Femoral dysplasia in a child. It is designated as preluxation, subluxation, or dislocation of the hip. The most basic manifestations of the disease include

Hip dysplasia is a congenital disorder of the joint formation process, which can cause dislocation or subluxation of the femoral head. Either underdevelopment of the joint or its increased mobility in combination with connective tissue deficiency is observed. At an early age, it manifests itself as asymmetry of skin folds, shortening and limitation of hip abduction. Subsequent pain, lameness, increased fatigue limbs. Pathology is diagnosed based on characteristic features, ultrasound and x-ray data. Treatment is carried out using special means fixations and exercises for muscle development.

ICD-10

Q65.6 Q65.8

General information

Hip dysplasia (from the Greek dys - disorder, plaseo - form) is a congenital pathology that can cause subluxation or dislocation of the hip. The degree of joint underdevelopment can vary greatly - from gross impairment to increased mobility combined with weakness ligamentous apparatus. To prevent possible negative consequences, hip dysplasia must be identified and treated in early dates– in the first months and years of the baby’s life.

Hip dysplasia is one of the most common congenital pathologies. According to experts in the field of traumatology and orthopedics, the average frequency is 2-3% per thousand newborns. There is a dependence on race: in African Americans it is observed less frequently than in Europeans, and in American Indians it is observed more often than in other races. Girls get sick more often than boys (about 80% of all cases).

Causes

The occurrence of dysplasia is due to a number of factors. There is a clear hereditary predisposition – this pathology 10 times more often observed in patients whose parents suffered from a congenital disorder of the development of the hip joint. The likelihood of developing dysplasia increases 10 times with a breech presentation of the fetus. In addition, the likelihood of this pathology increases with toxicosis, medicinal correction pregnancy, large fetus, oligohydramnios and some gynecological diseases in the mother.

Researchers also note a connection between the incidence rate and unfavorable environmental conditions. In environmentally disadvantaged regions, dysplasia is observed 5-6 times more often. The development of dysplasia is also influenced by national traditions of swaddling babies. In countries where newborns are not swaddled and the baby's legs are in a position of abduction and flexion most of the time, dysplasia is less common than in countries with traditions of tight swaddling.

Pathogenesis

The hip joint is formed by the head of the femur and the acetabulum. In the upper part, a cartilaginous plate is attached to the acetabulum - the acetabular lip, which increases the area of ​​​​contact of the articular surfaces and the depth of the acetabulum. The hip joint of a newborn baby, even normally, differs from the joint of an adult: the acetabulum is flatter, located not obliquely, but almost vertically; ligaments are much more elastic. The femoral head is held in the socket by the round ligament, articular capsule and acetabular labrum.

There are three forms of hip dysplasia: acetabular (impaired development of the acetabulum), dysplasia of the upper femur and rotational dysplasia, in which the geometry of the bones in the horizontal plane is disrupted.

If the development of any part of the hip joint is disrupted, the acetabulum, articular capsule and ligaments cannot hold the femoral head in its proper place. As a result, it moves outward and upward. In this case, the acetabular labrum also shifts, finally losing its ability to fix the head of the femur. If the articular surface of the head partially extends beyond the socket, a condition occurs, called subluxation in traumatology.

If the process continues, the femoral head moves even higher and completely loses contact with the glenoid cavity. The acetabular labrum is below the head and is wrapped inside the joint. Dislocation occurs. If left untreated, the acetabulum gradually fills with connective and fatty tissue, making reduction difficult.

Symptoms of dysplasia

Hip dysplasia is suspected when there is shortening of the hip, skinfold asymmetry, limited hip abduction, and the Marx-Ortolani slip sign. Asymmetry of the inguinal, popliteal and gluteal skin folds is usually better identified in children older than 2-3 months. During the examination, pay attention to the difference in the level of location, shape and depth of the folds.

It should be borne in mind that the presence or absence of this sign is not enough to make a diagnosis. With bilateral dysplasia, the folds can be symmetrical. In addition, the symptom is absent in half of children with unilateral pathology. Asymmetry of inguinal folds in children from birth to 2 months is not very informative, since it sometimes occurs even in healthy infants.

