Hip Dysplasia in Children

“Your baby has hip dysplasia” – this phrase sounds like a sentence to many parents. But instead of panicking, you need to immediately take up treatment so that you do not blame yourself for all sorts of consequences in the future. In what to do when we find ourselves in such a situation, we will understand this article.

What is hip dysplasia

Such a problem in children of the first year of life is quite common. This diagnosis is heard by many parents. They fear this verdict, but is it really so dangerous?

Dysplasia is not a disease, but a feature of the child’s body. Such a diagnosis can be heard with improper formation of the hip joint, as a result of which its head is in the wrong position in the acetabulum.

The diagnosis can be encountered when the femoral head is not firmly fixed in the joint bag. If the child moves incorrectly, she can easily jump them out of her. In addition, the hip bone may not be in the joint bag, but located slightly higher.

The danger of joint dysplasia in children

Having revealed dysplasia of the hip joints in the baby, it is impossible to delay in any case. From the timeliness of treatment depends on its effectiveness and duration. Much faster you can get rid of the problem if it was identified in the first six months of life than when it happened later. In the first case, the child will need up to a year to recover, while in the second it will take several years.

Treatment should be compulsory and completed. If you neglect therapeutic procedures, ignore the recommendations of a specialist, miss valuable time, postponing treatment for later, you can personally contribute to the fact that:

  • There will be inflammation, painful and serious;
  • There will be a dislocation of the hip, causing pain to the baby;
  • The gait of the child will change with dysplasia – he will be lame.

Causes of dysplasia

According to statistics, a quarter of children born are diagnosed with hip dysplasia. Some of them do not require intensive treatment. The problem is easily solved thanks to the work of the orthopedist and his constant control over a small patient. Joints are formed, acquire the correct anatomical shape. Other babies were less fortunate, and in order to fully recover, they need intensive care, and sometimes surgical intervention.

There is a scientific explanation for why so many babies are born with dysplasia. According to him, shortly before birth in the mother’s body, intensive preparation takes place. It is aimed at producing the hormone necessary at this time. It is relaxin. It acts on the joints (femoral-sacral), making them elastic. It is thanks to this that the female pelvis expands and prepares for the birth of a child.

In addition to the fact that the hormone affects the female body, it also affects the baby. Only now the bones and ligaments of an adult woman are formed and nothing threatens them, which cannot be said about the child.

The likelihood of dysplasia in an infant increases if:

  • A woman gives birth for the first time. It is during the first pregnancy that the production of relaxin is maximum;
  • The weight of the child exceeds 3,5 kilograms. The more the fruit weighs, the more its hip joints collide with pressure;
  • The birth of the girl is expected. Nature made sure that the female bone exceeded the male bone in elasticity. Therefore, in the process of fetal development under the influence of relaxin, it softens more. This is confirmed by statistics – for 7 girls with dysplasia, there is only 1 boy;
  • The diagnosis of pelvic presentation has been established. In natural childbirth, in this case, the legs and butt of the newborn appear first, and only then the head. Therefore, the lower body is faced with a greater load and pressure than during normal childbirth (head first). Given that the bones are soft, very often the femoral head is displaced;
  • On the maternal side, there are women who have had to deal with this problem. In this case, the probability of having a baby with dysplasia increases up to 4 times.

These reasons are very diverse. But knowing them, you can save the unborn child from a rather unpleasant diagnosis. Therefore, it is not necessary to absorb food in large volumes during pregnancy so that the fetus is not large. And if pelvic presentation of the fetus was detected on an ultrasound scan, then you should not risk it, but rather think about a cesarean section.

How to identify a problem

Only an orthopedic specialist can determine and establish a diagnosis. To do this, he needs to examine a small patient, examine the x-ray, the angle of the bone and much more. This question is very serious and requires the same approach.

But in some cases, parents can identify the problem. What signs should be the reason for an immediate appeal to an orthopedist:

  • Asymmetric folds (on the buttocks, groin, hips). You can determine this by turning the baby on his tummy and straightening his legs. In this position, it is necessary to examine the folds on these parts of the body. Each of them should have its own pair, located at approximately the same angle and at the same level. If inconsistencies are found – urgently to a specialist;
  • Different height of the knees. The child, who is lying on the back, carefully bends the knees and compares their height. If it is different, then it can be sa />
  • Different amplitude of the joint during the breeding of the legs. The baby is normal, if lying on his back, he can easily bend the legs at the knees and separate them to the sides. The presence of a problem is indicated by a different amplitude of the joints or a click when moving the hips to the side.

What to do when identifying signs of dysplasia

When parents suspect that something is wrong with their child, the best thing they can do is to consult a specialist. This should be done not only by identifying the above signs, but also with the aim of prevention. What for?

Many leading specialists, including Dr. Komarovsky, have repeatedly raised the issue of hip dysplasia in children up to a year old. If we analyze all of the above, we can conclude that:

  • The absence of signs of a problem does not indicate its absence. After all, deviations in the development of the joint can be bilateral and it is not so simple to identify them;
  • The presence of signs does not yet indicate that the problem has affected the baby.

You can take care of the baby’s health, the normal functioning of his musculoskeletal system in the future by regularly visiting a pediatric orthopedist.

He will examine the baby and prescribe procedures to identify the problem:

  • Diagnostics by ultrasound. The bottom line is screening analysis. It is prescribed to infants aged 1 to 3 months. If we are talking about children whose age is more than indicated, they are assigned an x-ray;
  • Roentgenography. A significant drawback of this procedure is that a small patient must be stationary during the procedure. And in some cases, it’s from the realm of fiction. Therefore, it is better to carry it out at a time when the baby is sleeping. Otherwise, the orthopedist may need parental help. In addition, the bones of the baby are not always clearly visible in the resulting image, because they are not dense enough.

