Congenital dislocation of a hip are one of the most often found malformations. According to the international researchers 1 of 7000 newborns has this congenital pathology. The disease affects girls approximately by 6 times more often than boys. Unilateral defeat meets 1,5-2 times more often of bilateral. The dislocation of a hip which is not diagnosed at chest age is shown by lameness of the child at the first attempt of independent walking. The most effectively conservative treatment of congenital dislocation of a hip at children of the first 3-4 months of life. At its inefficiency or overdue diagnosis of pathology expeditious treatment is carried out. Lack of timely treatment of congenital dislocation of a hip leads to gradual development of a coxarthrosis and the patient's invalidization.
Congenital dislocation of a hip
Dysplasia of a coxofemoral joint and congenital dislocation of a hip – various degrees of the same pathology arising owing to violation of normal development of coxofemoral joints.
Congenital dislocation of a hip are one of the most often found malformations. According to the international researchers 1 of 7000 newborns has this congenital pathology. The disease affects girls approximately by 6 times more often than boys. Unilateral defeat meets 1,5-2 times more often of bilateral.
Dysplasia of a coxofemoral joint – a serious disease. The modern traumatology and orthopedics accumulated rather wide experience of diagnostics and treatment of this pathology. The obtained data demonstrate that in the absence of timely treatment the disease can lead to an early invalidization. The earlier begin to carry out treatment, the result therefore at the slightest suspicion of congenital dislocation of a hip it is necessary to show the child to the orthopedic surgeon as soon as possible will be better.
Allocate three degrees of a dysplasia:
- Dysplasia of a coxofemoral joint. The articulate hollow, a head and a neck of a hip are changed. The normal ratio of articulate surfaces remains.
- Congenital incomplete dislocation of a hip. The articulate hollow, a head and a neck of a hip are changed. The ratio of articulate surfaces is broken. The head of a hip is displaced and is about the outer edge of a coxofemoral joint.
- Congenital dislocation of a hip. The articulate hollow, a head and a neck of a hip are changed. Articulate surfaces are separated. The head of a hip is above an articulate hollow and away from it.
Coxofemoral joints are located rather deeply, covered with soft fabrics and powerful muscles. The direct research of joints is complicated therefore pathology is revealed, generally on the basis of indirect signs.
- Click symptom (Marx-Ortolani's symptom)
Comes to light only at children aged up to 2-3 months. The kid is stacked on a back, his legs bend, and then accurately reduce and part. At an unstable coxofemoral joint there is a vyvikhivaniye and reposition of a hip which is followed by characteristic click.
- Assignment restriction
Comes to light at children about one year. The child is stacked on a back, his legs bend, and then without effort part in the parties. At the healthy child the angle of assignment of a hip equals 80–90 °. Restriction of assignment can testify to a dysplasia of a coxofemoral joint.
It is necessary to consider that in certain cases restriction of assignment is caused by natural increase in a muscular tone at the healthy child. In this regard bigger diagnostic value has unilateral restriction of assignment of hips which cannot be connected with change of a tone of muscles.
- Shortening of an extremity
The child is stacked on a back, his legs bend and press to a stomach. At a unilateral dysplasia of a coxofemoral joint the asymmetry of an arrangement of knee joints caused by shortening of a hip on the struck party comes to light.
- Asymmetry of skin folds
The child is stacked at first on a back, and then on a stomach for survey of inguinal, buttock and popliteal skin folds. Normal all folds are symmetric. Asymmetry is the certificate of congenital pathology.
- External rotation of an extremity
The child's foot on the party of defeat is turned out knaruzh. The symptom is better noticeable when the child sleeps. It is necessary to consider that external rotation of an extremity can come to light also at healthy children.
- Other symptoms
At children 1 years are aged more senior gait violation ("duck gait", lameness), insufficiency of gluteuses (a symptom of Dyushena-Trendelenburga) and higher arrangement of a big spit comes to light.
If pathology not to treat at early age, the early displastichesky coxarthrosis (at the age of 25-30 years) which is followed by pains, restriction of mobility of a joint and gradually leading to the patient's invalidization will become an outcome of a dysplasia.
At not cured hip incomplete dislocation lameness and joint pains develop at the age of 3-5 years, at congenital dislocation of a hip of pain and lameness develop right after the beginning of walking.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
- Conservative therapy
At a timely initiation of treatment conservative therapy is applied. The special individually picked up tire allowing to hold the child's legs taken away and bent in coxofemoral and knee joints is used. Timely comparison of a head of a hip to a vertluzhny hollow creates normal conditions for the correct development of a joint. What treatment begins earlier, those manage to achieve the best results.
It is the best of all if treatment begins in the first days of life of the kid. The initiation of treatment of a dysplasia of a coxofemoral joint is considered timely if the child was not 3 months old yet. In all other cases treatment is considered to be overdue. Nevertheless, in certain situations conservative therapy is rather effective and at treatment of children 1 years are more senior.
- Expeditious treatment
The best results at surgical treatment of this pathology are achieved if the child was operated aged up to 5 years. In the subsequent, the child is more senior, the smaller effect should be expected from operation.
Operations at congenital dislocation of a hip can be intra articulate and extra articulate. To the children who did not reach teenage age carry out intra articulate interventions. In the course of operation deepen a vertluzhny hollow. Extra articulate operations which essence consists in creation of a roof of a vertluzhny hollow are shown to teenagers and adults. Endoprosthesis replacement of a coxofemoral joint is carried out in the heavy and late diagnosed cases of congenital dislocation of a hip with the expressed dysfunction of a joint.