Dysplasia Of The Hip Joint In Newborns

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Dysplasia of the hip joint in newborns

Dysplasia of the hip joint in newborns is an underdevelopment of the largest joint in the human body (hip), as well as its segments. These segments include cartilage, ligaments, neural structures, muscles, and bony surfaces. Congenital dysplasia results in a dislocation or subluxation of the joint. Sometimes you can come across the concept of "congenital dislocation of the hip", but you need to understand that in this case we are talking about a complication of dysplasia.

More often, dislocations and subluxations form after the baby is born. Dislocation of the hip joint, which occurs even in the prenatal period, is extremely rare. Such dislocation is called "tetralogical". With it, the acetabulum, as well as the adjacent section of the femur bone, are in a developed state.

Children have been suffering from such pathologies since ancient times. For the first time, the symptoms of dysplasia were described by Hippocrates, who began to straighten the legs of infants with the help of weights.

Having heard such a diagnosis from a pediatrician, you should not panic, because in most cases this pathology is perfectly treated. Moreover, in the world, hip dysplasia occurs quite often: out of 1000 newborns, about 25 babies are born with it. Moreover, mainly female babies are sick.

Content:

• Forms of hip dysplasia in newborns
• Causes of hip dysplasia in newborns
• Swaddling for hip dysplasia
• Symptoms of hip dysplasia in newborns
• Diagnosis of hip dysplasia
• Treatment of dysplasia of the hip joint in newborns
• Consequences of dysplasia in a newborn
• Preventive measures

Forms of hip dysplasia in newborns

There are three forms of dysplasia, depending on their complexity:

• Pre-dislocation, which is characterized by the fact that the head of the femoral bone is not fixed in the acetabulum, but is able to move freely. The ligaments that should hold her are in a relaxed state, due to which instability appears. Due to the fact that the changes are insignificant, it is almost impossible to independently detect this pathology. The joint may even function normally, but there is a risk of transition to subluxation;
• The next, more complex stage of dysplasia is called subluxation. In this case, the head of the femur is slightly displaced up and to the side. It can come out of the acetabulum and get into place, it is at this moment that a characteristic click is heard;

• The most dangerous and requiring serious treatment is the stage called "hip dislocation". With it, the head will be located separately from the articular bag and move slightly back and up. The acetabulum is underdeveloped. It accumulates fatty and connective tissues.

Causes of hip dysplasia in newborns

The following factors are distinguished as the causes of dysplasia of the hip joints:

• Hereditary predisposition determined by genetic characteristics. Doctors established the fact that it is precisely those children whose mothers were also born with hip dislocation more often suffer from dysplasia;
• Unfavorable ecological situation in the area where the pregnant woman lives. According to statistics, children are prone to this developmental defect more often if the mother's body is affected by ionizing radiation, accumulation of exhaust gases and even passive inhalation of tobacco smoke;
• The age of the woman giving birth. The later the baby is born, especially if this is the first child, the higher the risk that he will have dysplasia;
• Certain diseases of the woman in labor, such as fibroids and the presence of adhesions. Hormonal changes in the body can also affect, in particular, an increase in the level of progesterone;
• Severe somatic diseases of the mother;
• Toxicosis in the early and late stages of pregnancy;
• Bad habits;
• Taking certain medications;
• Poor nutrition of a pregnant woman, which leads to a lack of vitamins and minerals in the child's body. These are calcium, phosphorus, iron, iodine and vitamin E;
• Abnormal position of the fetus in the womb: breech or breech presentation;
• Some features of fetal development: insufficient weight or short length of the umbilical cord;
• Imbalance of the water-salt metabolism of the fetus due to kidney disease;
• The entanglement of the newborn with the umbilical cord;
• Prematurity;
• Trauma to the baby during or after childbirth.

Swaddling for hip dysplasia

It is worth dwelling separately on swaddling children with hip dysplasia. At the moment, a scientific link has been established between tight swaddling of babies and an increase in the incidence of dysplasia.

For example, in African and Asian countries, children practically do not suffer from this disease. Due to the fact that babies are carried on their back, giving them freedom of movement, dysplasia develops in them extremely rarely.

Given this fact, the Japanese abandoned the tight swaddling of children, which was the oldest tradition in this country. The result was not long in coming - the incidence rate decreased 10 times.

Moreover, the important role of wide swaddling cannot be underestimated in order to prevent and treat existing dysplasia. This method gives very good results, especially if wide swaddling is used from birth. This contributes to the correct formation of joint tissues, normalization of blood circulation and a decrease in the risk of subluxation and dislocation in children with dysplasia. Wide swaddling makes it possible for the baby not to be limited in freedom of movement, but at the same time it somewhat restrains the limbs so that the baby smoothly adapts to the conditions of the big world. This not only calms the child, but also improves his sleep.

For wide swaddling, you can use both ordinary diapers and specialized devices. The latter include covers for wide swaddling and Frejk's pillow.