What should be the treatment for dysplasia

Before proceeding to the methods of treating dysplasia, you should understand what it should be aimed at. Everything is very simple here – the head of the femur should enter the articular cavity and be fixed there with the help of ligaments. This will allow her to always stay in place with any movements of the baby. In order for this to happen, a certain amount of time is required.

Effective therapeutic methods include:

  • Wide swaddling with dysplasia. The baby’s handles can be swaddled tight, so he will not wake himself up during sleep. But the legs should be spread apart. In no case should they be straightened. For this purpose, special panties or diapers can be used.
  • Special orthopedic devices. They allow you to fix the baby’s legs in the correct position – bent and divorced. The list of such devices includes a tire, which is presented in the form of a spacer between the legs, a plastic corset, and gypsum-based fixators. The most effective are Pavlik’s stirrups. The device received this name in honor of its creator, the Czech orthopedist.
  • Therapeutic gymnastics or massage. All necessary exercises should be carried out by a specialist from whom parents can adopt the basics and perform the procedure at home.
  • Electrophoresis – with the help of a low-voltage current, a medication is introduced to the baby. This allows you to focus the injected drug in one place.
  • Heat treatment. For this, white paraffin and ocerite (mountain wax) are most often used. Applications are made on their basis. They are recommended to enhance the effect of massage or therapeutic exercises.

These are the main methods of treating hip dysplasia in babies up to a year old. But the doctor should choose the right option only. In addition, he will tell you how to speed up the healing process (swimming helps a lot, wearing a diaper is 2 sizes larger, which will not allow the newborn to align the legs).

Dr. Komarovsky on dysplasia

Hip dysplasia in children

Pediatric Hip Orthosis Tubinger

Orthosis for the correction of hip dysplasia in children of the first year of life. Included in the standard of treatment in Germany and other European countries.

The well-known children’s orthopedic surgeon Bob Selter (Toronto, Canada), in his studies showed that the child’s hip joint develops best in conditions as close as possible to those created in the womb and are natural for its formation. He introduced into practice the term “natural position” (human position) – that is, the fetal position in the womb, when his legs are bent and slightly divorced. A necessary condition for the successful treatment of dysplasia (developmental disorders) of the hip joints in children of the first year of life is to maintain the following position of the legs:

  • flexion in the hip joints at an angle exceeding 90 °
  • controlled moderate abduction from 30 ° to 45 °

Early detection of the problem and the start of treatment immediately after the birth of the baby is the best prerequisite for the rapid development and maturation of the hip joint. The Tubinger Pediatric Hip Orthosis has established itself as a highly effective orthopedic treatment for hip dysplasia. The orthosis consists of two femoral stops, a median strut and a shoulder girdle. On the thighs are the hips of the child. The stops are interconnected by a spacer of adjustable length to set the degree of dilution of the hips. The bending angle of the child’s legs in the hip joint is set by changing the length of the two strands of beads connecting the femoral emphasis with the shoulder girdle.

Shishkevich Vladimir, orthopedic and traumatologistShishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.

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Key features of the Tübinger orthosis:

  • Proven treatment with proven effectiveness. .
  • High willingness of parents to cooperate with a doctor, as the orthosis is reliable and easy to use.
  • The angle of bending and abduction is easily reproduced when re-donning the orthosis without the need for additional settings.
  • Lightweight and comfortable design allows the child to actively move in an acceptable range.
  • The brace is waterproof and resistant to salt water.

Medical facts


The formation and development of the hip joint. The process of ossification (ossification) of the pelvic ring begins in the early fetal period with ossification nuclei in the iliac, sciatic and pubic bones. Subsequently, all three ossification nuclei merge in the center of the acetabulum. First, ossification of the internal part of the ilium occurs, then – external due to the unipolar movement of the growth plate towards the acetabulum. The ossification of the acetabulum can be significantly impaired if, during the ossification period, the direction of the shear force acting on the growth plates from the side of the femoral head is changed – for example, with pelvic presentation. Moreover, delayed ossification, requiring treatment, may be present already at birth. Before birth, the legs of the fetus are more or less fixed in a bent position, and immediately after it, the newborn begins to actively perform extensor movements. Such a load can withstand only the acetabulum with a sufficient degree of ossification. After birth, the various stages of acetabular ossification are detected by ultrasound and are classified according to the maturity scale of the hip joint proposed by Graf. At the beginning of the 3rd month of a child’s life, the acetabulum is fully formed. From this moment, the maturation of the femoral head and acetabulum is more proportional.

The stages of ossification can be assessed by ultrasound by measuring the angle described by the Graph, which determines the degree of maturity of the hip joint. At birth, this angle should be at least 50 °. If we assume that the process of ossification occurs linearly with the minimum permissible speed (orange line in Figure 3), then in accordance with the ultrasound data of the Count, by the 3rd month, the angle α should be at least 60 °. In 1990, in a statistical study by Chauner (Tschauner) it was shown that the average value of the angle α for normal joints (type
I according to the Count) at the 3rd month of a child’s life was 64,4 °. Taking for calculation a parallel graph (green line), we find that the optimal angle α at birth is 55 °. In 1994, based on data on the hip joints that developed independently (without the use of a therapeutic effect) and reached an angle of α = 4 ° in the 59th week of a child’s life, Chauner constructed the so-called “maturation curve” (Fig. 3). In 1999, by analyzing the performance of normal hip joint formation in healthy infants, Matthiessen was able to confirm, supplement and determine the parameters of Chauner’s “ripening curve”, as well as to describe the optimal development range (zone marked in yellow). This means that the process of differentiation and ossification of the acetabulum occurs exponentially in the first 6 weeks of life, slows down by the 12th week and evens out by the 16th week, when the femoral head and acetabulum begin to develop proportionally. Consequently, in case of delayed development of the hip joint treatment should be started as soon as possible in order to use the huge potential of the early stages of ossification and achieve rapid maturation of the acetabulum. The most effective approach, taking into account the principles of biomechanics and reproducing the “natural” position, which was described by Selter: bending
hips at an angle exceeding 90 °, with moderate abduction at an angle of 30 ° to 45 degrees.

