Congenital hip dislocation in a child

Every expectant mother eagerly awaits the birth of her baby. During pregnancy, many people experience various fears. A woman thinks about whether her baby is developing correctly, worries whether he has genetic diseases, whether everything is in order with the internal organs and anatomical structure. Unfortunately, these fears are unfounded. congenital hip dislocation is quite often diagnosed in newborns . This is not a dangerous pathology, it can be corrected and goes away without a trace if the disorder is detected in time and treatment is started, and the parents follow all the doctor’s recommendations.

What is congenital hip dislocation

A hip dislocation is a displacement of the femur relative to the acetabulum. The femoral head is normally located at the time of birth in a practically formed glenoid cavity. The geometry of a newborn's joint is different from that of an adult. It is an immature biomechanical structure with its own characteristics: the head of the femur and the glenoid cavity consist mainly of cartilaginous tissue, they have not ossified (therefore are not clearly visible on x-rays), the cavity still has a flattened shape, the ligaments are weak and overly elastic. Therefore, the joint is not firmly held in the cavity.

With various malformations of the femoral bone and glenoid cavity, the head is displaced vertically or laterally, that is, the joint does not articulate. In this case, instability of the joint occurs, and there may be subluxation or dislocation of the hip.

How are hip x-rays done for young children?

An X-ray of the hip joint is taken for a newborn lying down, the baby’s legs are specially stretched and straightened. Bending at the knees or pelvis is unacceptable and will not provide the necessary information. The legs also need to be moved slightly inward.

Before X-raying a newborn's hip joint, it is best to have him sedated. This will ensure that the clarity of the image does not deteriorate due to movement. The child's genitals are covered with a lead apron, which avoids future reproductive problems.

Why does congenital hip dislocation occur in a child?

Medicine still cannot name the exact reasons for the development of intrauterine dysplasia. But there are known provoking factors that greatly increase the risk of congenital hip dislocation. These include:

hereditary predisposition;
complicated pregnancy with toxicosis;
large fruit;
breech rather than cephalic presentation;
female sex of the fetus.

These factors increase the likelihood of joint dysplasia, which leads to congenital hip dislocation in newborns.

The intrauterine developmental defect itself can be expressed in various deviations from the norm:

acetabular dysplasia - a defect in the acetabulum, in which the head of the femur should be located (the socket is slanted or flattened)
proximal dysplasia – underdevelopment or abnormal development of the femoral neck, change in the value of the neck-diaphyseal angle (the angle between the central axis of the femoral neck and the midline of the diaphysis)
rotational dysplasia with various types of violation of joint geometry in the horizontal plane (manifests later as clubfoot)

That is, any underdevelopment, pathology of unformed structures leads to the fact that the head is not held in the articular cavity, the femur is displaced upward or laterally (goes outward), the articular capsule is inverted or deformed, and the joint itself is unstable.

Advantages of treatment at Top Ikhilov

By choosing the Top Ichilov Clinic for treatment, you get the following benefits:

Treatment by highly qualified doctors
, many of whom are eminent specialists in the country.
High-tech equipment
. This is especially important to emphasize in relation to surgery of the limbs and joints. In their practice, Top Ikhilov surgeons use minimally invasive techniques that are not accompanied by significant blood loss and injuries.
Russian speaking staff
. At Top Ichilov, many doctors are fluent in Russian, so you will not have problems with communication, which is very important. However, if necessary, we provide our patients with a professional translator.

(1 vote, average: 5 out of 5)

Degree of pathology

Since joint immaturity can be expressed by various abnormalities, disorders are classified according to severity:

A – normal joint without disorders;
B – pre-dislocation: there are non-critical disturbances in the anatomical structure of the joint. The head is in the glenoid cavity, but is held weakly.
C – subluxation: the femur is displaced, there is a valgus deformation of the glenoid cavity. This is the so-called borderline state, in which there is a high probability of developing pathologies in the future.
D – congenital dislocation of the hip: the head of the bone is located outside the acetabulum.

Diagnosis of congenital hip dislocation

An immature joint that has not yet formed at the time of birth or has an anatomically incorrect shape can be suspected immediately after birth, even in the perinatal center. External manifestations of congenital hip dislocation in newborns and children of the first year of life:

asymmetrical skin folds on the legs (one inguinal and/or gluteal fold is deeper than the other, located higher or lower)
shortening of the leg (with straight legs, one knee is higher than the other)
limited mobility of the joint, in which the hip is not sufficiently abducted to the side (normally, in a newborn, the legs are separated by 80-90°, after six months - by 60-70°. If the hip is abducted by 50° or less, then it is necessary to show the child to an orthopedist and share with him with his observations)
symptom of a click or slipping (when the child’s hip is abducted to the side, a characteristic click appears - the head is mobile and is not held in the articular cavity, it slips)

However, none of these signs by themselves is sufficient reason to make a diagnosis. For diagnosis, the child is prescribed an x-ray or ultrasound. Since the cartilage tissue in young children has not yet ossified, the picture is “read” using special tests - schematic axes are drawn through certain points of the cartilage and bones, which make it possible to measure two values: h and d. They talk about displacement of the femoral head, which can be used to judge whether it is normal or pathological.

