home Folk remedies Congenital hip dislocation: causes, symptoms and treatment. Congenital hip dislocation in children: causes and treatment Congenital hip dislocation consequences

Congenital hip dislocation: causes, symptoms and treatment. Congenital hip dislocation in children: causes and treatment Congenital hip dislocation consequences

Congenital hip dislocation occurs in approximately one in eight thousand babies. Hip dysplasia is an anatomical defect, the essence of which is the deformation of all components of the movable joint. Because of this, dislocation of the femoral head occurs, diagnosed at birth or a few days before it. The pathology is quite common; this type of injury accounts for approximately five percent of the total number of dislocations. The injury in question is the most discussed topic in pediatric orthopedics. Congenital hip dislocation can be treated conservatively only with early diagnosis. Otherwise, recovery cannot be achieved without surgery.

What it is

To understand the essence, you need to delve a little deeper into the anatomy of the hip joint. To begin with, it is worth noting that this movable connection is formed using femoral head and acetabulum. The latter is similar in shape to a bowl. A cartilaginous rim is located across the entire area of the dent, which is necessary for stabilizing functions. For example, keep the femoral head inside and limit damaging movements.

From the inside, the cavity is filled with fatty tissue, and the head is covered with cartilage tissue. A ligament extends from it, which is attached to the acetabular socket, thereby ensuring fixation of the head. From above, the joint is further strengthened by muscles and capsule. According to anatomical structure, the femoral head is located inside the acetabulum and is held there during any movement lower limbs(running, walking, gymnastic exercises).

Congenital hip dislocation occurs when the described structures have defects. The main one is that the head is not fixed in the cavity, resulting in injury. Choosing the most common anatomical problems, you can focus on the following:

Irregular shape and the size of the acetabular socket, it becomes flat and cannot function normally.
Disturbance in the development of the cartilaginous ridge.
Congenital weakness of the mobile joint, its abnormal length.

Why does pathology occur?

The factors causing the pathology have not been established in medicine today. But experts say there is a connection with certain events. The causes of congenital hip dislocation can be:

Breech presentation of the fetus in the uterus.
The fruit is too large.
Hereditary factor risk if one of your close relatives had a similar pathology.
Toxicosis during pregnancy in expectant mother.
Delay in the development of the intrauterine fetus.
Hormonal diseases during pregnancy, young age.

If at least one of the reasons listed was observed during pregnancy, you need to make an appointment with a pediatric orthopedist. Ideally, all newborns should be shown to this specialist in order to diagnose the problem in the early stages and eliminate it. This process will be much easier if you start treatment in a timely manner. Otherwise, you will have to deal with congenital hip dislocation in adults.

Classification

There are several divisions of pathology depending on the nature of the manifestation and severity. In our material we will talk about the latest classification, that is, the stages of hip dysplasia.

There are four main types:

Directly dysplasia. There are prerequisites for damage, but the injury has not yet occurred. Previously, this type of disease was not included in the classification, but then it was proven that if the symptoms are ignored, dislocation can occur. Today, this diagnosis is common and successfully treated.
Pre-dislocation. Here already we're talking about about the beginning of the deformation process. The capsule of the movable joint is tense, and displacement of the head is also detected. In this case, you need to make a minimum of effort to put it back. If you do nothing, the problem moves to the next stage.
Subluxation. There is a partial displacement of the head, due to which the ligament is greatly strained. As in the previous option, you can try to straighten it, but the chance of success is significantly reduced.
Dislocation. In this case, we can talk about a complete discrepancy between the acetabulum and the femoral head. The latter is very strongly displaced, to the point that it extends beyond the recess. As for the joint capsules, they are too tense and stretched. Interesting fact: according to statistics, congenital dislocation of the right hip is more common than the left.

Main symptoms

How to determine if a child has a deformity? There are several symptoms, but they are nonspecific.

In other words, it is very difficult to speak with absolute certainty about the presence of pathology.

Let's look at the main signs of congenital hip dislocation:

Baby's legs are different lengths. To determine this, you need to put the child on his back, bend his knees, and move his heels towards his buttocks. With these simple steps you can detect this symptom.
Asymmetry of skin folds on the legs and buttocks. This fact will be more difficult to determine. First you need to carefully examine the baby on the back and tummy. According to the rules of anatomy, all folds must be symmetrical and have the same depth. If you see a violation, you may suspect the presence of a disease. However, this symptom is rather unreliable, because in some children the folds are simply unevenly distributed. Therefore, it is necessary to contact an orthopedist to identify the pathology and treat it.
Limitation of leg abduction. Of all the signs of congenital hip dislocation, this one is usually found later. After all, such a situation can be noticed only a month after birth. You need to check the symptom by moving the baby’s legs to the side while lying on his back. Normally, the lower limbs are moved apart to the sides by ninety degrees. If you find such a symptom, this does not necessarily mean that the child has a pathology, because the baby’s muscles have not yet developed sufficiently.
Click. This is the most obvious symptom. When the baby's legs are moved to the side, a clicking sound can be heard. This means that the head has slipped out of the socket. Reduction of congenital hip dislocation occurs only after a high-quality diagnosis. You should not self-medicate, because you will only make the situation worse. It is better not to take any action without consulting your doctor.