Indications for the appointment of a hip orthosis Tubinger

The standard indication for the use of the Tübinger orthosis is hip dysplasia without signs of instability (stable types IIa, IIb, IIc on the Graf scale).
The optimal position for the treatment of hip dysplasia:

Conditions for effective treatment

Primary Information for Parents

Instructions for donning an orthosis:

Put on the shoulder belt over the child’s head and fasten it with the Velcro so that the track pattern is in front. With one hand, slightly raise the baby’s legs and lay his hips on the thighs. Putting your child in front of you so that his bent legs rest against your stomach, you can choose the desired angle
flexion in the hip joints (≥90 °). At the same time, your hands will remain free, and you can easily fasten the ends of the bead threads inside the white clip fasteners on the front of the shoulder belt.

If the standard length of the orthosis bead strands is not enough, they can be lengthened due to the spare sections fixed at the back on the shoulder belt. You can also use additional areas under the red clasps-clips on the lower part of the thigh stops. At the final fit, the beads are shortened in their upper part so that 3 beads remain on the front white clip fasteners on each side (parents should remember this number).

The degree of dilution of the child’s hips is set in accordance with age using a front strut, adjustable in length. Open the sliding lock-latch by moving it to the left (looking from the doctor’s side), set the required length of the spacer and close the lock by moving it as far as possible to the right until it clicks.

Using an orthosis

Completion of treatment

When normal values ​​are achieved according to ultrasound, wearing an orthosis can be stopped. In accordance with the recommendations of the working group on
the treatment of hip dysplasia of the German Association of Orthopedists and Traumatologists, at the final stage of treatment, a control x-ray is mandatory
the study of the pelvis and hip joints, since the deterioration of the state of the hip joint subsequently (the “endogenous factor” according to Mattissen) cannot even be ruled out
in children who do not have other health problems. In the first year of a child’s life, ultrasound is a reliable method for examining the hip joint, however, in the future, x-ray studies are necessary for monitoring, therefore, for the subsequent comparative assessment, the state of the joint at the time
end of treatment. Clinical examination and, if necessary, x-ray examination are recommended for children treated for hip dysplasia before they begin to walk, one year before starting school, and also, possibly, at the end of the period of active growth.

Hip Dysplasia

According to statistics, the parents of three out of a hundred newborn babies face a similar problem. Doctors under the term “dysplasia” mean congenital underdevelopment of the joint, which leads to disruption of its work and in the most severe case can cause chronic hip dislocation.

Such a disease in the absence of treatment does not end with anything good. Dysfunction of the lower limb, gait, pain in the hip joints and a high risk of disability are the consequences of advanced dysplasia. Therefore, all parents need to know the first symptoms of this ailment and understand the importance of timely visits to the orthopedist. Early diagnosis and proper treatment will help to avoid complications. Remember, the earlier the diagnosis is made, the more favorable the prognosis will be!

Cause

There is still no consensus among experts about the development of hip dysplasia in children. According to one version, the main reason is a malformation of articular tissues in early pregnancy (the first 2-3 months). Adverse ecology, exposure to toxic substances and some infectious diseases predispose to this.

According to another theory, the development of joints is affected by a high level of oxytocin – a hormone that causes the onset of labor. Accumulating by the third trimester, oxytocin increases the tone of the fetal femoral muscles, as a result of which subluxation of the hip joints gradually develops. Perhaps this is the reason for the greater prevalence of dysplasia among girls (5 times more often than boys), who are more susceptible to the influence of the hormonal background of the mother.

The risk of an incorrect intrauterine position of the fetus and a prolonged heavy birth (in the gluteal presentation) also increase the risk.

The tendency to dysplasia is often inherited, therefore, if any of the relatives already had such cases, you need to think about early diagnosis in advance.

First signs

Parents may suspect something was wrong, even before the consultation of the orthopedist. Most often this occurs with a severe form of the disease, when the head of the femur completely leaves the articular cavity. In milder cases, only a specialist can determine the presence of dysplasia, since subluxation and subluxation of the hip joint externally practically does not manifest themselves. However, there are main signs:

  • restriction of mobility (breeding) of the hips, often the baby begins to cry when trying to take the leg to the side;
  • asymmetry (mismatch) of the inguinal and gluteal folds, which become more pronounced on the damaged side.

But the presence of only these symptoms in case of hip dysplasia in a child is not an absolute sign of the disease and may be the result of a violation of muscle tone.

In case of dislocation, the hip joint practically loses its functions, and the affected leg is shortened. There is a “click symptom” – slipping of the femoral head from the surface of the joint when the child’s legs are bent in the knee and hip joints, as well as its reduction when they are bred.

Treatment

If dysplasia was not diagnosed in the first 6 months of life after childbirth, then the joint damage progresses – the limb is even more shortened, a pathological (“duck”) gait or intermittent claudication (with bilateral dislocation) is formed.

