HIP DYSPLASIA
Hip dysplasia — this is an innate inferiority of the hip joint, with subsequent disturbance of its development, which can lead (or already has lead) to subluxation or dislocation of the femoral head.
The laying of the musculoskeletal system occurs during the 4th-5th week of the fetal development, while the full formation occurs after the child begins to walk. Disturbances are possible at any stage of the development of the musculoskeletal system.
When the baby is born, the glenoid cavity turns out to be underdeveloped, namely, not deep enough. The growth of the femoral head slows down. The position of the femoral head is disrupted. Respectively, the growth and development of muscles, ligaments and capsule of the hip joint slows down and is disrupted too.
This pathology is found 4-7 times more often in girls than in boys, with a predominance of dislocation on the left side. Usually, congenital dislocation of the hip is observed in children born in breech presentation.
What may be the cause of dysplasia? - Heredity If the mother or the immediate family members of the child had orthopedic problems during childhood, there is a chance of inheritance of such deviations. - Poor nutrition during pregnancy – lack of vitamins and minerals - Pregnancy complications - toxicosis, infectious diseases requiring drug therapy.
The parent themselves may suspect hip dysplasia when inspecting the baby.
What may be the cause of dysplasia? - Heredity If the mother or the immediate family members of the child had orthopedic problems during childhood, there is a chance of inheritance of such deviations. - Poor nutrition during pregnancy – lack of vitamins and minerals - Pregnancy complications - toxicosis, infectious diseases requiring drug therapy.
The parent themselves may suspect hip dysplasia when inspecting the baby.
The main manifestations of hip dysplasia:
Normally, the hips in the hip joint of young infants can be easily diverted to 80-90° angle. Upon presence of dysplasia or congenital subluxation of the hip – the dilution of hips from the sore side is limited.
- Presence of asymmetry of the inguinal and buttock folds. On the affected side there are more of them and they are deeper. It should be noted that the limitation of hip dilution and the asymmetry of skin folds may not be solely associated with hip dysplasia, but may also be a consequence of a muscle tone breach.
- The hip and foot on the affected side are turned outwards more than on the healthy side.
- Upon dislocation, these symptoms are accompanied by a shortening of the leg from the affected side.
- In severe cases, when the femoral head is in a state of complete dislocation, we determine what is called "clicking symptom". It appears when you bend the legs of the child in the knee and hip joints, as well as during their subsequent dilution, when there is a diaplasis of the femoral head into the cavity of the hip.
Hip dysplasia should be identified immediately, in the first weeks of the child’s life, and prescribed treatment, otherwise a subluxation is developed, and by the time the child begins to walk, there will be a congenital hip dislocation.
For this purpose, the baby's legs, bent at the knee and hip joints, should be diluted at a right angle in the hip joints. Upon presence of dysplasia or congenital subluxation of the hip, the hip dilution will be limited on the affected side. In the case of duplex malformations, limitation is found on both sides, but in most cases the dysplasia and the corresponding limitation of movements are one-sided. Another sign of hip dysplasia is a violation of the symmetrical arrangement of folds under the buttocks and on the thighs. A click is felt when diluting the hips, with feet bent in the knees and hip joints. Upon presence of a dislocation of the femoral head out of the underdeveloped glenoid cavity at hip dilution, there is a click. When the baby's legs return to the midline, the hip is reduced again, and this is accompanied by a repeated click. The baby’s leg may appear shorter from the subluxation side.
Limitation in hip dilution. This symptom is almost always observed in this pathology during the 1st year of life. It’s also revealed when the baby is positioned on its back. To identify the limitations in dilution, the child’s legs are bent at the hip and knee joints. The examining person grasps the knee joint with the fingers and calmly spreads the legs of the child sideways. In this age, the dilution depends more on the tone adductor muscles rather than on anatomical changes in the joint.
In case of late diagnosis of subluxation, a child older than six months is defined to have a limit in hip dilution, there is a little limb shortening. Upon full dislocation the shortening increases, the gait is disturbed. "Duck walk” or intermittent claudication occurs when there is a bilateral dislocation.
Risk factors for this condition include:
• Racial Features – the highest percentage in newborn morbidity is in the Scandinavian countries, while such abnormality is hardly ever detected in Native People, African, Americans, and Chinese.
• Gender – more common in girls.
• Hereditary predisposition – the tendency to the disease could be inherited.
• Unbalanced diets of the pregnant – deficient in vitamins and minerals.
• Features of swaddling a newborn – the risk is increased if the leg swaddling is too tight.
• Pregnancy complications – toxicosis, infectious diseases requiring drug therapy.
• The risk is increased in children from the first birth, at breech (child is located at the womb with buttocks down), rapid or prolonged labor.
To summarize what we should look for:
• One leg of the child is shorter than the other;
• Additional fold on the hip;
• Asymmetry of buttock folds and buttocks;
• Asymmetry during leg dilution;
• Legs bent in the knees can’t be fully diluted (child’s knees touching the table);
• A click, happening at the time of bending the legs in the knee and hip joints.
Upon identification of these signs, the child must be shown to an orthopedist as soon as possible.
To summarize what we should look for:
• One leg of the child is shorter than the other;
• Additional fold on the hip;
• Asymmetry of buttock folds and buttocks;
• Asymmetry during leg dilution;
• Legs bent in the knees can’t be fully diluted (child’s knees touching the table);
• A click, happening at the time of bending the legs in the knee and hip joints.
Upon identification of these signs, the child must be shown to an orthopedist as soon as possible.