Sometimes young parents, coming to anotherplanned examination, hear from the doctor that their baby has dysplasia of the hip joint. Many young parents are greatly frightened when they hear about such a disease as dysplasia of the hip joints in children and begin to panic. Of course, dysplasia is a very unpleasant and serious disease, but its presence is no excuse for panic, but for the treatment of crumbs. Unfortunately, often doctors do not consider it necessary to give parents full information about this disease. And parents have a very vague idea of ​​what they had to face. But, as is known, the enemy needs to be known in person. It is about what hip dysplasia is, what its consequences are and how to treat it, and this article will be discussed. Dysplasia of the hip joints, as a rule, is a consequence of congenital dislocation of the hip. This kind of congenital deformation of the musculoskeletal system is one of the most common. The defeat extends to all components of the hip joint: a capsule, ligaments and muscles, a femoral head and an acetabulum. All these components have insufficient development. A similar complication occurs in about 5% of all newborn babies, and unilateral hip dislocation occurs three times more often than bilateral. The girls are most affected by this complication - they have an inborn dislocation about 5 times more often than boys.

Causes of dysplasia

Physicians have not yet come to a common opinion thatit is the cause of dysplasia of the hip joints. However, the majority of physicians involved in the study of this problem tend to believe that the main cause of congenital dislocation of the femur is precisely the defects in the primary embryo embryo, as well as the disruption of the normal process of intrauterine development of the fetus. The reasons for such violations are very, very many:

• Avitaminosis in a pregnant woman.
• Hormonal disorders in a future mother.
• Various infectious diseases suffered by a woman during pregnancy.
• The use of a woman during pregnancy, alcoholic beverages, narcotic substances, as well as smoking.
• Hereditary predisposition.

As shown by the studies conducted by the All-Russian Institute of Obstetrics and Gynecology, children with dysplasia of the hip joint are most often born in women who suffer:

• Early toxicosis of the first half of pregnancy.
• Late toxicosis of the second half of pregnancy - gestosis.
• Violations of water-salt metabolism in the mother.
• Violations of water-salt metabolism in the fetus.
• Violation of the cardiovascular system.
• Rheumatic heart disease.

In 50% of all births of children with dysplasiahip joints during pregnancy, the crumbs were in the pelvic presentation. That is why all children who are in the pelvic presentation, after childbirth are subjected to a thorough examination and follow-up at the orthopedic surgeon. Among young parents, a very erroneous opinion is very widespread, that sometimes congenital dislocations of the hip arise as a result of incorrect actions of medical personnel in the process of childbirth. However, in fact, this is not the case - in babies born with cesarean section, dysplasia of the hip joint is not less common than in children born naturally. Congenital dislocation of the hip is always a consequence of the preceding pre-extension of the joint. Anterior joint is accompanied by hypoplasia of the acetabular tissues, which is flattened, and also by a decrease in the size of the femoral head itself, which is poorly subjected to the process of ossification. In this case, the head of the hip often turns the upper end forward. This phenomenon is called an antithecy. Among other things, the child, as a rule, there are various anomalies of the normal development of the neuromuscular apparatus of the hip joint. Over time, the clinical picture of the disease changes: if in the first few months of the baby's life the thigh head has a shift outward and slightly upward, then during growth there is a significant shift up and inward, as a result of which the joint bag significantly stretches and grows in size. However, in some cases of mild dysplasia of the hip joint, the displacement of the femoral head is insignificant. As a rule, this is observed with subluxations. With dislocations of the same true displacement is much stronger. Also, when examining the child, you can see a significant modification of the structure and shape of the acetabulum and the head of the joint, as well as the articular bag and cartilage, muscles and ligaments. With a more detailed examination, it can be seen that the acetabulum is not simply flattened, but also elongated, with its posterior upper margin almost never developed. As a result, there is no emphasis on the femoral head necessary for normal functioning. In the acetabulum there is a gradual thickening of the cartilaginous bottom, development of excessive connective tissue on it. If dysplasia in children under one year was not diagnosed on time, and treatment of crumbs was also not started, with age, the course of the disease is significantly heavier. The child continues to develop a stable dislocation. Symptoms of dysplasia in children:

• The upper arch of the acetabulum often disappears almost completely.
• The hollow itself flattenes even more strongly and takes the form of a triangle.
• Due to the fact that there is no bony fence, the neck of the hip develops incorrectly - it is considerably shortened, has an obtuse cervical-diaphyseal angle.
• In addition, the neck of the hip, again because of the lack of an emphasis, turns forward.