Diagnosis of dysplasia is often carried out in the hospital. If this does not happen (recently ultrasound is done only if there are problems), then the parents themselves can ask the pediatrician to conduct an examination. It is safe for the health of the baby and guarantees high accuracy of the diagnosis.

However, if a single ultrasound scan showed the normal development of the joints, still do not forget about constant monitoring by an orthopedist. Scheduled examinations will help the child avoid possible problems.

The first visit to the orthopedist should take place no later than 1 month, then the obligatory ultrasound of the hip joint is performed. This is a prerequisite for the early diagnosis of dysplasia. Re-examination is carried out by the end of the 3rd, beginning of the 4th month, then the doctor may recommend an X-ray. Most difficult to diagnose a subluxation of the hip joint, which practically does not manifest itself and can only be seen on an x-ray.

Take the preventive observation by an orthopedist seriously – the timing of the examination is not random, each of them is associated with an important stage in children’s development. So, if dysplasia was detected in the first 3 months of a baby’s life, then after a course of treatment the joint’s working capacity is fully restored (usually by 6-8 months), and there are no long-term consequences.

The younger the child, the easier the treatment for dysplasia. For example, in babies up to 3 months, the joint can recover on its own, provided that the children’s legs are in the right position all the time. That is why the main treatment method in the early stages of the disease is free swaddling, in which the child’s legs are in a diluted state. At the age of 3 months, the divorced position of the legs is achieved by using the Frank pillow (Photo 1), selected according to the size of the child. The later the treatment is started, the more serious orthopedic devices are used, at 6 months the Mirzoeva bus (Photo 2) or Pavlik stirrups (Photo 3) are already used.

Photo 1. Pillow FrankPhoto 2. Tire MirzoyevaPhoto 3. Stirrups of Pavlik

In this regard, the experience of countries in Asia and Africa is interesting, where mothers traditionally most of the time carry children on their stomachs or behind their backs and do not swaddle. Cases of dysplasia are rare here, because the joints are provided with ideal conditions for normal development. On the other hand, in European countries it is customary to swaddle newborns fairly tightly (pressing the legs against each other) – in this position, even the mildest forms of joint underdevelopment can lead to the formation of dysplasia.

Doctors believe that free swaddling not only allows you to dislocate on your own at an early stage, but also stimulates the further development of joints, preventing the occurrence of complications. The meaning of free swaddling is that the baby’s legs should always be in a divorced position, but at the same time have sufficient freedom of movement. The easiest way to achieve this is with a wide diaper and disposable diapers: after putting a clean diaper on a child, a dense diaper is folded over it, folded into a wide ribbon – so that the baby can not move the legs together. In this position, the small patient should be 24 hours a day. Often, the doctor adds a course of therapeutic massage and daily gymnastics (including abduction-circular movements in the hip joints). In most cases of mild forms (subluxation, preluxation with a slight displacement of the femoral head), such treatment is sufficient.

Did not have time…

But if treatment and prevention were not carried out in the first 3 months of life, then a more serious and long-term treatment will be required for a full recovery. The danger of unrecognized dysplasia is that the baby’s bones are very flexible and subject to various deformations due to age-related features. The baby’s skeleton is constantly growing, but this same factor also explains its great tendency to malformations. Most joints (including the hip) in the first months of life consist mainly of cartilage, and any abnormalities in the connection of the bones lead to the formation of serious deformities. To stop the progression of the disease, it is necessary to return to a normal position all parts of the joint. For this, various types of discharge tires are usually used (indicated above), they hold the baby’s legs in position. After some time, the joint gradually “fixes” and begins to develop correctly.

At the age of 2-3 months, small patients with suspected dysplasia are usually not given an X-ray, since even with an unconfirmed diagnosis it is customary to prescribe a preventive course of treatment: the use of soft dilating tires, a course of therapeutic exercises (with abduction-circular movements) and massage of the gluteal muscles . Splinting and massage are well combined with physiotherapy methods, accelerating recovery.

Using distributing tires, remember that their design should not impede the free movement of the baby’s legs, otherwise the effectiveness of the treatment is reduced. It is impossible to remove the retaining structure without the permission of the doctor, the fixed position of the joints should be maintained constantly. In the case of mild forms of the disease, a distributing tire is worn on the baby only for the duration of sleep. The decision to discontinue treatment is made by the doctor based on the results of several x-ray studies and the disappearance of symptoms.

If after 2-4 weeks of treatment there is no spontaneous reduction of the dislocation, but complete relaxation of the femoral muscles is achieved, a more rigid fixation in combination with constant stretching is prescribed. To do this, apply a plaster cast, which allows you to keep the child’s hip joints fully divorced and bent at a right angle. Such treatment is resorted to in the case of severe forms or late diagnosis of dysplasia, when milder methods are already ineffective. Therefore, once again I want to draw the attention of parents to the importance of an early examination: when dysplasia is detected in the first 3 months, full recovery of the hip joints in 95% of children is achieved within 3-6 months of treatment.

For many, such long-term treatment seems difficult and tedious, often parents try to find more effective methods and . make a mistake. A mild phased treatment for an infant is much more effective and, of course, more sparing than the use of simultaneous closed reduction of dislocation under anesthesia, which can sometimes lead to serious complications.

Observation

By the end of the first year of life, all babies again undergo a routine examination with an orthopedist. Then conditionally distinguish several groups:

  • children with dysplasia who have not received any treatment;
  • children with severe, poorly corrected forms of dysplasia;
  • babies with residual effects of dysplasia.

