born premature;
• The baby has neurological abnormalities;
• At the birth of twins or triplets.

Hip dysplasia

“Your child has hip dysplasia” - very often this phrase from the mouth of an orthopedic doctor causes a state close to emotional shock in the child’s parents. But is everything so gloomy and scary, and what kind of pathology is this?

Dysplasia - this term means a violation of the formation of any organ or system of the body. In this material we will talk about hip dysplasia.

Hip dysplasia is understood as a disorder of the formation of the hip joint, involving all the elements that make up the joint: the osteochondral base, the ligamentous-capsular apparatus and the muscular component. This definition is quite broad and includes physiological immaturity of the hip joint, preluxation, subluxation and dislocation of the hip.

Physiological immaturity consists in the incomplete formation of the components of the joint without violating the congruence (correct comparison) of the articular surfaces of the bones and, as a rule, requires minimal treatment or only dynamic observation, and it is this form of pathology of the hip joint that is mainly assigned the diagnosis of “dysplasia”, although this is not entirely correct terminologically. In case of severe immaturity of the hip joint, it is necessary to carry out treatment to create favorable conditions for the proper maturation of the components of the joint.

Pre-dislocation of the hip is a joint pathology associated with the lack of stability of the femoral head in another component of the hip joint - the acetabulum and requires close attention. In the absence of adequate treatment, hip dislocation can lead to the development of joint deformity (arthrosis), which leads to pain and impaired joint mobility, and can also lead to hip dislocation after starting to walk.

Hip dislocation is the most severe form of pathology of the development of the hip joint, consisting in an almost complete discrepancy between the articular surfaces of the femoral head and the acetabulum. Such a malformation of the joint requires maximum efforts for careful diagnosis and active and prompt treatment. Late diagnosis or inadequate treatment leads to severe impairments in the mobility of the hip joint and ultimately leads to disability.

Now we understand why hip dysplasia receives so much attention from pediatricians and orthopedists. Why is the hip joint most susceptible to these misfortunes?

The fact is that the hip joint, due to its anatomical and physiological characteristics, is the most loaded joint in our body and a failure in one of its components leads to dysfunction of the joint and, ultimately, to a deterioration in the patient’s quality of life.
That is why the diagnosis of hip dysplasia can so often be heard from the mouth of an orthopedist, although one cannot help but admit the fact of some overdiagnosis of this pathology, but given the severity of the consequences in the absence of treatment, this is still justified. How common is hip dysplasia?
According to statistics, the incidence of hip dysplasia is 4-6 cases per 1000 newborns, and is 6-7 times more common in girls. Unilateral lesions predominate over bilateral ones (and the left hip joint is more often affected). Inheritance from mother to daughter is noted. Quite a lot of factors leading to disruption of intrauterine joint formation have been noted, among them are breech presentation of the fetus, narrow uterus, oligohydramnios, toxic and biological (primarily viral diseases of the mother during pregnancy) factors and much more.

When and by what methods can and should hip dysplasia be diagnosed? Can a mother herself suspect the presence of hip dysplasia in a child and, if so, using what techniques? The answer to this question depends on the severity of the joint damage. Let's try to answer this question by linking the timing and diagnostic methods to the baby's age.

When carrying out ultrasound diagnostics during pregnancy, it is possible to diagnose only gross disorders - subluxation and dislocation of the hip, that is, those changes in which the articular surface of the femoral head does not correspond to the surface of the acetabulum of the child's pelvis.

In the first 7-10 days of a child’s life, examination can reveal a “clicking symptom” or a “slipping symptom” - dislocation and reduction of the hip in the joint. These symptoms are detected in a child as follows: in a supine position, bend the legs at the knee and hip joints at an angle of 90 degrees. The thumbs are located on the inner surface of the child's thighs, the index and middle fingers are on the outer. With gentle abduction and traction of the hips, the femoral head is reduced into the acetabulum with a characteristic click.

After the 2nd – 3rd week of a child’s life, limitation of hip abduction comes to the fore in the diagnosis of hip dysplasia. To identify it, the child’s legs, bent at the knee and hip joints, are separated without force in a supine position. Normally, it is possible to spread the hips to an angle of 85-90 degrees to the surface. With increased muscle tone and spasm of the hip adductor muscles, abduction can be limited to an angle of about 70 degrees, but such a limitation in hip abduction can also be caused by a violation of the formation of the joints. Limitation of hip abduction on one side in most cases is a sign of pathology of the hip joint.