Diagnostics

It is enough to suspect a congenital dislocation of the left or right hip to begin necessary measures. It needs to be diagnosed comprehensively. To begin with, the orthopedist conducts a visual examination, during which you can notice the baby’s discrepancy with the norms. X-rays and ultrasound examinations provide a comprehensive picture of the situation. Based on these studies, the doctor can diagnose accurate diagnosis and prescribe a course of therapy.

It is worth noting that according to the rules, radiography is carried out for children from three one month old. This can be explained by the fact that the ossification of some parts of the pelvis must be completed, otherwise the picture will turn out to be uninformative. If it is necessary to determine pathology in children under three months, ultrasound is actively used. The advantages of this method are safety for the baby’s health and information content. Ultrasound can be done many times without harming the baby, plus, this study reveals with high accuracy this problem.

Complications

The consequences of congenital hip dislocation can be the most serious, but only if the pathology was not detected in time and the symptoms were ignored. Whether there will be complications or not also depends on the course and time of treatment. If the problem is not corrected, the patient will develop dysplastic coxarthrosis by the age of twenty-five. The victim will be constantly plagued by pain, and there will also be restrictions on movement in the joint. Lameness, which develops at three or four years of age, also results from advanced congenital dislocation of the hip. Congenital clubfoot also refers to pathologies of the musculoskeletal system. But dislocation is the most severe form.

Among the symptoms of the worst-case scenario, one can highlight the presence of intolerable painful sensations and complete immobility of the lower extremities. Therefore, you need to take care of your health, and then the risk of complications is significantly reduced. Besides, running form pathology sooner or later leads to disability. Congenital hip dislocation - serious illness, which needs to be eliminated in short time to avoid in the future unpleasant consequences.

Hip reduction

The decision on such a mini-operation is made by the attending physician. It can only be carried out in cases where there are no anatomical abnormalities in the structure of the hip joint. Reduction of a dislocation occurs only with high-quality anesthesia. The best option would be anesthesia. Concerning local anesthesia, it is practically not used due to low level efficiency.

There are two main methods for hip reduction:

Dzhanelidze's method. The patient should be placed on his stomach, face down, so that the leg hangs down. One doctor needs to press on the sacrum, thereby pressing the pelvis. Another doctor should bend the leg at the knee joint at an angle of ninety degrees and press on the popliteal fossa. This is not done abruptly, but smoothly, gradually increasing strength. When the charter is in place, you will hear a characteristic sound.
Kocher-Kefer method. Here the patient must be placed on his back. One of the doctors should fix the pelvis in a position in which the ilia are pressed. Another needs to bend the leg at the hip and knee movable joints at a right angle and stretch vertically upward. This method is ideal for reducing anterosuperior oblique dislocation.

Rehabilitation of congenital hip dislocation goes well if the joint is corrected in a timely manner. This process is not difficult, but you should not try to perform this action yourself. There are qualified doctors who will straighten the mobile joint in a timely manner, which will significantly reduce recovery time.

Massage and gymnastics

Treatment of the pathology in question must be comprehensive; this is the most effective therapy. Therapeutic exercises and massage are an integral part of this system. Using these procedures, you can achieve stabilization of a mobile joint, reduction of dislocation, strengthening of ligaments and muscles, as well as improvement of general health. physical development.

Massotherapy It is prescribed by a doctor and should only be done by professionals. Parents can learn a simple technique of restorative massage and perform it several times during the day, this will have a beneficial effect on the treatment of congenital hip dislocation. Doctors' recommendations boil down to the fact that the described procedure must be present in the course of therapy. As a rule, you should do about ten sessions per day.

In addition, therapeutic exercises should be included in the complex. No more help needed here qualified specialist, because parents and their children can easily master simple, but effective actions. To begin with, the orthopedic doctor will show you exactly what exercises are necessary, and then repeat them yourself at home. It is advisable that classes of this kind be held several times a day. If you follow all the doctor's advice, you can cure congenital hip dislocation in a short time. As practice shows, physiotherapy The baby likes it, especially when the classes are taught by the mother. It is worth noting that all exercises must be performed with the baby lying on his back or tummy. Why can't you sit or stand? Vertical position dangerous for this pathology, because the situation can only get worse.