The symptom of shortening of the femur is more reliable in diagnostic terms. The child is placed on his back with his legs bent at the hip and knee joints. The location of one knee lower than the other indicates the most severe form of dysplasia - congenital hip dislocation.

But most important sign, indicating congenital dislocation of the hip, is the “click” or Marx-Ortolani symptom. The baby is lying on his back. The doctor bends his legs and clasps his thighs with his palms so that II-V fingers were located on the outer surface, and the thumbs were located on the inner surface. Then the doctor evenly and gradually moves the hips to the sides. With dysplasia, a characteristic push is felt on the affected side - the moment when the head of the femur is reduced into the acetabulum from a dislocated position. It should be borne in mind that the Marx-Ortolani symptom is not informative in children in the first weeks of life. It is observed in 40% of newborns, and subsequently often disappears without a trace.

Another symptom indicating joint pathology is limited movement. In healthy newborns, the legs are abducted to a position of 80-90° and laid freely on a horizontal table surface. If abduction is limited to 50-60°, there is reason to suspect a congenital pathology. U healthy child For 7-8 months, each leg is abducted by 60-70°, in a baby with congenital dislocation - by 40-50°.

Complications

With minor changes and no treatment, any painful symptoms in at a young age may be missing. Subsequently, at the age of 25-55 years, the development of dysplastic coxarthrosis (arthrosis of the hip joint) is possible. As a rule, the first symptoms of the disease appear against the background of a decrease in motor activity or hormonal changes during pregnancy.

The characteristic features of dysplastic coxarthrosis are acute onset and rapid progression. The disease manifests itself unpleasant sensations, pain and limitation of movements in the joint. On late stages a vicious position of the hip is formed (the leg is turned outward, bent and adducted). Movements in the joint are sharply limited. In the initial period of the disease greatest effect is ensured through properly selected physical activity. With pronounced pain syndrome and vicious installation of the hip, endoprosthetics is performed.

With unreduced congenital dislocation of the hip, over time, a new defective joint is formed, combined with shortening of the limb and impaired muscle function. Currently, this pathology is rare.

Diagnostics

A preliminary diagnosis of hip dysplasia can be made in the maternity hospital. In this case, you need to contact a pediatric orthopedist within 3 weeks, who will conduct the necessary examination and draw up a treatment regimen. In addition, to exclude this pathology, all children are examined at the ages of 1, 3, 6 and 12 months.

Particular attention is paid to children who are at risk. This group includes all patients with a history of maternal toxicosis during pregnancy, a large fetus, breech presentation, as well as those whose parents also suffer from dysplasia. If signs of pathology are detected, the child is referred for additional studies.

A clinical examination of the baby is carried out after feeding, in a warm room, in a calm, quiet environment. To clarify the diagnosis, techniques such as radiography and ultrasonography are used. In young children, a significant part of the joint is formed by cartilage, which is not displayed on x-rays, so this method is not used until 2-3 months of age, and then special diagrams are used when reading images. Ultrasound diagnostics is a good alternative to x-ray examination in children in the first months of life. This technique is practically safe and quite informative.

It should be borne in mind that the results alone additional research not enough to make a diagnosis of hip dysplasia. The diagnosis is made only when both clinical signs and characteristic changes on radiographs and/or ultrasonography are identified.

Treatment of hip dysplasia

Treatment should begin as early as possible. Are used various means to hold the child’s legs in the position of flexion and abduction: devices, splints, stirrups, panties and special pillows. When treating children in the first months of life, only soft elastic structures are used that do not interfere with the movements of the limbs. Wide swaddling is used when it is impossible to carry out full treatment, as well as during the treatment of babies at risk and patients with signs of an immature joint identified during ultrasonography.

One of the most effective ways treatment of young children are Pavlik stirrups - a soft fabric product, which is a chest bandage, to which a system of special straps is attached that holds the child’s legs abducted to the sides and bent at the knee and hip joints. This soft design fixes the baby's legs in the desired position and, at the same time, provides the child with sufficient freedom of movement.