Symptoms such as shortening of one limb, rotation of the foot on the affected side outward from the average position (external rotation of the foot) also speak in favor of the pathology of the hip joint.

The most widely known among parents (so to speak “mommy symptom”) - asymmetry of the subgluteal folds - is not absolute and can be caused by many factors, but its importance in the diagnosis of hip dysplasia cannot be diminished, since this is the most common question that is addressed to orthopedist

Ultrasound diagnostics is currently widely used to confirm the diagnosis of hip dysplasia and monitor the dynamics of treatment. The positive aspects of this examination method include painlessness, non-invasiveness, relative safety and recently increased accessibility. Also, with the help of ultrasound examination of the joint, minimal changes in the structure of the hip joint can be detected. But, unfortunately, this examination method does not always give accurate results (its reliability is about 85-90%). Nevertheless, today ultrasound diagnostics is the main screening method for diagnosing hip dysplasia.

In cases where the clinical picture diverges from the ultrasound examination data or in case of late diagnosis of hip joint pathology, the X-ray method is used. With a correctly performed x-ray, the picture of the structure of the joint and the relative position of the femoral head in the joint becomes completely clear. But due to the fairly high radiation exposure during radiography, this examination method is used as rarely as possible.

In children older than one year, the main symptom is lameness on the affected side when walking or a “duck” gait in the case of a bilateral process. Diagnosis at this age is late. The clinical picture in this case almost always requires X-ray confirmation, since it is necessary to accurately determine the relative position of the joint components.

So, the child has been diagnosed with hip dysplasia, what to do next and how to help the baby?

Treatment for hip dysplasia should begin as early as possible. The goal of treatment is to center the femoral head in the joint and create conditions for the formation of the entire acetabulum. Early, most gentle, but systematic treatment allows you to completely restore the anatomy and function of the underdeveloped hip joint.

Centering the hip in the joint in the early stages of treatment is achieved by wide swaddling - two diapers are placed between the child’s separated hips and secured with a third one. For severe degrees of hip dysplasia, special spacer splints (Pavlik stirrups, Freik pillow, etc.) are used to center the femoral head. When using these splints, parents may have questions and difficulties in caring for their baby; here are some tips that will help you and your baby adapt during this period:

1. Only a baby diaper (disposable or gauze) should be under the stirrups or pillow. If you prefer to use gauze diapers, wear oilcloth panties that have fasteners on the sides.

2. When changing a diaper, do not lift the child by the legs, but place your hand under the buttocks.

3. Undershirts can be changed without removing the stirrups: unfasten the shoulder straps from the chest and remove the undershirt over your head.

You can wear loose pants, suits, and dresses over the tires.

4. While wearing splints, the child is bathed less frequently, so it is necessary to inspect the skin under the straps, under the knees and around the neck 2-3 times a day to make sure there are no signs of inflammation (redness) of the skin. During this period, it is necessary to wipe the child’s skin with a soft cloth soaked in warm water. When performing water procedures, you can unfasten one leg part of the stirrup, but do not remove it, and keep the leg in a bent and abducted position.

5. It is also necessary to monitor the hygienic condition of the splint itself; it should always remain dry, avoid getting powders and lotions under the belts, this can cause inflammatory processes on the baby’s skin.

6. When feeding, you need to be especially careful that the baby’s hips do not come together.

Wearing these devices (orthoses) is long-term – from 3 months to a year, and it is extremely important for the parents of a child diagnosed with hip dysplasia to be patient and not to become cowardly during the treatment period and to meticulously follow the doctor’s orders.

After centering the femoral head, they begin massage and therapeutic exercises aimed at creating the correct ratio of the articular surfaces. We can recommend several exercises that can be easily done at home.

1. With the child lying on his back, bend the child’s legs at the knee and hip joints as much as possible, and then straighten them completely.

2. In the same starting position, bend the child’s legs at the knee and hip joints at a right angle, moderately spread the hips and, giving a moderate load along the axis of the hips, perform rotational movements with the hips.

3. With the child lying on his back, we spread the child’s legs, bent at the knee and hip joints, as close as possible to the table surface.

All exercises are performed 8-10 times 3-4 times a day.

Also during this period, physiotherapy (paraffin baths, electrophoresis with calcium and phosphorus preparations) is used to improve nutrition of the joint components and complex orthopedic massage.

