Degrees and why they matter
Doctors distinguish several variants of the condition. Immaturity of the joint is a borderline variant, when formation is slower than normal and often catches up with it on its own under supervision. Dysplasia itself means underdevelopment of the acetabulum with the correct position of the femoral head. Subluxation - the head is partially displaced, dislocation - it has completely moved beyond the socket. The greater the displacement, the worse the depression is formed, and the more difficult the treatment. In newborns, the joint consists predominantly of cartilage, so it is plastic and responds well to the correct position of the legs, but this ability lasts only for several months.
- Immaturity of the joint - borderline condition
- Dysplasia - underdevelopment of the cavity
- Subluxation - partial displacement of the head
- Hip dislocation - complete displacement
- The cartilaginous joint of an infant is easily corrected
Risk factors
The main and most significant factor is breech presentation, in which the fetal legs are in an extended position for a long time, unfavorable for the joint. Female gender, first pregnancy, oligohydramnios and large fetuses, as well as familial cases of dysplasia play a role. Care after birth deserves special attention: tight swaddling with straightened and contracted legs impairs the formation of the joint, while a loose position with spread and bent hips, as when worn in a sling, on the contrary, promotes proper development.
- Breech presentation of the fetus
- Female gender
- First birth
- Oligohydramnios and large fruit
- Dysplasia in parents or siblings
- Tight swaddling with straightened legs
- Associated torticollis and foot deformities
How to notice it
Newborns may not have obvious signs at all - which is why examination by a specialist is required, and not observation by parents. Classic landmarks include asymmetry of the skin folds on the thighs and buttocks, different lengths of the legs, limited hip extension when the knees are bent, and a characteristic click during special tests. It is important to understand that asymmetry of folds itself occurs in healthy children and is not evidence of dysplasia. In children who have already begun to walk, late-diagnosed pathology is manifested by lameness, waddling gait and walking on the tip of one leg.
- Limiting the extension of bent legs
- Clicking sound during joint stability tests
- Asymmetry of the folds of the hips and buttocks
- Different leg lengths
- Lameness and waddling gait after starting to walk
- Often - complete absence of external signs
Diagnostics
An examination by a pediatric orthopedist is carried out in the maternity hospital and then at set times in the first year of life. The main method in infants is ultrasound examination of the hip joints, which allows you to see cartilaginous structures that are not accessible to x-rays and evaluate the joint according to standard criteria with measuring angles. It is usually performed at approximately one month of age, and is mandatory for children at risk. After the ossification nuclei have formed, from about four to six months, x-rays become informative. Self-diagnosis based on photographs of folds on the Internet is unacceptable.
- Examination by an orthopedist with stability tests
- Ultrasound of the hip joints about 1 month
- Mandatory ultrasound for breech presentation and familial cases
- X-ray of the hip joints after 4–6 months
- Repeated examinations within prescribed periods
- Assessment of symmetry of movements and length of legs
Treatment
There is only one principle: keep the hips in a position of flexion and abduction so that the femoral head is constantly centered in the socket and stimulates its correct formation. For mild forms, wide, free swaddling and observation are sufficient. For confirmed dysplasia, abductor devices are used - stirrups and special splints, which are worn according to the prescribed pattern for several weeks or months with follow-up examinations and ultrasound. In case of dislocation, closed reduction followed by fixation may be required, and if detected late, surgical treatment. Massage and therapeutic exercises serve as a complement to, and not a replacement for, orthoses. You cannot remove or change the mode of wearing the device yourself.
- Wide, loose swaddling for mild cases
- Abduction stirrups and splints as prescribed by a doctor
- Control examinations and ultrasound during treatment
- Closed reduction with fixation in case of dislocation
- Surgical treatment for late detection
- Therapeutic exercises and massage as an addition
- Avoiding tight swaddling
- Carrying in a sling or ergo backpack with spread legs