Surgical intervention

Conservative therapy when treating hip dislocation, it is based on fixing the legs in correct position. The baby needs to choose a splint or corset individually. Fixing devices of this type will hold the legs in the required position, which will significantly reduce the load on the hip joint. This therapy usually lasts no more than a month.

As already noted, there is characteristic symptoms congenital hip dislocation in children. Depending on their manifestations, the doctor prescribes a course of treatment. In the most difficult situations, only one thing will help the patient - surgery. It is recommended to do surgical intervention up to five years, then the chances of a full recovery are quite high. How older child, the more difficult it will be to cope with the disease without complications.

For children who have not reached adolescence, intra-articular interventions with deepening of the acetabulum are prescribed. In adults, the dent cover is recreated using surgery. Prosthetics are also possible, but this method used only in advanced cases. An artificial analogue is placed if a dislocation of the femoral neck is diagnosed with a clear violation of the functions of the mobile joint.

Congenital hip dislocation. Rehabilitation

Recovery period very important for further prognosis. Almost always in such cases, the orthopedist prescribes functional therapy. It is worth noting that the program is selected individually, depending on the severity of the injury, treatment method, age and anatomical features the victim. Typically the course includes special massage, medicinal physical culture and physical therapy. Specific procedures include electrophoresis with iodine, therapeutic baths and applications with ozokerite.

There is such a thing as wide swaddling. This method is more related to preventive measures than to therapeutic ones. This method is perfect for use if the child is at risk. For example, according to ultrasound examination determine the presence of the first stage of the disease or the immaturity of the joint is observed. Wide swaddling keeps the baby's legs apart, and this helps prevent disease.

Prevention and prognosis

As already noted, a favorable outcome is possible only if timely diagnosis and quality treatment. In other situations, complications may arise. Congenital dislocation of the hip, if symptoms are ignored, will have Negative influence on health in general. Diseases such as osteochondrosis, scoliosis, poor posture, shortening of one leg and flat feet occur in most cases.

If we talk about preventive measures, it is difficult to recommend anything. The disease in the vast majority of cases develops in newborns. If the pathology is identified and eliminated in early childhood, the prognosis will be most favorable. However, not everything is so rosy. Many people live with this problem for a very long time and are not even aware of its existence. Anatomical inferiority is very difficult to diagnose, because the disease proceeds calmly and with moderate physical activity does not appear.

The difficulty of congenital hip dislocation is that it is almost impossible to prevent the pathology. We can only recommend that women during pregnancy receive good nutrition, be sure to take what is prescribed by doctors vitamin complexes. This should help proper development fetus As soon as the prerequisites for a similar injury appear, treatment should begin immediately. Only in such a situation will therapy be most effective, and the patient will be able to return to a full life.

Congenital hip dislocation is a congenital disorder of the development of the osteochondral, ligamentous-capsular and muscular structures of the hip joint, leading to a persistent displacement of the articular ends of the bones that form this composition.

Etiology and pathogenesis. Congenital dislocation of the hip is associated with a delay in its development in the embryonic stage. Signs of hip dysplasia are noted at birth. As the child grows, joint dysplasia progresses, leading to displacement of the head femur outward and upward, flattening the acetabulum. The development of the nucleus and ossification of the head of the femur are delayed, which together with the neck is deformed. Bursa stretches significantly.

Classification of congenital hip dislocation

Pre-dislocation is characterized by maintaining the relationship between the femoral head and the acetabulum, but dysplasia of the ligamentous-capsular structures of the joint contributes to the dislocation of the femoral head from the acetabulum, followed by its easy reduction.

Subluxation is characterized by upward displacement of the femoral head beyond the acetabulum, while the acetabulum is flattened and elongated.

Dislocation is accompanied by stretching of the ligamentous-capsular structures of the joint with flattening of the acetabulum and displacement of the femoral head outside the acetabulum.

Symptoms of congenital hip dislocation

The symptom of the femoral head slipping (dislocation and reduction) indicates instability of the hip joint and is detected in the newborn period. The symptom is detected by abduction and traction of the hips in the distal direction with light pressure on the greater trochanter. In this case, the head of the femur is reduced into the acetabulum, making a characteristic clicking sound. When the hips are adducted, the femoral head dislocates.