Special exercises for strengthening the muscles play a major role in restoring range of motion and stabilizing the hip joint. At the same time, for each stage (spreading the legs, keeping the joints in the correct position and rehabilitation), a separate set of exercises is compiled. In addition, during treatment, the child is prescribed a massage of the gluteal muscles.

In severe cases, a one-stage closed reduction of the dislocation is performed, followed by immobilization with a plaster cast. This manipulation is performed in children from 2 to 5-6 years old. Once the child reaches the age of 5-6 years, reduction becomes impossible. In some cases, with high dislocations in patients aged 1.5-8 years, skeletal traction is used. If conservative therapy is ineffective, corrective operations are performed: open reduction of the dislocation, surgical interventions on the acetabulum and the upper part of the femur.

Prognosis and prevention

At early start treatment and timely elimination of pathological changes, the prognosis is favorable. In the absence of treatment or if therapy is insufficiently effective, the outcome depends on the degree of hip dysplasia, there is high probability early development of severe deforming arthrosis. Prevention includes examinations of all young children and timely treatment of identified pathologies.

Main symptoms:

• Violation of the depth of skin folds
• Violation of the position of skin folds
• Limited hip abduction
• Shortening one leg

Hip dysplasia is a congenital pathology of the formation of the joint, causing subsequent possible subluxation or dislocation of the femoral head. Hip dysplasia, the symptoms of which can manifest either in the form of underdevelopment of the joint, or in the form of excessive mobility in combination with insufficiency of the connective tissue, usually develops against the background of unfavorable heredity, pathology during pregnancy or gynecological diseases present in the mother.

general description

The danger of hip dysplasia lies in the fact that failure to detect it in a timely manner, along with the lack of the required treatment, can cause subsequent disruption of the functions performed by the affected lower limb, which is possible up to the development of pathology to such an extent that it determines the appropriate form of disability for the child. Taking this into account, the pathology relevant to hip dysplasia should be eliminated within the framework of early period its identification and, in fact, the life of the child.

The degree of underdevelopment of the joint against the background of dysplasia can vary significantly in each specific case, that is, it can be both gross forms of disorders and excessive mobility, combined with a general weakness of the ligamentous apparatus.

Hip dysplasia is a fairly common pathology detected in newborns. On average, the detection rate is 2-3% per 1000 newborns. What is noteworthy is that this pathology revealed a dependence in terms of race. Thus, representatives of the African-American race encounter this pathology less often than Europeans, while American Indians, for example, encounter it more often than any other race. It was also revealed that hip dysplasia in girls is diagnosed many times more often than hip dysplasia in boys - on average, girls account for about 80% of cases of detection of this disease.

It would not be amiss to dwell on the anatomical features of the area that is affected by hip dysplasia, as well as what changes this area undergoes against the background of the current pathological process.

The hip joint is formed by the combination of the acetabulum and the femoral head. The acetabulum in the form of a cartilaginous plate is attached to the upper part of the cavity; due to it, the area of ​​contact between the articular surfaces increases, and the depth of the acetabulum also increases. The head of the femur contributes to the performance of two main functions, in particular, it is the depreciation of the loads that fall on the femur when running, jumping and walking in order to avoid injury, and it also ensures the passage of joints through it, which provides nutrition to the head of the femur.

Due to the special configuration of the hip joint, a variety of types of movement become possible: outward and inward rotation, abduction and adduction, flexion and extension. In the normal state, the listed movements are performed with a slight amplitude, which is achieved by limiting the femoral head ligament and the cartilaginous rim. In addition to this, the joint is surrounded by many muscles and ligaments, with the help of which mobility is also limited to a certain extent.

In a newborn child, the hip joint, even in its normal state, differs from anatomical features joint of an adult. Thus, in a child, the acetabulum has a flatter shape, its location is also different, in particular, it is not in an inclined position, like in an adult, but in an almost vertical position; in addition, in a child, the ligaments here are more elastic. The femoral head is retained in the socket by the rounded ligament, acetabular labrum and articular capsule.

