Hip dysplasia in newborns: diagnosis and treatment
Prevention and treatment of hip dysplasia in newborns
Deviation in the development of the hip joints today called dysplasia. In former times this disease was determined as a dislocation of the hip. With this diagnosis may be a violation of various structures of the joint, including the femoral head, acetabulum and connective tissue. The way the thigh is positioned relative to the glenoid fossa determines the severity of pathology.
The remarkable fact that newborn babies the hip joint is not yet fully developed structure. This is not in itself of danger and falls under the definition of the norm, as over time the measure of how well distributed the load is, the formation of bone and connective tissue. But there are some indirect signs that help distinguish pathology from normal development of the hip joint.
The probable reasons of development of pathology
To determine which factor was the cause of the formation of hip dysplasia in each case is almost impossible. But there are a number of probable causes, each of which could serve as a starting point to the beginning of the development of deviations:
- breech presentation of the fetus, it reduces the motor activity of the fetus, the chances of abnormalities of the hip joint in this case increase if the child for a long time occupied such a position;
- the lack of water also reduces the mobility of the baby;
- birth trauma is a danger to the child’s body, as the result can be a dislocation of the limbs;
- hormonal changes pregnant women often occurs with visible disabilities, which may lead to the possibility of developing different kinds of pathologies in newborns, including hip dysplasia;
- gynecological diseases of the mother, which is also a loss of fetal movement, for example, an adhesive process;
- tight swaddling does not allow the hip joints to form correctly, as the movement of the baby again stiffness;
- studied the relationship of environmental problems in certain areas with an increased percentage of diagnosis of dysplasia;
- heredity also can not be excluded, as in the case that the pathology of the hip joint found in the family is not the first time, respectively, increases the risk of diagnosis of the deviations in the future;
- racial identity, while in Scandinavian countries, there is two times more cases of detection of pathology of the hip joint.
Risk, form and stage of dysplasia
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Taking into account the fact that newborns hip joint is still not fully formed and that is the norm, there is a possibility of misdiagnosis of disease, as immature joint is in the boundary condition, but also no violations in its development. It is therefore important to get the results of full survey before to diagnose because clinical signs are not always obvious.
Risk group includes cases where the joint is not fully formed, and much depends on how effective will be the preventive measures.
Also noted that this pathology is found in girls more often than boys.
To classify hip dysplasia in neonates in stages:
- Redviva is characterized by decentration of the femoral head in the articular cavity, however, at this stage, through indirect evidence it is quite difficult to distinguish pathology from developing immature joint.
- The second stage is called subluxation. The main symptom is the effect of slippage when the femoral head crosses the border of the acetabulum, that is, literally «slips». This occurs during the ghosts in the movement of the lower extremities. Reverse movement returns the head of the femur into the original position.
- Dislocation is the most severe degree of this condition is characterized by the strengthening of the common symptoms, as well as the visible manifestation of posture, lameness.
There are also several basic forms of this pathology, as it can occur otherwise, in addition to dysplasia of the acetabulum. There is a rotary pathology of the hip and dysplasia of the proximal femur. To diagnose one of the forms of deviation, it is necessary to survey, which will include measurement of the cervico-diaphyseal angle of the joint and bone geometry.
Main symptoms of the disease
Both parents and doctors have the opportunity to observe various clinical symptoms of this deviation, however, according to statistics, there are cases when perfectly healthy children, there were signs that characterize dysplasia.
That is why visual examination is insufficient for diagnosis, and the symptoms are only an indirect manifestation of the deviation. There are a number of characteristics:
- limitation of abduction of the lower extremities, it is necessary to bend your knees and try as much as possible to breed them;
- asymmetry of skin folds on the thighs and buttocks, to control this symptom, you need to put your baby on his stomach and straighten the legs;
- the lower limbs are different lengths, then there is apparent shortening resulting in the development of pathology;
- the effect of slippage, which is characterized by the release of the femur from the acetabulum, is determined by the dilution of the lower extremities;
- an audible click in the hip area when moving leg.
Diagnostic methods for the timely detection of the disease
The first step aimed at identifying the possible deviations in the development of the skeletal system of the child should be the examination of the orthopedic surgeon. Still in the hospital the doctors through the clinical signs to determine the presence or absence of this disease.
But parents are advised to visit a specialist, when the child turns 1 month, and then to repeat the examination in 3 months.
In the presence of disputable evidence of a doctor will direct further testing: ultrasound or x-ray. It is important to know that ultrasound is ineffective in the diagnosis of dysplasia, as this is quite difficult to avoid large errors in the measurement of the geometry of the bones. X-rays give much more accurate results, however, due to the physiological peculiarities of the organism of the child, it is recommended to carry out no earlier than 4 months baby.
Parents should know that early diagnosis of this pathology allows to quickly and as painlessly as possible to cure the child. The later is determined by hip dysplasia in newborns, the harder methods of treatment and longer recovery period.
The absence of any action to promote the correct formation of the hip joint or straightening of the emerging deviations, will lead to the deterioration of the structures of the joint. Also compounding the situation is the increase in body weight as the baby grows, as this increases the load on the joints and causes irreversible deformation, which is corrected only surgically.
If the detected dysplasia in a newborn is almost always enough to use conservative treatment, it is possible to do without surgery. The main place in the correction of abnormalities of the hip joints is given orthopedic tools, including:
- Stirrups Pavlik — used in case of diagnosed dysplasia, including dislocation of the hip joint in the newborn (most severe stage), and underdevelopment of the hip joints. The device consists of a chest belt that holds on to the shoulders of the child and «stirrups». These elements are interconnected by additional straps. Thus, Pavlik’s stirrups allow your child to be in frog pose. It is recommended to carry three weeks of age.
- «Pants» Becker, have similar construction, but the baby’s legs until the knees locked. Used in age 1 to 9 months.
- Functional tire with spacers. This may be an option with popliteal or femoral splints. Tire lever locks the legs in a certain position. Recommended for treatment aged 1 to 3 months.
- Frejka splint is structurally different from previous versions and represents a latch, which is located between the legs of the child. The latch is held by straps on the shoulders of the baby.
- Ergo backpack used 5 months and allows you to take the child the correct posture.
- The sling also performs the corrective function. This device can be activated with the first months of life crumbs, as this is an excellent preventive measure against hip dysplasia.
In addition to the use of orthopedic appliances is recommended to massage, physiotherapy or electrophoresis. Often with the use of bus bars or stirrups are assigned to all of these additional methods of treatment.
The prognosis for cure and prevention
The vast majority of newborns with a diagnosis of «dysplasia» after a short, but timely treatment recover.
One important aspect here is the level of neglect of the child. Sometimes in severe cases to correct the situation is possible only through surgery.
As a preventive means, it is recommended regardless of the schedule orthopedic massage, to wear baby on the hip, if he is holding back, to use the method of wide availability.