When the baby starts walking, the load on the leg increases many times. As a result of this, there are still a number of pathological changes that significantly worsen the condition of the baby:

• The acetabulum continues to significantly flatten, gradually becoming almost completely flat.
• Significant changes are made and the joint capsule -one is stretched due to the forward-shifted head.
• Sometimes the articular capsule can be generally soldered to the joint bag.
• Due to the fact that the head of the hip constantly slides upwards, a slip groove is formed on the acetabulum.
• The joint cavity is in most casesdivided into three parts and takes the form of an hourglass. The upper part of the joint surrounds the head of the thigh, the middle part surrounds the cavity, but due to the fact that the depression is flattened, part of it remains hollow. The round ligament in mild cases of the disease is well expressed, but sometimes it may be completely absent.

Diagnosis of hip dysplasia

The success of treatment of hip dysplasiajoint and the outcome of the disease largely depends on how timely the disease was diagnosed and the appropriate treatment was started. In the event that the treatment does not begin, the complications increase, in a geometric progression, like the snowman. That's why all the children in the hospital are examined by a surgeon - an orthopedist still in the hospital. As a rule, it is in the maternity hospital that the congenital hip dislocation is diagnosed for the first time. However, parents should remember that, despite the importance of early diagnosis, it is often very, very difficult to recognize it, and sometimes completely unreal. Dysplasia of TBS in children is often well disguised. That's why, even if the doctor did not find any reasons for alarm, all babies without exception should visit the orthopedic doctor one month after birth so that he can make sure that they are all right. Also, the consultation will be necessary when the kids reach three, and then six months. Parents should in no case ignore these visits to the doctor - they are very important for health crumbs - the consequences of dysplasia in children are quite severe. As already mentioned earlier, all groups of dysplasia consist of several diseases:

• Congenital prelux of the hip.
• Congenital subluxation of the hip.
• Congenital dislocation of the hip.
• Radiographically immature hip joint.

In order to correctly assess the conditionhip joint crumbs, a clinical examination of the child should be carried out according to a certain method. There are a number of specific symptoms and signs that a doctor can diagnose in a child dysplasia of the hip joints. The main of these symptoms are listed below, but parents should never attempt to diagnose themselves on their own - this can lead to unpredictable complications. However, it is still necessary to know about these symptoms:

• When the legs of the crumb are diluted to the side, there is a noticeably significant restriction in the hip joints.
• Also, when the legs are bent to the side in the presence of dysplasia of the hip joint, there is a symptom of slipping or, as it is sometimes called, a click symptom.
• If the crumb is put on the tummy, you can visually visualize the asymmetry of the gluteal folds of the baby.
• With a pronounced dysplasia of the hip joints, one can see with an unaided eye the shortening of one of the legs of a crumb.

Once again, it must be recalled that the diagnosis should beTo put only the doctor the surgeon - the orthopedist. Independently, without adequate medical education, to establish a diagnosis is almost impossible. Also, the baby, if put on his back, will have a significant restriction in the hip joint when trying to spread the legs to the side. It is this symptom that is one of the most constant and early signs of hip dysplasia. The more time passes, the older the child becomes, the stronger the restriction becomes. And if with the remaining forms of dysplasia this symptom can be expressed not very clearly, in the event that the baby has a formed dislocation, this sign will be expressed as brightly as possible. Dysplasia of the hip joints must be differentiated from other diseases in which such symptoms are possible:

• Spastic paralysis.
• Muscular contracture.
• Congenital viral deformity of the femoral neck.