There are three main forms of hip dysplasia: the acetabular form (the development of the acetabulum is subject to disruption), rotational dysplasia (characterized by a violation of the geometric features of the position of the bones along the horizontal plane) and dysplasia of the femur from the upper sections.

If the development of any of the departments in the hip joint is impaired, then the ligaments, articular capsule and acetabular labrum lose the ability to adequately hold the femoral head, that is, to keep it in the required place. This, in turn, leads to an upward and outward displacement of the femoral head. The acetabular labrum is also subject to displacement, and therefore its ability to provide fixation of the femoral head is finally lost. If the articular surface of the head partially extends beyond the location of the socket, the child develops a condition defined as subluxation.

In the future, if pathological process progresses, the femoral head moves higher, causing it to completely lose any connection with the glenoid cavity. The position of the acetabular labrum in this case is concentrated below the head, with a twist inside the joint, which already indicates this pathological condition like a dislocation.

Ultimately, if no treatment is attempted as this pattern progresses, the acetabulum begins to fill with fatty and connective tissue, which, in turn, leads to serious difficulties in further attempts to reduce the dislocation.

Hip dysplasia: degrees and types

Hip dysplasia may be accompanied by the following anatomical disorders:

• abnormal development of the acetabulum – here the acetabulum is partially corrected in its own spherical shape, acquiring a more flattened shape, becoming smaller in size;
• weakness of the ligaments in the area of ​​the hip joint;
• underdevelopment of the cartilaginous rim surrounded by the acetabulum.

The degrees of hip dysplasia are determined based on the pathological changes accompanying this state, in a general consideration we have highlighted them above, let us add in a little more detail their features:

• Dysplasia. With dysplasia itself we're talking about about the inferiority and abnormal development of the hip joint, but so far without accompanying changes in its configuration. It can be difficult to determine pathology only through visual examination, because here it is detected mainly through additional diagnostic procedures. Somewhat earlier, dysplasia was not considered as a disease at all during this period; it was not diagnosed and, accordingly, was not prescribed necessary treatment. Now dysplasia is a full-fledged diagnosis, moreover, it also happens that doctors carry out so-called overdiagnosis, which is explained by the “detection” of this disease in a completely healthy child, which, as is clear, is also not correct.
• Pre-dislocation. In this case we are talking about a condition that precedes subluxation and dislocation. The capsule of the hip joint here is in a stretched state, and the head of the femur, although slightly displaced, easily returns to its original, normal anatomical position. The gradual progression of pathological changes leads to the fact that preluxation, as already noted, is transformed into subluxation, and then into dislocation (if excluded necessary measures therapeutic effects).
• Subluxation of the hip. There is a partial displacement of the head of the hip joint relative to the socket. In particular, it bends the cartilaginous rim in the acetabulum while simultaneously shifting it upward. Because of this, the ligament in the head of the femur becomes stretched, it loses its characteristic tension.
• Hip dislocation. In this case, there is a complete displacement of the head of the femur in relation to the acetabulum, with which, as is clear, it is initially connected anatomically. That is, the head of the femur in this case is located outside the cavity, but outside, above it. The cartilaginous rim along its upper edge is in a position pressed by the head of the femur, which is why it bends deep into the joint. The femoral head ligament and articular capsule are in a tense and stretched state.

Let us also highlight the main types of dysplasia:

• Acetabular dysplasia. This type of pathology is caused by a violation of the development of the acetabulum alone, in which it has a reduced size, a flatter shape, and its cartilaginous rim is in an underdeveloped state.
• Femoral dysplasia. If we consider the normal anatomical position of the femoral neck, then here it articulates with the body of the femur, which occurs at the appropriate angle. If such an angle is violated, increasing or, conversely, decreasing, then this determines the main mechanism in the disease we are considering, that is, hip dysplasia.
• Rotational dysplasia. This form of dysplasia is caused by a violation of the configuration along the horizontal plane of anatomical formations. The axes surrounding the movement of each of the joints in the lower extremities do not coincide with each other in the normal anatomical position. If the axes do not coincide when they go beyond normal values, the head of the femur is positioned incorrectly relative to the acetabulum.