In cases of delayed diagnosis of hip dysplasia or in the absence of adequate treatment in the early stages, treatment is carried out by long-term staged casting, as well as surgical treatment, but in these cases there are no standard treatment regimens and the tactics of helping the patient are developed individually.

After treatment of hip dysplasia, the child should be registered with an orthopedist for a long time - from 3 to 5 years until the end of growth. If necessary, control radiographs are taken once every 2 years to monitor the correct development of the joint. Limitations on the load on the joint are also often imposed. For children who have received treatment for hip dysplasia, it is advisable to visit specialized orthopedic groups in preschool institutions.

In severe degrees of hip dysplasia, functional impairments are usually lifelong, even with timely initiation and proper treatment.

So what do the parents of the baby need to do in order to recognize hip dysplasia in time and, if this diagnosis has been made to the child, to prevent serious complications?

First of all, it is necessary to show the child to an orthopedist on time. The recommended periods for examination by an orthopedist are 1 month, 3 months, 6 months and 1 year.

If the orthopedist nevertheless diagnoses hip dysplasia, then the effectiveness of treatment depends 50 percent on the correct and timely implementation by the child’s parents of the doctor’s prescriptions. It is important to remember that the earlier treatment is started, the better the results and the lower the likelihood of severe complications. With early diagnosis of hip dysplasia and correct and timely treatment, a positive result is achieved in 96-98% of cases. You should not be AFRAID of this diagnosis, but it is necessary to treat the child, he needs your help and care!

I hope this material helped you understand what this incomprehensible and frightening diagnosis for many is - hip dysplasia, and it became clear to you how to deal with this pathology.

We recommend that you seek advice from orthopedists at the Family Doctor clinic by calling the contact center in Moscow +7 (495) 775 75 66, or through the online appointment form.

Preparation and performance of ultrasound of the hip joints in newborns

Ultrasound examination of TBD in children does not require any specific preparation. It is important that the baby is fed and calm, since excessive activity will not allow accurate results to be obtained. It is best if feeding is carried out half an hour before the start of manipulations. They provide the following:

• The baby is placed on the medical couch on his side, with the lower limbs bent in the lateral position;
• The diagnostician applies medical gel to the area under study, places the ultrasound scanner sensor on it and carefully moves it, tilting it at different angles;
• During the process, he observes the image that is displayed on the screen of the ultrasound machine.

After the procedure is completed, parents need to wipe off the gel and dress the baby. The results of the study are made available immediately.

Classification of normal angles and interpretation of ultrasound results of TSB in newborns

The doctor compares the average normal values ​​and the results obtained for a number of parameters, determining the absence or presence of pathology and its stage. One of the evaluation criteria is the echogenicity of the structures. Thus, if there is hyperechogenicity of the femur and the dome of the acetabulum, the formation of the TSB occurs correctly. In this case, the femoral head and cartilage plate will be hypoechoic.

Another criterion by which the assessment is made is the angle of the femoral head in relation to the acetabulum. In this case, the following classification has been adopted, the indicators of which are the norm for children aged two to three months:

• Angle α (“Alpha”) – is more than 60° and determines the level of elevation of the acetabulum;
• Angle “β” (“Beta”) is less than 55° and determines the development of the cartilaginous space of the acetabulum.

Experts distinguish 4 types of hip joints and 3 degrees of dysplasia:

Advantages of performing an ultrasound of the hip joints in children at the Doctor Nearby clinic

Specialists from the Doctor Nearby clinic network know better than anyone else that the accuracy of a TZD study depends on how calmly the baby behaves. They make considerable efforts to create the most comfortable conditions during ultrasound diagnostics: both for the baby and for the parents.

Appointments are by appointment only, so there are no queues. The research is carried out carefully and using modern equipment, which allows it to be as accurate as possible. The results are available immediately.

Our pricing policy is loyal to patients. You can verify this by reading our price list below. You can make an appointment by phone.

Who should not have an ultrasound?

Ultrasound procedure

It is so harmless that it can be done if indicated for both children and pregnant women. The reason for a temporary contraindication to the procedure may be a violation of the integrity of the skin at the examination site: an abrasion, rash, unhealed wound, purulent inflammation, etc.

The only contraindication due to the inability to conduct an informative examination is excess weight. In this case, you will have to look for another method of obtaining information ( MRI

,
radiography
,
computed tomography
).