Hip dysplasia( congenital dislocation of the hip) - Causes, symptoms and treatment. MF.

Let's talk about such anomaly of hip joint development as congenital dislocation of hip or, in the language of physicians, hip dysplasia .The causes of dysplasia may be various factors, such as "heredity", "pelvic presentation of the fetus", "toxicosis of pregnancy," "a large fruit," and even an elementary underdevelopment of the fetus. And the dysplasia itself differs according to the forms: pre-bleeding( immature unstable joint, which in the future develops either normally or in the direction of subluxation, with the head of the hip as easily dislocated, so easy and set in place), subluxation( this is already a change in the joint structure,accompanied by a shift of the femoral head to the acetabulum upwards and to the side) and dislocation( complete displacement of the femoral head).All these changes lead to a pathology of the supporting function of the lower limb.

It is possible to detect the presence of dysplasia in a child only after it has been born. Therefore, the mother should show appropriate attention to the baby, since his birth.

Congenital dislocation of hip

Symptoms of hip dysplasia in children

How can a mother suspect a congenital hip dislocation? Undoubtedly, you need to be more attentive to the child who is at risk( the reasons for the development of dysplasia have been described above).There are also certain symptoms on which an anomaly can be suspected. These symptoms characterize the clinic of the disease.

1) If the child does not have a year:

is a symptom of a "click"( a symptom of the sliding of Marx-Ortholani.) In practice: at the time of maximum hip withdrawal, the head seems to "click" into the cavity, asking mothers not to conduct experiments on children and provide a definition of thissymptom to competent specialists);
- asymmetry of skin folds. Mom, watch this! When you put the baby down with your stomach and straighten the legs, it becomes noticeable that the Podagial folds are at different levels( in a healthy child they are the same);
- restriction of rotation of the thighs of your child in different directions;
- with the naked eye you can see the shortening of one leg relative to the other;
- during sleep it is obvious that the knees brought to the tummy are at different levels.

Symptom of Marx-Ortolani

2) Children over the age of:

- the child later gets on his legs and starts walking( only in 15-16 months there is this desire);
- the baby limps on a sore leg( duck walk);
- more pronounced lumbar flexure;
- the symptoms that you identified in children under one year are becoming clearer.
- the points of attachment of the gluteal muscles are similar, and the muscle tone itself is weakened. This is the symptom of Trendelenburg: when standing on a dislocated leg, the other half of the pelvis is lowered.

Diagnosis of hip dysplasia in a child

If doctors suspect a diagnosis of joint dysplasia, they need to conduct a radiography, on the basis of which the violation of hip joint development in the child is finally determined. Also use ultrasound joints, arthrography, CT, angiography and arthroscopy. And most importantly, remember that you yourself never need to put any diagnoses, because a child may not have dysplasia, but simply a severe bruise or stretch due to some kind of injury.

A good skill is required to detect these symptoms, as restriction of hip withdrawal can also be observed, for example, in spastic paralysis, with congenital viral deformation of the neck of the hip, and still spasm of the muscles of the newborns. The asymmetry symptom of skin folds is taken into account in the presence of other symptoms, and is not an absolute sign, although it is observed in about 50% of patients.

When the doctor has determined and diagnosed, one must strictly follow his further guidance and not engage in self-medication. Remember, the earlier the disease was diagnosed and treated, the better the prognosis!

Treatment of hip dysplasia

Treatment consists in the dilution and fixation of the legs of the baby until the moment when the joints and muscles "get stronger".

Treatment of prelum: to withdraw the legs( unbent condition) to the sides and fix in this position( use Vilensky tires and rod-spacers that are fixed with gypsum or special cuffs.) Treatment of subluxation: thigh should be perpendicular to the body axis( use CITO,Volkova, the pillow of Freik, the stirrups of Pavlik, the wide swaddling.

Treatment of dysplasia: Pavlik's stirrups, wide swaddling

Treatment of the dislocation is much longer: is used to adjust it by prolonged( about 4 weeks) stretching the legs along the axis, with their simultaneous dilution, rotation into the inside and smooth insertion of the hip bone heads to the cavities, after whichoverlap tires for up to 7-8 months. If there is no result, they resort to surgical treatment.

Information for mothers: in the first month of life, it is necessary to apply a wide swaddling of the child in independent of whether there is already a diagnosis of dysplasia or not( fold the diaper rectangular and lay between the legs of the baby( the legs are sideways at 60-80 °). The legs are bentin the hip and knee joints. The child quickly gets used to this kind of swaddling and perfectly tolerates. Of course, if there is a possibility, it is better not to swaddle the child at all

Also it is necessary to conduct therapeutic gymnastics: breed a toddler's hip during a shiftwhen exercising 6-8 times, it is useful to swim on the tummy. Thus you can stretch and warm up the muscles of the lower limbs that your child will only benefit.)