All these diseases must be fullyare excluded, and only after that the doctor can establish the diagnosis of dysplasia of the hip joint. For this, the child needs to conduct a full examination and careful study of the condition of absolutely all ligaments and muscles of the hip joints, and ultrasound examination and roentgenogram of the hip formulations is simply necessary. Also, the doctor, when examining the baby, necessarily takes into account the influence of certain age factors, for example, the physiological rigidity of the muscles of the crumbs. This physiological rigidity often does not allow you to breed legs even in perfectly healthy crumbs. However, such difficulties arise only sporadically, sometimes there are no problems with the breeding of the legs. But in the event that a baby has dysplasia of the hip joint, it will be possible to dissolve the legs only after the head of the joint has been fixed. Based on the totality of all the symptoms that the doctor will be able to detect during the external examination of the crumbs, as well as the data of the diagnostic examination of the baby, a verdict about the presence or absence of such a serious disease as hip dysplasia will be made. It is also necessary to tell a little more about the symptom of slipping, or clicking. For the first time this symptom was written by a Soviet orthopedic surgeon back in 1934. After a while he was described by an Italian doctor who gave the symptom one more, the third name - a symptom of instability. The essence of this disorder is that when trying to spread the legs of the crumbs to the side, a dislocation of the hip dislocation takes place. This is the most directional dislocation and causes a click sound that the doctor hears. With subluxations, the sound will be a little quieter and, probably, it will not be heard. However, the doctor will certainly feel it at hand. When the baby's legs are brought to the middle line, a repeated dislocation of the head takes place, which is also accompanied by the sound of the lye and a single flinch of the leg. When carrying out such a study, it is necessary to take into account the fact that the click symptom most often disappears almost completely by the end of the first week of life of the crumbs. But sometimes, if the baby has muscular hypotension, it can persist even for several months, usually the first three to four. The asymmetry of the inguinal folds, as well as the folds on the hips of the baby, or their different numbers on the right and left thigh, is often evidence that the crumb has dysplasia of the hip joint. As a rule, it is on the side with which the joint is affected, the number of folds is larger, and they are much deeper than the second side. These folds are located proximally. However, in itself this symptom can in no case become the basis for diagnosing hip dysplasia. Such asymmetry can be observed even in healthy children, whereas in one third of children suffering from hip dysplasia, this symptom is not observed at all. That is why this symptom can be considered as a sign of dysplasia of the hip joint only in combination with other symptoms, but not on its own. Also a very significant sign of dysplasia of the hip joint is the presence of crumbs in the outer rotation of crumbs. It is always pronounced strongly enough. Often, it's mothers who pay attention to this symptom, and it is he who is the reason for seeking medical advice from an orthopedic doctor. The rotation is most noticeable when the baby sleeps. As a rule, pronounced shortening of the leg, which is noticeable by eye, happens in the case of a high dislocation of the thigh. Contrary to the erroneous opinion, rotation is possible not only with one-sided dislocation, but also with two-sided dislocation, in the event that the hips are located at different heights. Some mothers try to determine by themselves, with the help of centimeter tape, how much one leg is shortened. However, in infants it is almost impossible to do this - they tell about the difference in the length of the legs from the way the knee joints are located. To do this, the legs of the baby, bent at the knees, should be pressed against the tummy. Once again, we draw your attention to the fact that all such manipulations should be conducted only by a medical professional. Virtually all the above signs of dysplasia can be expressed all, or only a part, and sometimes the presence of them does not indicate hip dysplasia. If a doctor has any doubts, the parents should in no case refuse a more detailed examination. If the diagnosis is not confirmed, both you and your attending physician will know for sure that the child with the joints is all right. And do not be indignant and blame the doctor for insufficient competence - this is absolutely justified precautionary measure, since a dysplasia of the hip that is not diagnosed in time can lead to the child having a severe disability in the future.

X-ray diagnostics

The most successful diagnosis of dysplasiahip joint in newborns using the X-ray method of investigation. Produced as follows. The doctor puts the crumb on the back and straightens out its legs. Taz baby is pressed tightly to the cassette with the film. The reproductive organs of the crumb must necessarily be protected from radiological radiation specially designed for this lead plate. This plate, with its proper placement, does not interfere with the radiographic examination. The orthopedic physician, when evaluating the results of the study, takes into account the specific age features of the structure of the hip joints of the newborn baby:

• In infants, the ossification of the femoral head is almost completely absent.
• The height of the femoral head of a newborn is equal to the width of the neck of the hip.
• The acetabular cavity in infants has a cartilaginous structure, so on the radiographic image it does not give a contrasting shadow.

If, with normal development of the baby, ossificationhead of the thigh appears about half a year, then in children suffering from hip dysplasia, ossification occurs no earlier than a year old.

Diagnosis of congenital hip dislocation in children of the senior year

If small children in some casesdiagnosis of congenital dislocation of the hip is difficult, then from the moment when the child begins to walk, it is much easier. In children who have reached the age of one year and begin to take their first steps, one of the first symptoms attracting the attention of parents and doctors and suggesting the presence of dysplasia of the hip joints is the very beginning of the walking process. Most often, this occurs when there is a bilateral dislocation, but sometimes it can occur with one-sided dislocation. Obviously, such children have a specific, characteristic gait - either instability of the crumb, or its lameness with unilateral dislocation of the hip. If the crumb has a congenital bilateral dislocation, the gait will be overwhelming, resembling a duck. Despite the fears of parents, the baby does not feel any pain. The child spends as much time on his feet as there are healthy children, while his behavior is absolutely ordinary - he is cheerful, active, and willing to play. In children after the year, some of the symptoms of hip dysplasia also persist, but they are much less pronounced than in younger children:

• That leg, which is dislocated, as well as in crumbs, is in the position of external rotation.
• Despite the fact that there is no absolute shortening of the limb, a shortening of the limb with a dislocation is preserved.