Ultrasound of joints is a safer and no less accurate diagnostic method than x-rays. Therefore, it is now used much more often.

What to do if your child is diagnosed with congenital hip dislocation

Treatment of congenital hip dislocation is based on methods that allow the head of the bone and the acetabulum to form and take an anatomically correct position. To do this, it is necessary to hold the legs for a long time in an open position, but not fix them rigidly, and do not deprive the child of the opportunity to move. Under no circumstances should you tightly swaddle a baby with his legs together and straightened. On the contrary, it is recommended to use disposable diapers and wide swaddling (helps with mild forms of joint dysplasia), soft orthopedic devices (special pillows, splints, elastic stirrups).

The orthopedist also prescribes massage and exercise therapy for the baby. These procedures help strengthen muscles, stabilize the joint apparatus, and after removing the dilating leg of the orthopedic structure, restore full range of motion and accelerate the child’s physical development.

If congenital hip dislocation is diagnosed too late, at the age of 2-5 years, then a rigid plaster cast is used for treatment. Reduction of a dislocation with this treatment brings much more inconvenience and psychological discomfort to the child and parents (the child is in a cast for up to 6 months), but it is possible to do without surgery.

In the most complex and advanced cases, congenital dislocation is treated only with surgical methods (corrective osteotomy of the pelvic bones with derotation of the deformity).

If congenital hip dislocation is diagnosed and treated in a child under 1 year of age (maximum 2 years), then it is almost always possible to stabilize the joint using gentle non-surgical methods. All elements of the joint, although with a slight delay, are correctly formed. Therefore, the main thing is to pay attention to the developmental defect, not to miss this severe orthopedic pathology, to start treatment as early as possible and complete it to the end, in no case to interrupt it without permission.

Hip dysplasia in children

Prevalence, causes, treatment prospects.

Among the pathologies of the musculoskeletal system in children, hip dysplasia is the most common. Girls, however, make up about 80% of patients. There is also a racial-ethnic dependence on the spread of dysplasia: it is practically not detected in the Chinese and blacks, while 2-9% of white children suffer from this disease. In addition, risk factors for dysplasia are breech presentation, tight swaddling of straightened legs, toxicosis and drug correction of pregnancy. Heredity also plays a big role: a parental history of dysplasia increases the likelihood of a child developing this pathology tenfold.

These statistics require some explanation. There is an opinion that children have begun to suffer from this disease tens of times more often over the past 50 years. This is wrong. The real reason for the deterioration of statistical indicators is the improvement of diagnostic methods and detection of the disease at an early stage. If previously the diagnosis was made only in the case of the most severe stage of the disease, congenital dislocation of the hip, now it is possible to identify subluxation, preluxation and even physiological immaturity of the hip joint.

Normally, the hip joint of an adult is formed by the head of the femur, the acetabulum and the ligamentous apparatus that holds the head in the socket and provides a sufficient range of motion. With dysplasia, the ligaments cannot hold the head of the femur in the socket during certain movements and then subluxation occurs.

If the head of the femur comes out completely from the acetabulum, then this condition is called hip dislocation.

In the absence of proper treatment for a dislocation, the shape of the bones gradually changes, a new joint is formed (neoarthrosis), but the child grows up disabled - lameness and different lengths of the limbs, as well as the occurrence of further skeletal deformities are inevitable. With timely detection and adequate correction of pathological changes in the joint, complete rehabilitation of patients is recorded in the vast majority of cases. This is why early diagnosis of hip dysplasia is so important.

Diagnostic algorithms.

Ideally, while still in the maternity hospital, the orthopedic doctor conducts the first examination of the newborn for the presence of this pathology. In the first days of life, the presence of a “clicking symptom” (when, when the hips are moved apart, the joint is reduced into the acetabulum with a characteristic sound) is an absolute indication for the start of treatment, which is successful in almost 100% of cases. The next examination of the child by an orthopedist is scheduled at 1 month. The doctor assesses the symmetry of the popliteal, subgluteal and inguinal folds by straightening the child's legs. Then, with the knees bent, he checks the separation in the joints.

Limiting dilution on both sides most often means increased muscle tone and is corrected by a neurologist. If abduction is limited on one side, then most likely this is a congenital pathology of the hip joint. If the separation in the hip joint is too wide, a bilateral lesion should be excluded. The most gentle and at the same time the most informative diagnostic method for this age is ultrasound. On ultrasound, you can see not only bone, but also cartilaginous structures, evaluate how stable the morphology of the joint is and evaluate the dynamic capabilities during the study.

The next scheduled visit to the orthopedist should be made when the child is 4 months old (ossification nucleus). This period should not be neglected, even if the doctor previously said that the child was practically healthy. The hip joint of an infant is an unstable system at birth and immature; pre-development and ossification (ossification) of some structures occurs after birth, and a normally developing joint can unexpectedly slip by this age and result in pathology. At this age, with dysplasia, the shortening of the leg on the affected side will already be visually noticeable. Children with suspected hip dysplasia undergo an ultrasound scan, and if the diagnosis is confirmed by ultrasound, an X-ray examination is performed. It is impossible to do without radiation exposure, since only an x-ray gives a fairly clear picture of the exact angle at which the head of the femur is displaced. At this age, treatment is successful in approximately 80% of cases. The same assessment of the joint is carried out at 6 months, but if dysplasia is detected, its treatment is successful only in half of the cases.