Symptom of limited hip abduction The symptom is detected in the supine position with the hips spread to the sides. The legs should be bent at the knees and hip joints. Normally, the hips are abducted to a horizontal plane, with their outer surfaces touching the changing table. In the presence of congenital dislocation, there is a limitation of hip abduction on the affected side.

Symptom of asymmetry of the skin folds of the thighs. In the supine position and fully extended legs, the location of the skin folds along the anterior inner surface of the thighs is checked. With congenital dislocation of the hip, an asymmetrical location of the skin folds is noted with a proximal displacement on the side of the dislocation. When lying on the stomach, there is a displacement of the gluteal fold higher on the side of the hip dislocation.

Symptom of limb shortening. It is determined in a supine position with the legs bent at the hip and knee joints. The feet are strictly placed on the surface of the table. Limb shortening is determined by the level of the knee joints. On the hip dislocation side, the knee joint is located lower.

Children older than 1 year have an unsteady gait, lameness, or a swaying “duck” gait with bilateral dislocation.

Diagnosis of congenital hip dislocation

To treat hip subluxation, spacer splints are used, which allow the head to be centered in the acetabulum within 3-4 weeks. The period of fixation of the limbs in the spacer splint is up to 5 months.

Congenital dislocation diagnosed in the newborn period is treated with spacer splints for up to six months. In case of late diagnosis (after 6 months), a combined treatment method is used, including abductor splints and plaster casts to fix the head in the acetabulum.

In children aged one year, reduction of congenital dislocation is carried out using single-stage orthopedic adjustments followed by the application of plaster casts.

Prognosis for congenital hip dislocation. Early diagnosis and treatment make it possible to achieve complete anatomical and functional restoration of the joint in 100% of children.

The article was prepared and edited by: surgeon

Congenital hip dislocation or, in other words, hip dysplasia is the most common congenital malformation in infants. Statistical data states that, on average, in three to four cases per 1000 newborn babies, this pathology, and the disease affects girls about six times more often than male children.

Due to the abnormal development of the elements of the hip joint, dislocation occurs (complete separation articular surfaces bones) or subluxation (partial separation of the articular surfaces of bones), which can be corrected with conservative treatment methods only in early infancy- usually up to six months. Therefore, it is important for young parents to know the main symptoms of the pathology and the consequences of the development of its complications. If there is any suspicion regarding the baby’s illness, they should promptly contact professional help see an orthopedic doctor.

The hip joint has the following elements: the articular (acetabulum), the femoral head and the femoral neck. The acetabulum is cup-shaped, covered inside with cartilage tissue (ridge) and filled joint fluid. The femoral head has a similar external cartilaginous covering and is additionally connected by ligaments to the glenoid cavity. spherical shape The head allows it to stay securely in the acetabulum and allows the joint to move in different directions.

Congenital manifests itself in the following defects in the development of articular elements:

violation of the required dimensions of the articular cavity or deformation of the cartilage cushion, as a result of which the cavity does not have the appropriate shape to hold the femoral head;
incorrect angle of inclination of the head in relation to the neck of the femur (“antetorsion angle”);
defect in the development of joint ligaments (excessive elasticity).

The above pathologies in combination with weak muscle tissue favor the occurrence of congenital dislocation or subluxation of the hip in newborns. Pathology of the hip joint can develop on one side or simultaneously on both.

Causes

The root causes of abnormal development of the constituent elements of the hip joint have not been studied or established. Congenital hip dislocation, according to clinicians, can be provoked by a number of external and internal factors, such as:

severe toxicosis (gestosis) in a pregnant woman;
the position of the child’s body in the womb does not correspond to the norm, for example, there is a breech presentation;
large fruit;
the expectant mother is in the age category up to 18 years;
previously transferred infectious diseases pregnant;
fetal developmental delay;
unfavorable environmental conditions for bearing a baby (radiation, emissions of harmful substances into the air, water pollution, etc.);
bad habits;
gynecological diseases that limit the child’s movement during intrauterine development (adhesions, fibroids);
premature birth;
injuries received by the child during childbirth;
genetic predisposition to inherit the pathology, when one of the parents was diagnosed with “congenital subluxation (dislocation) of the hip.”

Dislocation of the femoral head without appropriate treatment provokes the development of dysplastic coxarthrosis. This change is accompanied constant pain, reduces joint mobility and ultimately leads to disability.

Degrees of dysplasia

Congenital hip dislocation has several degrees of severity of the disease:

dysplasia - the surfaces remain congruent, but there are clear anatomical prerequisites for the development of dislocation;
preluxation - normal fit between the articular elements is maintained, but the joint capsule is tense, there is displacement and excessive mobility femoral head inside the joint;
subluxation - the fit of the surfaces of the joint elements is disrupted, the ligament is significantly stretched, the head of the femur is moved out of place;
dislocation - there is an absolute discrepancy between the head of the femur and the glenoid cavity, the head of the femur is located outside the joint, the articular capsule is significantly tense and stretched.