If necessary, each child is prescribed further treatment – conservative (massage, gymnastics, physiotherapy) or surgery. If the diagnosis of “irreversible dislocation” is confirmed, then an operation is necessary – an open reduction of the joint under anesthesia.

If it was possible to correct the dislocation by conservative methods, surgery on the joint is not performed, but sometimes an extra-articular surgery is required to help fix (stabilize) the joint. Most often, such interventions are performed in babies older than 3 years, when the child’s body is easier to tolerate anesthesia. But surgical treatment of the joint itself should be done as early as possible! Therefore, the formation of the joint is considered optimal by 12-13 months, when the baby begins to walk.

Moms whose children are given dysplasia. This article helped me a lot.

My first children with a diagnosis of hip dysplasia (TBC) were my five children. Now they already have their own children. The eldest daughter was diagnosed 23 years ago, there was an appointment – stirrups. Even then, I did not agree that this was the only way of treatment. This made me look for alternative methods of treatment and develop my own technique for infants. Now I can say with confidence that there is such a way. The results of many years of work, statistics, and medical histories confirm this. It would be more correct to call this technique prevention, which is absolutely necessary for all kids. Preventive treatment immediately after birth allows you to get rid of many concomitant diseases with the disease scoliosis and osteochondrosis in adulthood. And although many parents believe that scoliosis cannot be avoided, I can say with confidence that my children and patients who began treatment from infancy grow up healthy, sturdy and beautiful. But everyone has the right to decide which treatment method to choose.

What is dysplasia?
Dysplasia is the underdevelopment of an organ or tissue.
Hip dysplasia (TBS) is a common pathology of the musculoskeletal system in newborns and infants, characterized by underdevelopment, displacement, non-centering, asymmetry of TBS elements: acetabulum, femoral head with surrounding muscles, ligaments, capsule.

There are three types of hip dysplasia:
1) anticipation
2) subluxation
3) dislocation of the hip.
Pre-dislocation and subluxation occurs in every 2-3 child, it is one-sided and two-sided proceeds almost painlessly in childhood, while the child is free to walk, run and even jump, parents do not notice almost any deviations, except clubfoot, volus stop, scoliotic posture .
With pre-dislocation – the femoral head can be freely moved inside the joint, while the ligaments surrounding the joint are weakened, instability is formed.
Subluxation – the head of the femur can pop up and return to its place in the joint, and, as a rule, a dull click is heard.
Dislocation is an extremely rare occurrence; for 1000 children born, one has such a pathology. With a dislocation, the femoral head lies outside the joint.

Causes of hip dysplasia (TBS dysplasia):
1) Gluteal presentation of the fetus, when the legs are bent at the hip joints and unbent at the knee, the feet are at the shoulders (often the outcome of childbirth is a cesarean section).
2) Intrauterine cord entanglement.
3) Birth and postpartum injuries
4) Gynecological diseases in the mother, which can hamper the intrauterine movement of the child.
5) Genetic predisposition, if this pathology was observed in relatives.
6) Hormonal disorders in women during pregnancy.
7) Premature babies.
Exposure to external environmental factors.

Where does dysplasia come from?
In this case, terminology is indispensable. We describe one of the mechanisms of the origin of dysplasia in children. With functional blocking in the cervical spine (which occurs during childbirth and after), the upper lobe of the trapezius muscle is tensed, at the same time, tension also occurs in the lower lobe, and subsequently blocking in the lumbosacral and iliac sac joints occurs in the thoracic spine. As a result of this, the iliac crest rises higher on one side, the pelvis is skewed (twisted pelvis). What stirrups in this case can be said if on one side the leg looks shorter than the other. Accordingly, the femoral head is located asymmetrically with respect to the other. Any dynamic loads in this case are painful. And no massage and no orthopedic appliances will correct this situation. Lost every hour, every day, not to mention weeks and months. And if we recall the displacement in the cervical region (read about torticollis) – which leads to impaired cerebral circulation and recall the hypothalamus, which regulates the production of hormones by other glands, including the production of hormones responsible for normal growth and full development, it becomes fearfully.
As you can see, treatment should be comprehensive, thanks to the use of manual diagnostic methods and therapy, many problems can be successfully corrected without waiting for the process to worsen.

Symptoms.
What should alert parents.
Up to 1 month. Increased tone of the back muscles, visually one leg is shorter than the other, an additional fold on the buttock, asymmetry of the gluteal folds and buttocks, incomplete dilution of the legs, with bent knees. The body position of the child is C-shaped, holds the head on one side, often on one hand the child holds a clenched fist.
3 to 4 months. When the legs are bent in the knee and hip joints, a click is often heard, a flat-foot foot (the heel is not in the same line with the lower leg). One leg is visually shorter than the other.
6 months and older. The habit of getting up and walking on fingers, while walking with the fingers of one or two legs turned inside or out, clubfoot. Excessive curvature of the spine in the lumbar – horizontal pelvis, gait, “like a duck.” Visual slight curvature of the spine, stoop. One leg is shorter than the other due to the beveled pelvis.

Treatment.
Conventional treatment for hip dysplasia
Even among orthopedic surgeons, traumatologists, and surgeons, there is no consensus and understanding about dysplasia. Dysplasia manifests itself in all children differently and is not always determined immediately after birth. The joints may be “normal” at birth and in the first few months of development, but later diagnosed as abnormal-pathological by 6-12 months.
At the initial examination immediately after birth, even a very experienced orthopedist cannot give an accurate diagnosis, although a predisposition to hip dysplasia can be predicted from the first day. If you pay attention to torticollis, in which the child constantly keeps his head in one direction.

