Symptoms, causes and treatment of subluxation of the hip joint
The treatment of subluxation of the hip in children and adults
Hip dysplasia — a congenital inferiority of the joint that occurs due to improper development leads to the dislocation or subluxation of the femoral head.
There are 3 forms of dysplasia, subluxation, and dislocation previva.
The stage of the disease
Redviva — the immaturity of the unstable joint, which can develop normally on or before the subluxation. The capsule is stretched, causing the head mywikipedia and reduce into the cavity.
Subluxation of the morphological changes of the joint, accompanied by displacement of the femoral head relative to the basin upward in the direction. The contact head with the cavity retained and it is not beyond the boundary of limbus. With proper treatment, the joint can return to normal state, otherwise there is a risk of complete dislocation.
The dislocation is characterized by complete displacement of the femoral head and is the most severe form of dysplasia. It is a violation of the contact articular surfaces of bones violation of the joint capsule and without it due to mechanical effects or pathological processes in the joint. Dislocations are complete and incomplete. Sprained is far from the body part of the limb.
Classification of subluxations
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Congenital dislocation is the most severe form of the disease and is characterized by complete displacement of the femoral head. This stage of dysplasia is detected at birth of the child to develop as a result of an incorrect treatment or lack thereof at all. The cause of the disease — heredity, pathological condition of pregnancy or clinical signs of instability of the joint.
Acquired subluxation develops as a result of the changing children, use of a restrictive child seats or cradle locking of the hip joint for a long time.
The reason for the pathology is a genetic factor or a narrow uterus, which contributes to the displacement of the joint during intrauterine development.
Symptoms of pathology
The symptoms of subluxation of the hip can be expected even before the birth of the child. Breech baby, morning sickness in pregnancy, dysplasia from parents, talipes or large fruit should be cause for concern in terms of the possible disease. Even if orthopedic symptoms do not exist, children will still belong to the group of risk.
There are 4 groups of clinical features of subluxation of the joints:
- shortened femur;
- the asymmetry of the skin folds;
- the symptom of slipping Marx-Ortolani and modification Barlow;
- limitation of hip abduction.
During the inspection pay attention to such detail as the symmetry of the skin folds. Moreover, asymmetry is more informative in 2-3 months after birth. The gluteal, inguinal and popliteal creases deeper and more numerous.
The phenomenon of shortening of the thigh is an important criterion for the diagnosis, characterized by shortening of the femur due to posterior displacement of the femoral head in the acetabulum. He points to congenital subluxation of the hip joint and is confirmed by the fact that if the kid lying on his back in the position with bent knees and hip joints, one knee is lower than the other.
Symptom Marx-Ortolani — identify with it, the subluxation can only be up to 3 months, after which it disappears. It is determined in the following way: the legs bend at the knee and hip joint at a right angle, then driven to the middle line and carefully bred in the side. From the side of the dislocation can be heard like a click, in which the baby’s leg shakes.
Diagnosis of the disease
The diagnosis of «subluxation of the hip» is placed primarily on the basis of clinical symptoms and the results of ultrasonic examination and x-rays.
- Screening of newborns — most countries use it when the diagnosis of subluxation of the hip in newborns.
- Another way to learn about the disease — the method of Marx-Ortolani. If during the examination, hear a click or clunk in the hip area, conducting additional methods to clarify the diagnosis and what caused the disease.
- Methods Ortolani and Barlow — newborn diagnostic methods used in modern medicine.
- Ultrasound and x-rays — secondary after clinical signs diagnostic methods. They can be used to visualize anatomical features.
- Asymmetry of the gluteal folds and the apparent length difference of the lower extremities may indicate unilateral dysplasia.
- Assessment of the hips at the Harris is one of the main ways to evaluate normal operation and function of the joint after surgery.
To suspect and timely diagnosis of the disease needs a podiatrist during the inspection of a newborn baby still in the hospital. Then the risk group or sick children observed a podiatrist’s place of residence. Prescribe special orthopedic treatment, which continued until the final diagnosis.
The final diagnosis is based on visual inspection of the results of instrumental methods of diagnostics and continuous monitoring of the child.
Methods and devices that are used for the treatment of the disease
The main principles of treatment include the following standard methods:
- early start;
- the use of special orthopedic devices for long-term retention of the legs in flexion and abduction ;
- exercise and movement in the hip joints.
Start the disease is impossible, as subluxation of the hip in adults is virtually untreatable due to the established position of the bones of the joint relative to each other.
In the treatment of subluxation of the hip in children with displacement of the femoral head or without it offer multiple types of pillows, tyres, trousers, stirrups, and other devices. Their goal is to keep breeding position legs, giving them function.
Babies up to 3 months to confirm the diagnosis enough clinical symptoms, x-ray examination is not required. All children of this age are prescribed the same measures of treatment-and-prophylactic direction — breeding legs with pads (wide swaddling, stirrups Pavlik, elastic tires or pillow frejka) and also gymnastics otodama-circular motion in the joint and massage the gluteal muscles.
In a small age, it is unacceptable use of rigid structures — Shin, which prevent the movement of the limbs.
Primarily for the treatment of congenital subluxation of the hip joint is used:
- pillow frejka;
- bus Volkova or Vilna;
- Pavlik’s stirrups;
- wide swaddling — used for prevention and mild degrees of subluxation;
- simultaneous reduction of dislocation and headband Cocina — used in severe cases.
To determine how to treat subluxation of the hip joint and what structures to install the child needs attending.
When assigned to the operation
If the positive effect from the conservative treatment methods does not apply correcting operations. For the treatment of dysplasia of the joint use a lot of surgical methods:
- reduction of dislocation open;
- derotation and corrective varus osteotomy;
- operation on the pelvic component — a method of osteotomy of the pelvis for Chiari;
- palliative operations (Koenig and Trench).
Conservative treatments are effective in children. The older the person, the greater the likelihood that surgical intervention will help to get rid of the disease.
Early diagnosis and correctly prescribed treatment will help avoid complications, it is possible to completely get rid of the disease. Some people, except for the external defect and claudication do not experience any symptoms and signs of disease.
Others, on the contrary, without timely treatment can have serious consequences. Besides limping, you may feel pain in the knee region and hip joint, sometimes the misalignment of the pelvis, or atrophy of limb muscles. In rare cases, affected are the lumbar spine (hyperlordosis), the reduced function of the pelvic organs, affects lower back and pelvis.
To avoid the appearance of disease or its further development, requires regular inspection by a podiatrist. Wide swaddling is one of the effective preventive ways to subluxation of the hip joint in the newborn.
Its essence lies in the fact that two of the diaper to lay between the legs of the baby and give flexion or abduction of the legs in the hip joints, and the third diaper to fix the legs. Wide swaddling retains the flexion and breeding of 60-80 degrees.