In addition, for the treatment of a child with joint dysplasia,

is used - physiotherapy(electrophoresis with calcium in particular on the region of the hip joint);
- massage( classical massage, using such techniques as stroking, rubbing, kneading and vibration);
- curative gymnastics( the most effective hydrokinesotherapy is physical exercise in water).

Massage and exercise therapy should only be carried out by a trained health worker.

When treating hip dysplasia, the child does not start walking for a long time. But do not put the child on his feet without the permission of an orthopedic doctor, because you can lose everything that you have achieved during the treatment of the disease.

If conservative treatment is not successful, an operation is performed: repositioning the femoral head .The operation can be carried out for children only older than five years. There are different methods of surgical intervention. Conditionally they can be divided into such groups:

- an open dislocation of the hip joint dislocation;
- surgery on that part of the femur that is closer to the pelvic bones;
- operations on the hip bone( Chiari osteotomy);
- operations that are aimed at facilitating the lives of sick children, their suffering and pain reduction( palliative operations) in Shantz, Koenig. The number of operations is determined individually. After the operation, a sufficiently long fixation is carried out, followed by rehabilitation using reasonable physical activity, therapeutic gymnastics, physiotherapy and massage.

If you follow the recommendations of a doctor, then the treatment ends after 1-2 years.

Massage

Rehabilitation of children with hip dysplasia

Postoperative rehabilitation of sick children with hip dysplasia is a controversial topic for many orthopedists. There is no one opinion on how long gypsum immobilization should last, about the methods of physiotherapy, about when to start the load. One thing that can be said for sure is that the normal further development of the joint and the avoidance of possible complications depends entirely on the quality of rehabilitation.

Postoperative rehabilitation tasks:

- improvement of the muscles;
- restoration of motion in the joint, which underwent surgery;
- learning to walk.

Rehabilitation Periods:

1. Preoperative.

2. The period of immobilization( a co-curative bandage), lasts 2-3 weeks, plus the reconstruction of the acetabulum up to 4-5 weeks.

3. We change the baby bandage from gypsum to the special discharge tire of Vilensky( 2-6 weeks after the operation).

4. The last period begins about a year after the operation and lasts about a year and a half. The main task of this period is to teach proper walking. The child should not limp, while maintaining a smooth posture, the steps should be smooth. Walking immediately should be short-lived( 5-10 minutes), gradually increasing the time to 30 minutes;always alternate walking with rest. Simultaneously with walking exercises are used in the standing position( these can be squats and feet with legs, of course with support).
Since the fourth period, it is desirable to conduct exercises in the pool.

Therapeutic exercises for hip dysplasia

Its tasks:

- strengthening of the dorsal, abdominal and gluteal muscles, internal thigh rotators, etc., if necessary stretching and relaxing muscles, if they are strained;
- increased body tone;
- improvement of the respiratory and cardiovascular system and their functions;
- respiratory gymnastics, which will certainly enrich the baby's body with oxygen and will give new strength in the fight against the disease.

Physiotherapy

- From the second to the third day of treatment we apply UHF-therapy. The procedures take place every day for 6-10 minutes( 5-7 exposures).

- Since the second week, joints with dysplasia should be exposed to a variable magnetic field of low frequency( sedative and restorative action, increased metabolism, blood circulation, nutrition of tissues.) Duration - 10-20 minutes, daily, 15-20 sessions.

- UFO on the unoperated joint.

- vitamin therapy( vitamins of group A, vitamins B, C, D, etc.)

- electrostimulation of weakened muscles.

- ozocerite or paraffin 3-4 times immediately on the knee joint of the operated leg, and then on the hip joint( 30-40 minutes, temperature 40-45, every day, 20-25 procedures).

When discharging a sick child, the instructor in curative gymnastics teaches parents some of the main and individual methods of massage for the child and a set of physical exercises.

Forecast of hip dysplasia

If you identify hip dysplasia at an early age, then, if you designate the right and timely treatment, the disease can be completely eliminated, as if it did not exist.

Also today, many people live with hip dysplasia all their lives, while not experiencing any disturbing symptoms and signs, in addition to an external defect and gait changes, which is not a positive trend.

If the parents did not perceive the child as a child and the disease was discovered accidentally during the examination, for example, radiography, the newly diagnosed patient should regularly and regularly undergo an examination with an orthopedist and come to inspections no less than once a year.

Rev.doctor of traumatologist-orthopedist Savchenko V.R.