Hip dysplasia: causes

The reasons in this case can be identified as predisposing factors that contribute to the development of such a pathology in a newborn child:

• Not correct position the fetus, in particular - breech presentation, in which in the womb the fetus is in a position with the pelvis towards the exit of the uterus, and not, as expected, with the head;
• large size of the fruit;
• heredity - that is, the presence of the pathology in question in the parents;
• toxicosis in a pregnant woman, which is especially important when it appears in a young expectant mother.

Some other factors play a separate role. One of the options is to identify the features ecological environment in the region where the child was born. It was revealed that dysplasia is diagnosed on average 6 times more often in those regions where such a situation is defined as unfavorable. Another factor is the peculiarities of swaddling children. Thus, in countries where the child is not swaddled, due to which the legs can be in a bent and abducted position for a significant period of time, the diagnosis of dysplasia occurs several times less frequently than in countries where tight swaddling is preferred.

If at least one of the predisposing factors is present, the child at birth is registered as at risk for the development of pathology, even if the child is in a normal, healthy condition, in the absence of anatomical abnormalities inherent in dysplasia.

Hip dysplasia: symptoms

Symptoms, which are discussed below we'll talk, is revealed during the examination, therefore this point can also be attributed to the diagnosis of dysplasia; these symptoms consist of the following features:

• Violation of the location of folds on the skin, violation of their depth. During the examination, the doctor pays attention to the location of the folds under the left and right buttocks, inguinal and popliteal folds. They should normally be located at the same level. Accordingly, with a deeper position of the folds on one side when compared with the other, we can assume the relevance of the disease we are considering. Meanwhile, this sign cannot be called a reliable indicator of the disease, because in most newborn children there are certain differences in the position of the folds with such a comparison. As a rule, the folds are leveled out when the child reaches the age of 2-3 months. In addition, we note that if a diagnosis such as bilateral dysplasia is relevant, then asymmetries in the position of the folds will most likely not be detected.
• Shortening of one of the legs compared to the other. This sign can be considered the most reliable, but it can only be detected in the case of a severe form of the disease, with an already formed hip dislocation. The head of the femur is displaced backward, which contributes to the shortening of the limb. To check for this symptom, during the examination, the doctor stretches both of the baby’s legs, comparing the level at which the kneecaps are located.
• Slipping symptom (“click symptom” or Marx-Ortolani sign). No less reliable and, at the same time, reliable method for identifying the disease we are considering. Here the child must be placed on his back, after which the doctor grasps his legs so that the thumbs grip from the inside, and the remaining fingers, accordingly, grip from the outside. Next, attempts are made to separate them apart. In the absence of disturbances in the configuration of the joints, that is, normally, the baby’s hips can practically be laid on the surface on which he is laid (on the table), that is, it is possible to separate them to 80-90 degrees. If there is dysplasia, then the hip on the affected side can be abducted only to a certain position, and then with the doctor’s hand, during such manipulations, a characteristic click is felt, indicating the reduction of the femoral head. In the future, if the leg is released, it will again be in its original position, then, in a certain period of time, with a sharp movement, it will dislocate again. Detection of dysplasia by a doctor on the basis of this symptom is allowed only when the child is about 2-3 weeks old; in other cases, the diagnostic method is not informative.
• Limited hip abduction. This symptom can be detected in a child aged 3 weeks. It is defined in the same way as the previous “clicking” symptom. On the healthy side, the child’s leg can lower to the table surface almost to the very end, while with the affected leg it will not be possible to achieve the same result.

It should be taken into account that the persistence of dysplasia in congenital hip dislocation subsequently becomes the cause of gait disturbances in older age. Adoption vertical position the child subsequently determines the asymmetry of the position of the folds (popliteal, inguinal and gluteal).