To identify such changes in a child in the first months of his life, an ultrasonographic diagnostic method is used, and after four months from the date of birth of the baby, an X-ray examination is used.

Symptoms of the disease

Congenital dislocation of the hip has a number of nonspecific symptoms, the presence of which may suggest a pathology in the child. Before and after the age of one year, symptoms manifest differently due to the child’s maturation, development, and worsening of undiagnosed pathology.

Congenital hip dislocation manifests itself in newborns from 0 to 12 months in the form of the following signs:

the Marx-Ortolani symptom, which manifests itself in children under three months of age in the form of a characteristic click (the femoral head freely exits the glenoid cavity) when bending the legs at the knees and spreading the hips;
asymmetry of the gluteal-femoral skin folds;
Dupuytren's symptom, in which there is unimpeded movement of the femoral head up and down;
the baby experiences shortening of the affected limb;
turning the foot outward in a child with a developed pathology usually occurs during sleep, but this symptom can also occur in healthy children;
limited abduction of both legs or one leg when flexed (hip abduction angle is less than 80-90 degrees);
Barlow's symptom, in which, as a result of flexion of the leg at the hip, displacement of the femoral head occurs.

Congenital dislocation of the hip in children over 12 months is expressed in the form of the following symptoms:

the child begins to walk late - usually after a year;
in the presence of a unilateral dislocation, lameness appears on the affected leg; in the case of a bilateral anomaly in the development of the hip joints, the child has a “duck gait”;
there is a curvature of the spine in the lower back;
standing on the sore leg, the child leans towards the healthy limb, and his pelvis tilts towards the other (Duchenne-Trendelenburg symptom);
the head of the femur cannot be felt in the area of the hip joint.

If the above symptoms are present, an accurate diagnosis and further treatment the child is established by an orthopedic doctor based on the results of examinations carried out using x-rays (after 3 months of age), ultrasound or MRI of the hip joint.

Treatment options

Congenital hip dislocation should begin to be treated immediately after diagnosis.

Treatment of congenital hip dislocation is carried out conservatively and operational methods. If the disease is not detected in early age, then it gets worse in the future, complications arise that require surgical intervention. Most favorable period For the treatment of dysplasia with conservative methods, the age of the child is considered to be up to 3 months; if the diagnosis is made later, then the treatment is considered late. However, even at an age older than 3 months, a number conservative techniques treatments give good results.

For congenital hip dislocation conservative treatment carried out in several ways or a combination of these methods.

Therapeutic massage is a mandatory procedure for dysplasia, it allows you to strengthen the muscles, as well as stabilize and straighten the damaged joint.

Fixation of the legs with the help of plaster or orthopedic structures is performed for a long period of time, allowing you to fix the legs in a spread position until the increase cartilage tissue on the acetabulum and stabilization of all components of the joint. The structures are installed and adjusted only by the attending physician. Examples of orthopedic structures are Pavlik splint, Freik splint, Vilensky splint.

Physiotherapeutic procedures, such as electrophoresis, applications with ozokerite, ultraviolet radiation, are used in complex treatment dysplasia.

In the absence of effectiveness from the use of the above conservative treatment methods at the age of one to five years, closed reduction of the dislocation is sometimes prescribed. After the procedure, a fixing plaster structure is applied for up to six months, while the child’s legs are fixed in an extended position. After removal of the structure, rehabilitation is carried out.

Surgery is prescribed for congenital hip dislocation in cases where conservative methods not allowed positive results. Suitable age for the operation it takes 2-3 years. Surgery performed in several ways:

open arthroplasty reduction of congenital hip dislocation;
endoprosthetics, or joint replacement;
reconstruction of the ilium and femur, the joint capsule is not opened;
a combination of the above treatment methods.

The method of surgical treatment is chosen by the doctor taking into account the anatomical modifications of the joint.

Prevention

Prevention of congenital hip dislocation is carried out in several stages.

Prenatal (prenatal) and intranatal (delivery) prevention involves compliance with following rules future mother:

timely completion of periodic examinations by a gynecologist-obstetrician, compliance with his instructions and appointments (undergoing an ultrasound scan of the fetus, taking tests, taking medications) to prevent the development and timely diagnosis of defects in the fetus;
abstaining from smoking and drinking alcohol;
compliance healthy image life (daily walks, doing exercises for pregnant women, adequate sleep);
application of principles proper nutrition(fractional consumption of food; the diet should contain balanced food, rich in fiber and protein - dairy and meat products, fresh vegetables, greens and fruits; it is necessary to exclude the consumption of fried, spicy, salty, canned, fatty foods);
timely consultation with a doctor if signs of gestosis appear ( high pressure, swelling);
correct behavior during childbirth (following the doctor’s instructions).