Each child is individual and develops according to the genetic characteristics of the parents. Parents are not afraid of the fact that the child at 7-8 months still has no teeth and, for example, the large fontanel did not “close” in time. Parents are sure that the teeth will grow and the fontanel will harden, although these two conditions can be compared with “mouth dysplasia” and “skull dysplasia.”
But the signs of hip joint dysplasia need to be constantly monitored, because in fact, dysplasia in children is a weak, incomplete development of the joint, in most cases it is a natural feature of the body of a small child, and much less often a sign of illness – a true dislocation.
Over the past 30-40 years, nothing has changed in the treatment of hip dysplasia, with the exception of various orthopedic appliances and their testing in children. Pavlik’s stirrups, Freyk’s tire, CITO, Rosen, Volkov, Shneiderov, the apparatus of Gnevkovsky . – these orthopedic devices are needed only with a true dislocation of the hip. And they are prescribed to almost every child from one month to one year of constant wear, with the exception of bathing. Often the psyche of the child is disturbed – at first he is tearful, restless, and then depressed, depressed, closed, indifferent to everything. Children have repeatedly brought to me in the apparatus at the age of 2,5 years, they are very different in physical and mental development. Although there were those who adapted and jumped and ran in a race car with peers.

Modern treatment of dysplasia in children with manual medicine

In order to make an appointment with a doctor, you need to take photocopies of extracts from the hospital, the conclusions and conclusions of the orthopedist, an X-ray or ultrasound, and a photocopy of their description.
If we approach the problem of dysplasia in infants in a new way, we must admit: traditional treatment often only torments babies. In order to establish the root cause, whether it is a dislocation, a subluxation or a subluxation. At the earliest stage, you should not torment the baby with orthopedic appliances. Every day, the child must learn the world, experience dynamic loads on the hip joints, in which blood circulation improves, all functions are restored, normal physiological development of the hip joints and tissues surrounding it occurs.
They approach this problem one-sidedly only from the side of orthopedics, considering only violations in the hip joints, forgetting about the integrity of the whole organism, as a single functional system is impossible.
Most narrow specialists are very critical of the innovations of treatment – the use of manual medicine, I believe that if the technique works, then it should be applied. I was pleasantly surprised when I visited the International Conference on Manual Therapy in 2002 that I am not alone in opposing obsolete treatments for dysplasia. There are already orthopedists who are learning manual therapy techniques, but in Ukraine this is still a matter of the future.
Manual therapy in the hands of a “non-specialist” can cause irreparable harm to the patient’s health.
There is a choice – massage and orthopedic appliances. For example, various stirrups, insoles from flat feet, devices – corsets from scoliosis, a “chance” collar, corset belts from radiculitis, crutches, and a wheelchair.
Either manual medicine, but one must remember that every day lost in childhood is irreplaceable. At each stage of the development of the child, both organs and tissues are constantly forming. Do not let the body adapt to problems – look for ways to solve them. “A tablet for the tongue is the simplest.” Movement is life. And if something is wrong in biomechanics, then this should be eliminated, not anesthetized and delayed. The body will tell you at the first stage with acute pain, which the baby can not say, but this can be determined by tonic muscle tension. Look for the reason that this pain comes from, and do not suppress this pain.
In severe cases – a true dislocation of the thigh – I am for the treatment to be carried out comprehensively, using manual therapy and orthopedics together, in extreme cases, and surgery.
Everyone chooses the path to solving the problem, i.e., treatment, himself. And what was laid in childhood will grow. In this particular case, we are talking about children, parents choose, since no one takes into account the opinion of the baby. He can scream for some time, arrange sleepless nights, making it clear that he does not agree with this, but cannot change anything – parents decide.
If you are told that a child with dysplasia will not walk or limp, then this is not so. The probability of lameness is only with an extreme form of dysplasia – with a true dislocation of the hip. The rest of the children walk normally and outwardly practically do not differ from their peers until a certain age. But these children are guaranteed no less terrible disease – scoliosis, osteochondrosis with all concomitant diseases. Unfortunately, scoliosis awaits those children who were tortured, wearing stirrups in their childhood, various devices, they did massages, ultraphoresis, did swimming and did not really receive the right treatment, i.e. they did not initially eliminate the reason why this all happened.

Hip dysplasia in children up to a year – methods for determining massage and treatment

Abstract of the article:

Delay in the development of babies

One of the most common diseases in newborns is dysplasia of the legs, hip, or knee joints.

Causes of foot dysplasia in children

The health of the future baby largely depends on the mother. What kind of lifestyle she leads. How is the pregnancy going? The further healthy development of the child depends on the proper development of the fetus in utero.

The main reason for the development of leg dysplasia in the baby is a lack of calcium in the mother’s blood. Therefore, the expectant mother needs to eat well, take vitamins, spend a lot of time in the fresh air, neither be nervous, nor drink alcohol and do not smoke.

Suspected Dysplasia

There is such an aphorism “it’s better to stay awake”. In order for the baby to not have serious health problems in the future, it is necessary to diagnose and start treatment for dysplasia up to six months of age, in extreme cases until the baby starts walking.

You can identify the developmental delay yourself, the pathology of the knee braces is clearly visible. You can not say about hip dysplasia, the help of an orthopedic surgeon is needed here.

How to check dysplasia at home

Caring parents are very attentive to the baby and can check at home if the baby has a developmental delay.