Massage for dysplasia

If your baby is diagnosed with dysplasiahip joint, the orthopedic doctor will appoint the crumb all the treatment he needs. Parents should strictly follow all the doctor's recommendations and do nothing themselves. The only thing that mom can do, if the doctor does not give other recommendations, is a light massage. Before you start the massage, pay attention to the state of your hands. Hands should be clean, dry and warm. Nails should be cut short, remove rings and bracelets - anything that can disrupt the integrity of the skin of the crumbs. To massage crumbs it is not advisable to use various cream for massage, intended for adults - this can lead to the appearance of crumbs in allergic reactions in the form of skin rashes. It is much more reasonable to use either ordinary baby oil or baby powder. The following are the basic methods of massage, which must be done for children suffering from hip dysplasia:

• Lay the crumb on the back, grab the whole areapalm of the thigh and begin to do light massaging movements. Make sure that your movements are not too strong. To begin massage movements it is necessary with easy stroking of a skin - watch that pressure on a skin was not considerable. The fingers should slide over the skin, but do not move it. Then the thumb and forefinger need to start making spiral movements. It is necessary to continue them for about three minutes, excluding places near the genitals. With spiral movements, pressure should be slightly increased - the skin should already be shifted. After that, place the pads of your fingers on the affected joints and massage them thoroughly, putting considerable pressure on the muscles. However, in no case do not overdo it - the crumb should not show any signs of anxiety or displeasure.
• After that gently flip the baby on the tummy and in the same way as described above, gently massage the inner thighs.
• Next, go to the gluteal area. Gently begin to rub the buttocks of the crumbs, making circular motions. After that, start not to squeeze and unclench the buttocks of the crumb slightly. During the whole time of the massage, carefully observe the reaction of the crumbs and at the first signs of discontent stop the massage.
• After you finish the massage of the buttocks,you need to go to the foot massage of the crumbs. Take the foot and begin to massage it gently from the heel to the fingers. Thoroughly massage each finger. Repeat with the second foot.

In addition to massage for dysplasia of the hipjoints for children is extremely useful therapeutic gymnastics. Gymnastics, as well as children's massage with dysplasia, must be done systematically, every day. Otherwise, all your efforts will not bring any health benefits to the crumbs. During the day, mom with a crumb should do gymnastics at least twice a day. Each of the exercises must be repeated 10 to 15 times. The following are the basic exercises that mom can do with her baby:

• Exercise "bicycle". Put the crumb on the back, bend his legs in the lap and pull to the tummy. Act very, very carefully. Imitate the feet of a crumbs ordinary riding a bicycle.
• Exercise »bending and unbending legs. To do this, one leg of the baby in the knee, the second - completely straighten. Then change your legs. Make sure that your movements are smooth and unhurried.
• One of the legs bend in the knee and in the hipjoint, and the other press the pelvis of the crumbs and start bent legs to make circular motions. After five to six rotations, change the legs. At once you need to do two or three doses.
• Exercise "frog". Place the crumb on the back, slightly bend the legs in your lap and spread it apart. Start synchronously making circular motions with both feet.

When performing all the exercises, parents shouldobserve simple but very important rules. Firstly, spreading the legs of the child to the side, be sure to be very careful and do not make sudden movements. In no case do not raise the legs forcibly, as if overcoming an invisible obstacle. Bind the hips as much as possible without any effort. Parents should in no case forget about the need to visit a surgeon physician - an orthopedist in time. The course of the disease, such as dysplasia of the hip joints, requires constant and careful observation of the doctor, who will constantly adjust the course of treatment according to the specific course of the disease in each case. Only a constant observation of the course of the disease in the dynamics allows timely to make the necessary adjustments in the treatment of the child. If you had to face such a disaster as dysplasia in infants, do not despair in any case. Nowadays, modern medicine has learned to cope successfully even with a fairly severe form of hip dysplasia. Remember that you and your doctor have one common goal - the health of your child. Children's dysplasia is successfully treated. That is why the first thing that parents need to do is to find a good orthopedic doctor, whom they can fully trust. If you feel that for some reason you do not get to contact your PCP, try to find another specialist. Otherwise, constant conflicts with the doctor can negate all your efforts. The health of your crumbs is in your hands and depends on your patience, love and perseverance! We advise you to read:

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