Postnatal prevention involves compliance with the following rules by the mother in relation to the newborn child:

excluding swaddling a baby with straight legs, which can cause development, since this position of the baby’s legs is unnatural;
wide, loose swaddling that preserves the physiological position of the baby’s legs;
therapeutic and preventive massage, including exercises for spreading the legs of a newborn;
carrying a child with legs spread apart in kangaroo-type devices, starting from 2 months of age, and excluding vertical load on children’s legs until permission from a doctor to perform such actions is obtained;
if there is a genetic predisposition, quarterly examination and observation by an orthopedic surgeon is required.

Timely prevention, early diagnosis and treatment of the identified pathology contribute to a favorable outcome for the child’s health.

For many years, there was an unfair opinion that congenital hip dislocation is the result of careless actions of obstetricians when a child is born. Perhaps in some very in rare cases Dislocations also occur in maternity hospitals, but congenital dislocation is a completely different disease and much more serious. This disease is formed in utero. Due to improper development of the joint, the fetal femoral head becomes loose in the socket intended for it.

The articular cartilages are not visible on radiographs, so congenital hip dislocation can only be detected in a born baby. Therefore, it is strongly recommended that mothers, together with the doctor, carefully examine the newborn in the first days. If the baby has one leg even slightly shorter than the other, and the buttock folds are asymmetrical, if he lies unevenly and unequally moves his legs to the sides, you have every reason to be seriously concerned.

One of the first methods of prevention and treatment of congenital hip dislocation, the easiest and at the same time effective, is wide swaddling. Doctors insist that this is how babies are swaddled in maternity hospitals, including those who do not have any defects. And this is the only way mothers should swaddle their children at home until they are three months old. It's not at all difficult to do this.

If you use diapers, then on top of the diaper or under it you need to place a flannel diaper, folded in four, and secure it with a simple diaper folded in a triangle. With this method, the baby is in the “frog” position, and the femoral head takes its place in the socket. Under no circumstances, and even more so if the hip is dislocated, should you swaddle your baby tightly. And don’t believe anyone if they say that without tight swaddling, the baby’s legs will become crooked - this prejudice has long been refuted by practice.

What happens when treatment for dysplasia is not started from the first days of a child’s life? The baby's skeletal system is developing, the femoral head gradually increases in size. At the same time, the idle cavity is filled connective tissue and becomes smaller, and it may very soon turn out to be extremely difficult to set the enlarging head into it. Very unfavorable secondary phenomena develop: the femoral head moves sideways or higher from the socket. When the baby moves, the “dangling” head, like a roller on asphalt, rolls along the cavity and crushes it to such an extent that this area stops growing - in the future it will have to be increased surgically.

It is strongly recommended that parents show their baby to an orthopedic surgeon as soon as possible after discharge from the hospital. Much to our chagrin, some mothers and fathers come to their senses too late and bring in babies who are already starting to walk, and it becomes noticeable that they fall heavily on one leg.

Congenital hip dislocation in newborns is often combined with another serious illness- hypertonicity of the adductor muscles. The hip does not abduct not because its head is not in the socket, but because the natural muscles are overstrained. To relieve spasm, very long-term treatment, in which, in addition to the orthopedist, a neurologist also participates. Late treatment of dysplasia is very difficult and requires complete mutual understanding between the doctor and parents. It lasts for many months or even years, and the result depends on the professionalism of the one who treats the child, and on the parents’ careful compliance with all medical recommendations.

Even if it is possible to straighten the femoral head into the socket, then at some stage a residual subluxation develops, because it is precisely because of the delay in treatment that the baby has not developed correct joint. It is a huge disaster for a child if mom and dad seek help from chiropractors or any other “healers” who promise to cure congenital hip dislocation in one session. As a result of a simultaneous, sharp reduction of dislocation, the same amount of dislocation occurs sudden disturbance blood circulation and then a terrible complication develops - necrosis of the femoral head.

Therefore, parents should remember that it is impossible to cure this disease in a short time. At very early start Treatment with the help of soft diverting pads can sometimes reduce the dislocation in three to four months. In more difficult cases Pavlik stirrups and other special devices are used for treatment. All medicinal products should be used only as prescribed by an orthopedist, and not on the advice of friends, relatives, or acquaintances.