To check the knee joint, put the baby on the tummy and legs bent at the knees, press it to the tummy. Normally, the fold should be symmetrical and even. Pathology will immediately be obvious.

To check the hip joint, put the baby on the back, press the legs bent at the knees slightly to the tummy and gently move the hips to the sides in a circular motion.

Normally, the joints move symmetrically, easily, with constant repetition, the legs should touch the surface on which the child lies. In case of pathology, the hips cannot be parted and if you look at the elongated legs, it may turn out that they are of different lengths. Gluteal and femoral folds will not match.

If parents have suspicions and doubts, it is better to seek help from a specialist.

Symptoms of Hip Dysplasia (TBS)

Dysplasia of the child’s hip joints has three phases:

  • pre-dislocation – the femoral head does not border the hollow of the joint;
  • subluxation – the femoral head is partially associated with the depression of the joint;
  • dislocation – the femoral head is not centered with the cavity of the joint (a very difficult case).

There are three main symptoms of TBS underdevelopment:

  1. circular hips cannot be done;
  2. asymmetric buttock, inguinal and folds of legs;
  3. the leg in which the joint is affected is shorter than relatively healthy.

The above symptoms are common. Each case is individual. Only a doctor can give a qualified assessment by looking at the baby and making a bridle diagnosis.

Dysplasia of the knee in children

Knee dysplasia is a deformation of the patella. It arises as a result of a violation in the development of the cartilage and bone structure of the joint, muscles and ligaments. Underdevelopment of the knee brace is very common among newborns. If you take 1000 children, then 6 of them are born with pathology. In the absence of the necessary treatment, there is a risk of disability.

Symptoms of Knee Dysplasia

If we talk about newborn children, we note six symptoms:

  • cups of knees are asymmetric;
  • different lengths of legs (in severe stages of the disease);
  • the child begins to walk late; as a result, a “duck” gait forms, walking on fingers, increased tone;
  • toes twisted either inward or outward;
  • X-like or O-like curvature of the legs;
  • pain

Diagnostics

Diagnosing dysplasia in the early stages is very difficult, but possible. After birth, on the second day the baby is examined by an orthopedic surgeon. If there is a suspicion of a developmental delay, difficult birth or some other risk, the doctor may prescribe the baby with an ultrasound diagnosis of TBS.

Nowadays, this is a completely harmless method that can give an 80% diagnosis if it is dislocated or before dislocation of the hip joints.

The next scheduled examination of the doctor is carried out when the child is 1 month old. During this period, for children with an increased risk of developmental delay, the appointment of an ultrasound of the hip joints is a prerequisite.

The third visit to the doctor – an orthopedist is carried out when the baby is 3 months old. During this period, it is already possible to do an X-ray of TBS, which will 100% confirm or refute the diagnosis of dysplasia of one of the three phases (dislocation, sub-dislocation, pre-dislocation).

Why is this such a diagnosis for a little man? It is possible to determine and diagnose “dislocation” only by taking a special picture, since this phase is asymptomatic.

An ultrasound doctor looks at stability, development, the angle of inclination of the peak of the articular cavity, determines the degree of stability. Based on these results, the doctor makes a diagnosis, prescribes the prevention or treatment of dysplasia.

Treatment and prevention of dysplasia in children

Probably many people know that in infants in the first month the femoral head can self-correct to the joint cavity. For this, only one condition is necessary – more often the child’s legs should be divorced. Since swaddling is not necessary now, the baby has every chance to independently cope with the presentation of TBS underdevelopment, if any.

And also to develop the slope of the visor of the hip joint. The main prevention is mobility and functioning, as well as the baby’s age, the sooner the better. A good method of prevention is to do wide swaddling, circular hips breeding every day.

At this age, bones and cartilage are very flexible, so the correct location of the crumbs is very important. Be sure to strengthen the baby with Aquadetrim Vitamin D3.

If we talk about the treatment of underdevelopment of the hip joint, there are many types of diverting tires, pillows, so that the legs are in the breeding position. In case of knee disease, the baby needs to wear knee pads. The main task is not to hamper the movement of the child to the maximum. Mandatory to use the circular abduction of the hips massage and exercise therapy.

If conservative methods are powerless, doctors perform surgery. An operation is performed, the femoral head is centered in the joint cavity, forming a normal cavity for strong support. Be sure to adhere to the orthopedic regimen.

Dysplasia is being treated! The main thing is to diagnose and take the necessary measures in time!

Hip dysplasia in children: how the disease is diagnosed and treated

The disease is accompanied by impaired motor function of the limb, can be diagnosed in the first months of life. If the disease is detected on time, then conservative treatment is effective. In advanced cases, an operation is required.

Degrees

Hip dysplasia is common in infants, occurs in 5-10% of babies. Possible consequences in the future depend on a timely diagnosis. The joints of the newborns are not yet fully formed, so the disease responds well to treatment.

This disease is a severe malformation, in which all the constituent elements of the articular joint are affected. In total, 3 degrees of leg dysplasia in children are distinguished:

  • Stage I (pre-dislocation). This is the easiest. If the disease is diagnosed at the initial stage, it means that the head is not biased relative to the acetabulum. Forecasts are the most optimistic.
  • II stage (subluxation). Manifested by a slight bias.
  • Stage III. If a hip dislocation is detected, the treatment is the longest, since it is manifested by the exit of the head from the acetabulum. Massage and exercise therapy are not enough.

Also, dysplasia of TBS can be one- or two-sided.

