Dysplasia Of The Hip Joints In Children

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Dysplasia of the hip joints in children

Dysplasia of the hip joints is a congenital underdevelopment of the hip joint with a violation of its functions.

It is found in about 3 out of 100 newborns. Girls suffer from it 5 times more often than boys. Dysplasia of the hip joints occurs on all continents of the globe, and the frequency of its occurrence does not depend on nationality and race.

For a long time it was believed that congenital disorders in the structure of the hip joint are less common among the peoples of Africa and Asia than among Europeans. In reality, this is not the case, the frequency of the formation of pathology in the prenatal period is the same, but the number of newborns who have persistent disorders in the hip joint as they grow older is actually less in countries with a warm climate. This is due to the traditional way of carrying the baby on the back or hip with divorced legs and the absence of tight swaddling and tight cradles.

Content:

• Symptoms of hip dysplasia
• Reasons for the development of hip dysplasia
• Classification
• Diagnostics
• Treatment of hip dysplasia in children

Symptoms of hip dysplasia

All symptoms of hip dysplasia can be divided into 2 large groups:

• observed in newborns (0 to 12 months);
• typical for children over 1 year old.

Symptoms of the disease in newborns

Underdevelopment and pre-dislocation of the hip joints manifests itself very poorly. And most often it is discovered by accident during a routine examination by a pediatrician or orthopedist. With close observation of the newborn, slight asymmetry of the gluteal and popliteal folds, stiffness and discontent of the child when trying to spread the legs bent at the hip and knee joints to the sides can be noted. Ultrasound examination reveals late formation of ossification nuclei in the femoral head. On X-ray images, you can find a slight flattening of the roof of the acetabulum, the slope of the outer edge.

Subluxation and dislocation of the hip joint is characterized by a richer clinical picture.

It is characterized by the following symptoms:

• click symptom;
• limiting the breeding of the legs;
• Erlacher's symptom;
• asymmetry of the popliteal and subgluteal folds;
• relative shortening of the leg on the affected side;
• turning the leg outward.

The best time for diagnosis is the first week of a newborn's life. During this period, physiological hypotonia of the muscles of the lower extremities predominates, therefore it is quite easy to determine all pathological symptoms. After 7 days of life, neurologically healthy infants develop physiological hypertonia and some manifestations of subluxation and dislocation may not be noticed.

• The “click” symptom is defined at the moment when the doctor or parent tries to spread the child's legs bent at the knees to the sides in the hip joints. The head of the femur, emerging from the glenoid cavity, enters the joint with a characteristic crunch. When the legs are brought in, a click is heard again, which means that the thigh is again outside the joint.
• Limited dilation of the legs helps to determine subluxation and dislocation of the hip joint in almost 100% of cases, when studying this symptom in children without pathology of the nervous system on the 5-7th day of life. If the legs are divorced by 50-60%, this is a sure sign of trouble in the hip joint.
• The Erlacher symptom is tested as follows: the straightened leg of the child, in which a subluxation or dislocation is suspected, is slowly brought to the opposite healthy leg. And then they also gradually bring the diseased leg to the healthy one. Normally, the leg crosses the opposite limb in the lower or middle third of the thigh; in severe forms of hip dysplasia, this occurs in its upper third.

• The asymmetry of the skin folds should be checked both with the child lying on the back and on the stomach. Attention is paid not to the number of skin folds, which can normally differ on both limbs, but to the depth and height of their location.
• The relative shortening of the leg is detected as follows: the newborn is laid on its back, the legs are bent at the knee and hip joints, the feet are pressed against the couch. The level at which the knees are in relation to each other is assessed. Normally, they should be located at the same level. If one of them is lower, then this indicates a relative shortening of the leg.

With congenital dislocation of the hip, the diseased leg is unnaturally turned outward, this is determined when the leg is straightened in the hip and knee joint in the supine position.

Symptoms in children after 1 year

In children after 1 year of age, it is quite easy to detect hip dysplasia, since by this time difficult to diagnose mild forms of the disease disappear or pass into a more severe form.

There is a limp on the sore leg, and with bilateral dislocation of the hip, a duck gait. There is a significant decrease in the size of the gluteal muscles on the affected side. With pressure on the heel bone in the position of the child lying on his back with straightened legs, the mobility of the limb axis from the foot to the hip joint is determined.

Reasons for the development of hip dysplasia

3 theories of the development of hip dysplasia can be distinguished:

• violation of tissue laying in the embryo;
• genetic predisposition;
• exposure to hormones.

Violation of tissue laying in the embryo

For the first time, the rudiment of the hip joint appears in a human embryo at 6 weeks of intrauterine development. Movement in this joint is possible from the 10th week of pregnancy. Under the influence of external and internal damaging factors, the formation of joint elements is disrupted.

External reasons may include:

• radiation;
• chemicals, including some drugs;
• unfavorable ecology.

The most important internal damaging factor is viral diseases transferred by the mother in the first trimester of pregnancy, including influenza, rotavirus infection.