If treatment begins at three months of age, then no devices are prescribed, but a functional plaster cast is applied. Reduction of the dislocation under its influence occurs within one to six months. If it is impossible to reduce the dislocation using a plaster cast, they move on to the next stage of treatment - they do this under anesthesia and achieve good results. But unlike chiropractors, doctors spend a very long time preparing the child for this procedure.

Very much in severe cases When all these methods are not enough, they resort to surgical intervention. Sometimes a dislocated hip becomes so rotated around its axis that a detorsion osteotomy has to be performed. This is a corrective operation and there is no need to be afraid of it. When the roof is undeveloped, a depression is made Plastic surgery, which is called plastic roofing.

Upon completion of treatment, a gentle regimen is prescribed, compliance with which depends entirely on dad and mom. First of all, it consists in complete liberation from school lessons physical education. Running, jumping, somersaults - all this is not for your baby. The following are prohibited: sports, dynamic dancing, long hikes with heavy lifting, and anything that creates excessive stress on the hip joints. Also required therapeutic exercises, aimed at strengthening all muscle groups that surround these joints. That is, for the gluteus maximus and medius and abdominal muscles, which are also involved in walking. It is useful to engage in swimming and cycling, but not to the point of fatigue.

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Congenital hip dislocation is one of the most severe and common diseases of the musculoskeletal system in children. Problem early detection and treatment of this disease is still very important among modern tasks of pediatric orthopedics. Early treatment Congenital dislocation of the hip is considered the basis for the prevention of disability in this disease, since complete recovery can only be achieved by treating children from the first weeks of life.

The causes of this pathology are still unclear. However, there are many theories trying to explain this very important question, we present some of the theories of the occurrence of congenital hip dislocation below.

Theories of congenital hip dislocation

– trauma to the pregnant uterus.

– injury to the hip joints during childbirth.

– chronic excessive pressure on the fundus of the uterus, oligohydramnios.

Pathological position of the fetus, breech presentation, extended position of the legs - Naura (1957).

- Theory of the defect of the primary anlage - Flight (8th century).

The theory of delayed development of the hip joints - T. S. Zatsepin, M. O. Friedland, Lorenz.

Congenital hip dislocation is an extreme degree of hip dysplasia. This underdevelopment affects all elements of the hip joint, both bone formations and surrounding soft tissues.

There are three degrees of severity of underdevelopment of the hip joint:

1st degree – pre-luxation, is characterized only by underdevelopment of the roof of the acetabulum (Fig. 101). In this case, the paraarticular tissues, thanks to minor changes, keep the femoral head in the correct position. Consequently, there is no displacement of the femur, the head is centered in the acetabulum.

2nd degree – subluxation. In this case, in addition to the underdevelopment of the roof of the acetabulum, an outward displacement of the femoral head (lateral position of the femur) is detected, but it does not extend beyond the limbus.

3rd degree – congenital hip dislocation. This is an extreme degree of hip dysplasia, which is characterized by the fact that the femoral head completely loses contact with the underdeveloped acetabulum. In this case, the thigh is displaced outward and upward (Fig. 102).

P atogenesis congenital hip dislocation is still poorly understood. Some researchers believe that a child is born not with a dislocation, but with a congenital inferiority of the hip joint, i.e., with a pre-dislocation. Then, under the influence of increased muscle tone and body weight, the hip may shift, forming a subluxation or dislocation. Others believe that the cause of congenital hip dislocation is a defect of the anlage, i.e. the proximal part of the femur is primarily formed outside the acetabulum. At the same time, due to the absence of a constant irritant in the cavity - the main stimulus for the normal formation of the pelvic component of the joint, the necessary conditions are created for the development of dysplasia.

Girls get sick 3-6 times more often than boys. Often the process is two-way. The left joint is affected more often than the right. In children from their first pregnancy, congenital dislocation occurs twice as often.

Clinic. The diagnosis of hip dysplasia should be made already in maternity hospital. When first examining a child, aggravating factors in the medical history should be taken into account: heredity, breech presentation, uterine anomalies, pregnancy pathology. Then a clinical examination is carried out.