Causes

Congenital hip dislocation in an infant occurs for the following reasons:

  • hereditary predisposition;
  • too large or small birth weight;
  • pelvic presentation of the fetus;
  • first or late pregnancy;
  • improper nutrition of a pregnant woman, bad habits;
  • gynecological diseases that interfere with the movement of crumbs along the birth canal;
  • vitamin deficiency;
  • infections during pregnancy.

An important role in the appearance of dysplasia in a baby is played by the hormone relaxin, which is responsible for muscle relaxation and softening of the pregnant woman’s bones. But it affects not only the woman’s body, but also the fetus. With a high concentration of it, the bones of the hips become very soft and during the process of childbirth subluxation or dislocation can occur.

Symptoms

Symptoms depend on the degree of the disease. There are 2 groups of signs of hip dysplasia in infants: which are visible only to a specialist and those that parents can see.

Most often, stage 2 and 3 are visible to the naked eye. Signs of hip dysplasia in children:

  • femoral, gluteal or inguinal folds are asymmetric, are at different levels;
  • legs of different lengths;
  • the presence of additional femoral folds;
  • small amplitude when breeding legs bent at the knees;
  • knees of different heights;
  • crunch when bending and unbending legs.

If the newborn has at least one symptom, it is urgent to go to the hospital.

There is a mistaken assumption that a baby with TBS dysplasia cannot walk. He walks and runs no worse than his peers.

Soreness and stiffness during movement occurs at a later age, more often after 5 years, as the load on the joints increases.

Which doctor treats hip dysplasia in children?

If there is a suspicion of transient hip dysplasia in a newborn, you need to show the baby to the pediatrician. Further treatment will be done by an orthopedist. In some cases, a neurologist consultation may be required. Orthopedic examinations are scheduled as scheduled when the baby is 1, 3, 6, and 12 months old.

Diagnostics

With congenital pathology, doctors can make a diagnosis already in the hospital after examining the child. Since the hip joint continues to form from 3-4 months to the 8th, pathology can be diagnosed during this period. That is why a routine orthopedic examination is so important.

The basis of the diagnosis is an ultrasound examination or x-ray.

How to independently determine the dysplasia of the hip joints in newborns? You can do some simple tests. Recommendations are as follows:

  1. Check the folds on the hips, under the booty and knees, they should be on the same level. Put the baby on the tummy, straighten the legs.
  2. Check flexibility. The supine position, bend the legs at the knees and spread the hips to the sides. Huge power can not be applied. In infants up to a year, flexibility is very developed, if the amplitude is different or the angle is less than 90˚, then this is a pathology.
  3. Check the height of the bent legs. They must be on the same level. To check the baby lay on his back, bend the legs at the knees, feet rest on the surface.
  4. Compare the legs in length. When lying on their backs, they should be the same length.

If you have even the slightest suspicion, you should go to the orthopedist.

Treatment

Treatment is prescribed immediately after the examination. It is important every day, since with the growth of the child the likelihood of negative consequences of hip dysplasia in children increases, the degree increases.

Therapy is long, ranging from 1 month to a year, it can not be interrupted. At the time of treatment, parents should be patient, as infants do not approve of medical manipulations.

At the early stage, enough gymnastics and massage, wide swaddling is important. Its essence is that the legs remain spread apart. To do this, a diaper folded in the form of a rectangle (width 15-17 cm) is placed between them, it should reach the knees. Legs bent at the knees should be pulled apart so that the angle is 60-80˚. Then you can move on to swaddling. The baby will quickly get used to the position of the lead and will not be capricious.

Massage is carried out by a specialist, if it is not correct to press on the hip, you can aggravate the dislocation. Therapeutic gymnastics is selected for each baby individually, classes during bathing are useful. Dysplasia in a one-year-old child is treated with active, in nursing – passive exercises. At the same time, a course of physiotherapeutic procedures is prescribed, electrophoresis is most effective.

Dislocations are treated using orthopedic devices:

  • Pavlik’s stirrups;
  • Gnevkovsky apparatus;
  • spreader tires;
  • gypsum fixers;
  • plastic corsets, for example, Freyk pillow.

They hold the legs in a diluted position.

Treatment of hip dysplasia in children after a year is often surgical. With the help of surgical procedures, the head is adjusted, then the limb is gypsum-plated. In severe cases, several operations may be required.

Aftermath

The negative effects can be easily avoided if TBS dysplasia in newborns is treated for up to 6 months. Treatment will be most effective and after a year this illness can not be remembered. If, in the first year, therapy was not carried out, then severe complications arise that worsen the quality of life of the baby. What is the disease dangerous?

The consequences of hip dysplasia in newborns:

  • hip dislocation, which is accompanied by severe pain;
  • lameness;
  • inflammatory joint diseases;
  • arthrosis;
  • dysplastic coxarthrosis.

The earlier treatment for hip dysplasia in children is started, the more effective it is. If diagnosed after one year, then it can take years to recover. The success of therapy is in question, sometimes chronic joint diseases occur.

With the development of arthrosis, the pain syndrome interferes with the movement of the child. The symptoms that have arisen are forced to resort to endoprosthetics.

Prevention

Prevention of congenital dislocation should be done during pregnancy. It is necessary to eat properly, to cure infectious diseases in advance. With a large weight, the baby should give preference to cesarean section.

It is necessary to abandon tight swaddling. Instead of diapers, it is better to dress the child in clothes so that his movements are not constrained. It is necessary to do exercises, massage, and also visit an orthopedist.

You should take care of the baby’s health in the first year of life. Find out all about dysplasia, how it looks, do not miss scheduled examinations.

Shishkevich Vladimir

Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews. It specializes in the treatment of diseases in orthopedic, traumatological, vertebrological profiles

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