As additional methods for diagnosing hip dysplasia, it is mandatory to carry out X-ray examination(allowed to be performed from the age of 3 months) or ultrasound (without age restrictions). Diagnostics can also be supplemented by MRI or ultrasonography of the joint.

Hip dysplasia: consequences

As is clear from the specifics of the pathology, in the absence of an appropriate approach to the disease, its further course causes the development of complications. Thus, children with dysplasia begin to walk later than their peers; their gait is characterized by instability, clubfoot, swaying from foot to foot, and lameness. In frequent cases, increased lordosis from the lumbar side is detected with compensatory development of kyphosis from the thoracic segment.

Disability due to hip dysplasia can occur literally from an early age. Lack of treatment also leads to a number of diseases in adulthood, which is caused by the progression of this pathology, combined with osteochondrosis.

An important feature that is relevant for the lower extremities with dysplasia is that they are simply not capable of withstanding prolonged loads.

Due to hip hypermobility, a general “looseness” of the musculoskeletal system develops. Without timely elimination congenital dislocation, the joint, gradually adapting to the distorted motor function, will receive slightly different outlines, both from the side of the head of the femur and from the side of the location of the acetabulum. A joint corrected in this way will not be full-fledged, because it is simply not adapted to provide the limbs with support or adequate abduction. In this case, we are talking about such a pathology as neoarthrosis.

The most unfavorable complication of the disease we are considering is the development of dysplastic coxarthrosis. This disease develops by the age of 25-35, if it is not treated when it appears. surgical intervention with joint replacement, the person loses his ability to work.

Treatment

As already noted, treatment for hip dysplasia should be started as early as possible. It uses a variety of means, due to the influence of which the baby’s legs are fixed in the desired position, in particular, these are various splints and devices, special pillows, panties, stirrups, etc. Treatment of babies in the first months of their life is carried out only with the use of elastic and soft structures, the impact of which will not interfere with normal movement of the limbs.

As one of the most effective options Pavlik stirrups have proven themselves in the treatment of dysplasia. This product is in the form of a chest bandage, the basis of which is soft fabrics, special pins are attached to this bandage, thanks to which the appropriate impact is provided on the child’s legs so that they can take the desired position. With this fixation, not only the necessary impact on the legs is ensured, but also sufficient freedom for movement.

Hip dysplasia in children is a fairly common disease today. It does not always appear immediately, so remember that it is necessary to regularly have your child examined by a doctor. How dangerous is the disease? The fact is that with age, if timely treatment is not started, a person can become disabled.

Do not neglect your doctor’s advice, listen to his recommendations. Remember, it is easier to prevent a disease at the very beginning than to undergo long-term treatment later. Get your child diagnosed in a timely manner.

Hip dysplasia - description

Hip dysplasia is a fairly common pathology, but parents often have a question: why does it look absolutely healthy child Are they forced to wear stirrups, spreading devices and other orthopedic devices that cause a lot of inconvenience to the baby and delay his motor development?

The fact is that undiagnosed or undertreated hip dysplasia in infancy adult life leads to disruption of its functioning, even disability.

Dysplasia is a congenital defect of the hip joint associated with improper development of its constituent structures: the musculo-ligamentous apparatus, the articular surfaces of the pelvis and the head of the femur.

Due to impaired growth of joint structures, the femoral head is displaced relative to the articular surface of the pelvis (subluxation, dislocation). Surgeons and orthopedists use the term “hip dysplasia” to combine several diseases:

• congenital preluxation - a violation of the formation of the joint without displacement of the femoral head;
• congenital subluxation – partial displacement of the femoral head;
• congenital dislocation is extreme dysplasia, when the femoral head does not come into contact with the articular surface of the acetabulum pelvic bone;
• X-ray immaturity of the hip joint – borderline state, characterized by a lag in the development of bone structures of the joint.

In newborns and children in the first months of life, preluxation is most often observed - a clinically and radiologically determined disorder in the development of the hip joint without displacement of the femoral head.