Genetic predisposition

There is a high incidence of hip dysplasia in parents who have suffered from this disease. Among all cases of this pathology, the violation of the structure of the hip joint, due to various genetic factors, is approximately 25%.

Also, dysplasia of the hip joints is often found in conjunction with congenital myelodysplasia, a disease based on a violation of the formation of blood cells in the red bone marrow. Perhaps this is due to the fact that the red bone marrow located in the pelvic bones, undergoing a pathological process, disrupts the development of the acetabulum.

Hormonal effects

By the end of pregnancy, the female body has a high level of the hormone progesterone, which has a relaxing effect on ligaments, muscles and cartilage tissue. This is necessary to prepare the mother's pelvis for childbirth. However, progesterone is able to cross the placental barrier and enter the fetal bloodstream. This leads to a softening of the ligamentous apparatus and the capsule of the hip joint, which can be the reason for its malformation. The development of this condition can be facilitated by abnormalities in the position of the fetus, as well as difficult labor in the leg and breech presentation.

Classification

Dysplasia of the hip joint is subdivided into 4 degrees of severity, depending on the severity of changes in the articular components:

• immaturity;
• pre-dislocation;
• subluxation;
• dislocation

The mildest degree is the immaturity of the joint tissue components. It is defined as a condition between disease and a transient feature of a healthy joint. Most often seen in premature babies. Babies born at term may also have immaturity of the hip joint. This is especially true for low birth weight newborns whose mothers suffered from fetal-placental insufficiency during pregnancy.

The next in severity is pre-dislocation. It is based on a change in the shape of the acetabulum, but the femur does not leave the limits of the joint, in addition, its very structure does not undergo changes.

In case of subluxation, it may mark a change in the shape of the femoral head; it moves inside the joint to its very border, but never goes beyond it.

Congenital dislocation is the most severe form of hip dysplasia. The structure of the joint is grossly disturbed. There is a strong change not only in the shape of the glenoid cavity, but also in the femur, ligaments, muscles and the joint capsule. The femoral head leaves the glenoid cavity and is located behind its anterior or posterior edge.

Diagnostics

Revealing hip dysplasia at the stage of underdevelopment and pre-dislocation presents great difficulties.

In children under the age of 3 months, the following techniques are used to make a diagnosis:

• interviewing the child's mother;
• inspection;
• Ultrasound;
• Radiography.

Interviewing the mother helps to find out the course of pregnancy, infections transferred during this period, existing hereditary diseases. During the examination, attention is drawn to the presence or absence of characteristic symptoms.

For children under 6 months of age, the study of the hip joint is performed using ultrasound. It includes 2 phases: static, during which the motionless joint is studied, and dynamic, performed with passive movements of the child's leg in the hip joint.

Ultrasound can determine the degree of ossification of the femoral head, the stability of the joint during movement. In a healthy child, the size of the ossification nuclei in millimeters corresponds to the age in months, for example, at 1 month - 1 mm, at 2 months - 2 mm. If the diameter of the ossification points does not correspond to physiological norms, this may indicate dysplasia.

Currently, there is a compulsory screening ultrasound of the hip joints for all children at the age of 1.5 months.

X-ray examination is carried out for newborns older than 6 months, as well as for children of any age, with suspicion of subluxation and dislocation. X-ray images can accurately determine the structure of the bone components of the joint. The radiologist determines the value of the acetabular angles and, based on additional lines, assesses the location of the femoral head.

Treatment of hip dysplasia in children

The choice of a particular technique in the treatment of hip dysplasia directly depends on how much the articular elements are changed.

Immaturity of the hip joints

If this pathology does not give any clinical manifestations, including, does not cause difficulty in breeding the child's legs, then conservative methods are used:

• wide swaddling without the use of orthopedic devices;
• remedial gymnastics aimed at movements in the hip joint;
• massage, physiotherapy.

Treatment is carried out within a month, after which the child is sent for a second ultrasound and X-ray. If the immaturity of the joints is accompanied by a limitation of the leg dilation, then it is recommended to wear spacer splints similar to the Frejk pillow with repeated control after 1 month.

In both cases, the fixation of the legs is accompanied by a daily complex of physiotherapy exercises, a course of massage and physiotherapy (electrophoresis with calcium, paraffin baths, salt baths).

Pre-dislocation

It is treated conservatively. To keep the legs in a divorced state, orthopedic devices are used: Freik's pillow, abduction splints, Pavlik's stirrups. Massages, physiotherapy exercises and physiotherapy are also used.

Subluxation and dislocation

With this severity of hip dysplasia, plaster casts are applied to fix the legs in the desired position. The duration of wearing a plaster cast is determined individually.

With the ineffectiveness of conservative methods, severe lesions of the acetabulum, as well as with late diagnosis, surgical treatment is indicated with the restoration of the normal shape of the hip joint and fixation of its constituent elements.

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Author of the article: Sokolova Praskovya Fedorovna, pediatrician