U In a newborn, the following symptoms can be identified, which are characteristic only of congenital hip dislocation:

asymmetry of skin folds on the thigh (Fig. 103). Normally, in young children, three skin folds are most often identified on the inner surface of the thigh. Some orthopedists call them adductor. With congenital dislocation of the hip, due to the existing relative shortening of the leg, there is an excess of soft tissue of the thigh in comparison with the norm and therefore the number of folds can be increased, in addition, they can be deeper or their location is not symmetrical to the folds of a healthy leg. At the same time, parents often complain about existing diaper rash in such folds with which it is very difficult for them to “fight”. It should be noted that it is not possible to make a diagnosis based on the presence of this symptom, especially since almost 40% of healthy children can have such asymmetry of the folds on the thigh.

external rotation of the pedicle. It especially manifests itself in a child during sleep.

shortening of the leg, is associated with a displacement of the proximal part of the femur outward and upward. Therefore, it is called relative or dislocation. It should be determined by giving the position of flexion in the hip joints to an angle of 90, and in the knee joints - to an acute angle and look at the level of standing of the knee joints (Fig. 104). The knee joint of the diseased leg will be located horizontally below the healthy one. When determining this symptom, it is necessary to securely fix the child’s pelvis to the changing table. Otherwise, shortening of any leg, even a healthy one, can be detected.

flattening of the gluteal region(Pelteson's sign) is caused by this muscle group on the affected side.

-limitation of hip abduction. This symptom is revealed as follows (Fig. 105): the children’s legs are given the same position as when determining its length. From this position, abduction is performed in the hip joints. Normally, when full abduction is achieved, the doctor’s hands touch the changing table, which corresponds to 80 - 85. With congenital dislocation, hip abduction will be significantly less. It should be remembered that in the first 3 months this symptom can be positive in absolutely healthy children. This is most often associated with the presence of physiological hypertonicity of the newborn’s muscles.

head slippage(click or Ortolani-Marx symptom). Identified during determination of the level of abduction in the hip joints. A click is a reliable sign of reduction for any dislocation. Congenital dislocation is no exception. The symptom is not detected in all patients and lasts only 5-7 days from the date of birth.

absence of the femoral head in the femoral triangle upon palpation is a very reliable sign extreme hip dysplasia.

X-ray diagnostics. To confirm the diagnosis, an X-ray examination of the hip joints is indicated at the age of 3 months.

D To clarify the diagnosis in doubtful cases X-ray examination hip joint surgery can be performed at any age.

Reading radiographs under the age of 3 months presents certain difficulties, because the proximal part of the femur consists almost entirely of cartilaginous, x-ray transparent tissue; the pelvic bones have not yet merged into one innominate bone. It is too difficult to achieve symmetrical styling in children. A variety of patterns and radiological features have been proposed to address these challenging diagnostic challenges.

L treatment congenital pathology , and equally, congenital dislocation of the hip is more successful the earlier it is started.

It is advisable to begin conservative treatment of hip dysplasia in the maternity hospital. Mother teaching child carrying out exercise therapy, proper swaddling of the baby, which should not be tight. The child's legs in the blanket should lie freely and be maximally abducted at the hip joints.

WITH for preventive purposes and children with suspected hip dysplasia, until a final diagnosis is made, can be prescribed wide swaddling. It consists in the fact that between the legs bent and abducted at the hip joints, after the diaper (pampers), a multi-layer flannel diaper is laid (it is better to take two) in width equal to the distance between knee joints child.

P
after diagnosis of dysplasia varying degrees If the child is severely ill, treatment in diverting splints is indicated (Fig. 101, 112). The essence of their treatment is that when abducted in the hip joint, the femoral head is centered in the acetabulum and is a constant irritant for the reconstruction of the underdeveloped roof of the acetabulum. The duration of the child's stay in the splint is monitored radiologically: complete deconstruction of the roof of the acetabulum on the radiograph is an indication of the end of treatment. For these purposes, many outlet busbars have been proposed.

In children over a year old gradual reduction of the hip is applied using adhesive tape traction(Fig. 113), proposed by Sommerville and improved Mau. In this case, after applying sticky-plaster (bandage or adhesive) bandages to the legs and thighs with a system of weights through blocks, the legs are installed in the hip joints at a flexion angle of 90º, and in the knee joints - full extension at an angle of 0º. Then gradually, over 3-4 weeks, they reach a level of full abduction in the hip joints to an angle close to 90º. In this position, fix the position of the legs plaster cast(Fig. 114) for the period of complete reconstruction of the roof of the acetabulum, determined by radiographs. Average term treatment – 5-6 months.

P If treatment fails or pathology is detected late, it is indicated surgical treatment. Most often it is performed when the child reaches 3-4 years of age.

P A large number of surgical interventions have been proposed. But more often than others, based on a large clinical material, preference is given to extra-articular operations in which the adaptation mechanisms that have developed in the joint as a result of its underdevelopment are preserved, but create favorable conditions for the further life of both the joint and the patient. In children's and adolescence give preference to Salter's operation (Fig. 116), in adults, osteotomy according to Chiari