Congenital dislocation of hip

Congenital dislocation of the hip is a severe pathology characterized by underdevelopment of all the elements of the hip joint (bones, ligaments, joint capsule, muscles, vessels, nerves) and disruption of the spatial relationships of the femoral head and the acetabulum. This is one of the most common diseases of the musculoskeletal system in children.

Anatomical, functional and trophic disorders in the joint without adequate treatment progress and lead to severe secondary changes in the structures of the joint. Violated the function of support and limb movement, the position of the pelvis changes, the spine warps, deforming osteochondrosis develops and dysplastic coxarthrosis - a serious progressive disease that occupies a significant proportion in the structure of disability of young patients.

ICD-10 code

Q65.1 Congenital dislocation of the hip is bilateral.

Causes of congenital hip dislocation

Congenital dislocation occurs due to incorrect formation of the hip joint.

Anatomical substratum of pathology - hip dysplasia - occupies one of the first places among all congenital deformations and meets with a frequency of 1-2 per 1000 births. Statistically significant prevalence of pathology in girls (1: 3) on the left side (1: 1.5), is more common in the breech presentation of the fetus. Cases of pathology inheritance are described.

The disease is much more common in girls than in boys. There is evidence that among children born with breech presentation, the frequency of congenital dislocation of the hip is significantly higher than among children born in the headache. Congenital dislocation of the hip is more often one-sided. Disturbances of the hip joint leading to the development of dislocation can occur in utero as a result of the influence of many adverse factors: hereditary diseases of congenital dislocation of the femur in the mother, other diseases of the musculoskeletal system), illnesses suffered by the mother during pregnancy, maternal malnutrition during pregnancy lack of vitamins A, C, D, group B), the use of medicines (including antibiotics), especially in the first 3 months of intrauterine development of the fetus, when the occurrence it is the formation of its organs.

The implementation of anatomical prerequisites for hip dislocation is facilitated by underdevelopment of the acetabulum, weakness of the lumbosacral joint apparatus, the onset of walking, leading to qualitatively new mechanisms of the appearance of the most severe form of pathology - dislocation of the hip. It is established that about 2-3% of dislocations are teratogenic, i.e. Formed in the womb at any stage of embryogenesis.

[1], [2], [3], [4]

How to recognize a congenital hip dislocation?

Symptoms of hypoplasia of the hip joint can be detected by careful examination in the first days of life of a newborn, more often when swaddling. Noticeably the restriction of the dilution of one or both legs bent at right angles in the hip and knee joints, the unequal number and different levels of skin folds on the hips. In the case of unilateral dislocation, the groin and gluteal folds differ in depth and extent, the folds in the popliteal fossa do not coincide. On the side of the dislocation the folds are higher, there are more of them, they are deeper and longer. Sometimes (often during bathing) one can see a symptom of external rotation: in a child lying on his back, the knee cups are contoured from above, and laterally due to a turn of the legs.

The presence of a congenital dislocation of the hip may be indicated by a faint crunching or clicking in the area of one or both hip joints, resulting from the slip of the femoral head from the articular cavity when the legs are brought and straightened.

If the congenital dislocation of the hip is not diagnosed in the first months of life, treatment of pathology has not begun, from the 5-6-month-old age, a limb shortening can be detected. On the possibility of congenital dislocation should also be thought of if the child spares a single leg, does not sit down and does not cost, the more he does not go to the age set. The orthopedist examines all newborns in the maternity hospital, but immediately after birth, congenital dislocation of the hip is not always possible to establish. Re-examination of the child by an orthopedist is mandatory at the age of 1-3 months, then at 12 months.

Depending on the severity of the disease at the time of the birth of the child, the following forms are distinguished: 

1. dysplasia (simple underdevelopment) of joints - the ratio in the joint of the head of the femur and the acetabulum is normal, the cavity and underdeveloped;
2. subluxation (the head of the hip partially exits from the joint fossa); 
3. dislocation (the head of the thigh completely exits from the joint cavity).

Diagnosis of congenital hip dislocation

Treatment of congenital hip dislocation

Recovery with complete anatomical restoration is possible only under the condition of early functional treatment. The principles of treatment of dysplasia or dislocation suggest reaching and maintaining optimal conditions for the further development of the acetabulum and the femoral head. It is necessary to provide for the possibility of surgical intervention to change the unfavorable course of the disease, residual subluxation and / or residual dysplasia.

With late diagnosis and, accordingly, treatment, in severe forms of pathology (teratogenic dislocations), the improvement of anatomical and functional indices and the restoration of the limb's ability to restrain are achieved by reconstructive-reconstructive operations on the osteoarticular apparatus. Such treatment reduces functional disorders, improves prognosis of life activity and increases social adaptation at the most active age.

Treatment of congenital hip dislocation

For the treatment of congenital dislocation of the femur, early diagnosis and the immediate onset of therapeutic measures are extremely important. Each missed month lengthens the terms of treatment, complicates the methods of its conduct and reduces effectiveness.

The essence of the treatment of congenital dislocation of the femur consists in flexing the legs in the hip joints and completely diluting them ("frog position"). In this position, the head of the femur is contrasted with the acetabulum. To keep the legs in this position, use a wide swaddling, orthopedic panties, various bandages. In this position the child spends a long time (from 3 to 8 months). During this time, the hip joint is normally formed.

At a late diagnosis of the disease for the adjustment of the dislocated head of the thigh, use metal tires, apparatus, and subsequently operational methods of treatment.

The long forced placement of the child in the tire creates a lot of inconvenience when carrying out hygienic care for him. Pay attention to the cleanliness of the tire, do not allow contamination by excrement and urine. To wash the baby carefully, so that the tire does not get wet. The kid, who is in the tire, needs a foot and upper body massage.

The child can and should be spread on the stomach from the second month of life. To create the correct position of the body, put a small soft roller under the chest, and after removing the tire, the child is planted so that the legs are diluted.

Physiotherapeutic procedures are an integral part of the complex of conservative treatment. Before applying the plaster bandage, drug electrophoresis is performed with 1-2% novocaine solution on the hip joint area or on the adductor hip muscles, the course consists of 10-12 procedures.

During the period of gypsum immobilization and after the removal of the plaster bandage, procedures are prescribed that improve blood circulation and mineral electrophoresis with 3-5% calcium chloride solution on the hip joint and 2% solution of euphyllin, 1% nicotinic acid solution on the segmental zone (lumbosacral spine). 

To stimulate the weakened gluteus muscles, improve the feeding of the joint, sinusoidal modulated currents are assigned from the apparatus "Amplipulse". The course shows 10-15 procedures. The application of therapeutic exercise, relaxing massage for the adductor muscles of the hips, strengthening - for the gluteus muscles, 10-15 sessions per course, repeated 3-4 times a year, through 2.5-3 months is substantiated.