In a one-year-old child, it is easier to diagnose a dislocated hip joint, since new symptoms are added at this age, but, unfortunately, only 4% of children are cured when the diagnosis is made so late. Such children begin to walk several months later and limp when walking, tilting the body to the affected side. With bilateral damage, a “duck” waddling gait is observed. But the most reliable picture of the condition of the hip joint is still provided only by an x-ray. In case of confirmed pathology, for a detailed assessment of the articular structures and the choice of treatment tactics, arthrography can be performed with the introduction of a radiopaque substance directly into the joint capsule. The technique is deeply invasive, but in some cases irreplaceable.

The need to conduct a radiation examination on a child at such an early age is, of course, a disadvantage of this diagnostic algorithm, and today ultrasound examination methods are considered more relevant for children under one year of age. In addition to ultrasound screening of the hip joint, performed through a lateral approach (with the child positioned on its side), Doppler ultrasound is increasingly being used as an additional harmless and non-invasive diagnostic method. This method allows you to determine the presence of pathological changes in the vessels that supply the joint structures. But today, unfortunately, there are no clear figures for normal indicators and degrees of pathology, since different authors give different values, so this method is used mainly for monitoring the condition during treatment.

The youngest diagnostic method is MSCT - multislice computed tomography, which makes it possible to establish in all details, including in 3D mode, the exact relationships of joint structures. This technique is used mainly in older children who have not been diagnosed with a dislocation in a timely manner.

Treatment methods.

Today, pediatric orthopedics is so developed that with early diagnosis, the prognosis is almost always conditionally favorable. If dysplasia is detected in a child during examination in the maternity hospital, depending on the situation, wide swaddling or treatment with a splint may be recommended. Many children with physiological immaturity of joint structures are prescribed wide swaddling for the purpose of prevention.

For wide swaddling, a diaper folded in 6-8 layers is placed on top of the diaper between the baby’s legs, preventing the legs from being too close together. This spread of the legs helps keep the hip joint components in the correct position.

In case of a more serious violation, a splint is applied: soft cuffs wrap around the ankles, the legs are passively spread to the sides and in this position are fixed with a bar fixed in the cuffs.

Weekly, and after a month - once every two weeks, they check how much freer the movements in the joint have become and, taking this into account, change the length of the spacer bar. These simple methods allow in most cases to achieve cure within 3-4 months.

Sometimes a Freika pillow is used, essentially the same wide swaddling, but allowing less movement in the hip joint.

“Pavlik stirrups” are also used - a device that does not allow straightening of the legs, but does not limit any other movements.

If the diagnosis is made later, from 3 to 6 months, or the treatment turned out to be not effective enough based on the results of the control x-ray examination, then a plaster cast can be applied with the maximum possible non-violent abduction, rigidly fixing the joint in the correct position, followed by treatment with a splint. The duration of treatment with such a bandage varies from 2 to 6 months. Next, to consolidate the result, a spacer splint is applied for a period of about 3 months. If the formation of articular structures is delayed, physiotherapeutic procedures may be prescribed.

With a later diagnosis of dysplastic disorders in the hip joint and with high dislocations in a specialized hospital, reduction of the dislocation and subsequent treatment with a plaster cast in the Lorenz position, FTP, can be applied. In all cases, after completion of treatment, children are prescribed several courses of massage and physical therapy is required.

In children with severe dislocations, in case of ineffective conservative treatment or too late diagnosis, operations are performed, the purpose of which is to restore the relationship of the anatomical structures of the joint and its subsequent long-term immobilization. Sometimes not one, but several operations are required, and it is not a fact that the outcome of treatment will be the patient’s rehabilitation.

Recommendations for parents.

If your child has been diagnosed with hip dysplasia, you should under no circumstances panic, but you should prepare for what will be difficult. Children with splints, splints and Freika pillows may sleep worse and be more capricious, want to be held in their arms and, of course, parents have a completely natural desire to get rid of orthopedic structures as early as possible. This is absolutely impossible to do, since the state of stabilization in children occurs quickly, but is also quickly lost, so it is necessary to adhere to the period indicated by the orthopedist-traumatologist.

You should not skip routine examinations with an orthopedic doctor, since early diagnosis of diseases in general and hip dysplasia in particular is the key to a child’s health in the future. Do not neglect the recommendations for the use of wide swaddling for a baby. This type of swaddling does not cause any inconvenience to the child and is a guaranteed preventive measure for severe joint pathology.

Don't take lightly things like your child's limited hip mobility or unsymmetrical crotch folds. Even if your doctor said that everything is fine, but your parent’s heart is restless, in this case it is better to consult with another specialist and conduct an additional examination than to calm down and discover an obvious problem when it will be very difficult, and sometimes impossible, to correct it.