Symptoms of hip dysplasia in newborns

Symptoms that can determine if a newborn has dysplasia include:

• Spinal muscle tension, expressed in increased tone;
• Shortening of the leg, on the side of which there is a developmental defect, relatively healthy limb;
• The presence of an extra fold on the buttock;
• The position of the feet. One or even both legs may be unnaturally twisted outward;
• Asymmetry of folds on a healthy and diseased leg;
• Inability to fully spread the limbs of the newborn to the sides. For this, they first have to be bent at the knees;
• The child may be in an uncharacteristic position for a healthy baby. His back will be arched outward in the lumbar region, and his shoulder blades and legs will be raised. This position of the body resembles the letter "C";
• The baby's head is tilted to one side. The fingers on one of the hands are constantly clenched;
• The so-called “slipping” symptom. It is characterized by a click that will be heard when the legs of the crumbs are spread apart;
• Secondary symptoms, which include atrophied muscles adjacent to the affected joint, as well as a low, barely audible pulse in the femoral artery.

You should not look for a combination of several signs in order to refer a child to an appointment with an orthopedist. If there is at least one of these symptoms, then you should worry about the baby's health in advance.

Diagnosis of hip dysplasia

To diagnose and clarify the stage of dysplasia, doctors can use the following techniques and studies:

• Radiography that has limitations. Taking into account the age characteristics of the child, the study should be carried out as soon as possible with the use of special protective pads;
• Ultrasound diagnostics, which can be used repeatedly, both for the purpose of making a diagnosis, and for further control. Ultrasound will reliably show the clinical manifestations of the disease, and will also make it possible to determine the muscle tone of the lower extremities;
• With the help of computed tomography, additional parameters can be identified, for example, to determine the degree of muscle atrophy of the diseased limb;
• MRI is used when there is a need for an operation;
• General examination to identify external signs. It is performed first by a pediatrician and then by a pediatric orthopedist. If there is a suspicion of dysplasia, the history of the disease is determined.

Treatment of dysplasia of the hip joint in newborns

The earlier the pathology is diagnosed and treatment is started, the faster the child's joint will recover. The therapy itself directly depends on the severity of the disease. If we are talking about pre-dislocation, then doctors practice massage of the buttocks, thighs and lower back of the newborn. Recommendations are given for wide swaddling, which was mentioned above. Also, the child is sent to physiotherapy procedures, which consist in electrophoresis of the hip joints using calcium chloride or aminophylline. At home, it is necessary to carry out therapeutic exercises, which consists of a set of exercises.

If the child has a subluxation of the joint, then more radical methods of treatment should be used. First of all, they consist in the baby wearing special stirrups and following the recommendations for swaddling.

If a newborn has a dislocation, then a splint is indicated for him. The wearing time will depend on the severity of the condition. Sometimes, if there are certain indications, surgical intervention is used. It consists in the fact that the head of the femur is set into the joint capsule, the rest of the joint elements are adjusted, the muscles and ligaments are tightened and lengthened. Both open reduction of the joint and its positioning using an endoscope can be used.

Rehabilitation activities consist in strengthening the hip muscles, activating regeneration processes, and improving blood supply.

Consequences of dysplasia in a newborn

If there is no treatment, then at an early age this can threaten the child with serious trouble. Children develop a limp while walking, it can be both subtle and pronounced. Also, the baby will not be able to move his leg to the side, or he will do it with great difficulty. The child will be bothered by constant pain in the knees and in the pelvic area with possible skewed bones. Depending on the severity of the symptoms of dysplasia, children have muscle atrophy of varying severity.

Gradually, as the child grows, the consequences of untreated dysplasia will worsen and be expressed in the development of the so-called "duck gait", when the baby waddles from one leg to the other, protruding the pelvis back. The motor activity of such a child will be limited, which will entail underdevelopment not only of the other joints, but also affect the work of all organs and the general physical development. In the future, the muscles of the leg can absolutely atrophy, the person will begin to be haunted by constant incessant pain. In adult patients, spinal hyperlordosis is observed in the lumbar spine. All organs located in the pelvic region are also affected.

All this can be avoided if treatment is started on time and preventive measures are followed.

Preventive measures

Preventive measures aimed at eliminating the risks of developing dysplasia are as follows:

• Timely ultrasound diagnostics. If this is not done in the hospital, then it must be completed at the age of 3 months;
• Compulsory scheduled examination by an orthopedic doctor;
• Avoiding any vertical load on the limbs, until such time as it is recommended by the doctor;
• Wide swaddling, as well as wearing in a sling;
• Regular exercise of the child, in accordance with age;
• Compliance with all the recommendations of the doctor and the intake of vitamin complexes by the mother at the stage of gestation.

The prognosis for recovery is generally good. If treatment was started before the age of three months, then healing occurs in 97% of cases.

At the same time, those children who did not receive adequate therapy for up to six months, with the appointment of a rehabilitation program at this age, recover only in 30% of cases. Therefore, it should be understood that dysplasia is a curable disease, but it cannot be delayed with its treatment.

The author of the article: Sokolova Praskovya Fedorovna | Pediatrician

Education: Diploma in the specialty "General Medicine" received at the Volgograd State Medical University. A specialist certificate was immediately received in 2014.