Hip dislocation in children symptoms and treatment. Congenital dislocation of the hip: causes, signs and symptoms, diagnosis and treatment. Carrying out preventive measures

Congenital hip dislocation is one of the most common pathologies of the musculoskeletal system. Early detection and its timely treatment are important tasks of modern orthopedics. Prevention of disability is based on adequate therapy immediately after the diagnosis of the disease. Complete recovery without the development of any complications is possible in the treatment of children from the first days of life.

Congenital dislocation is found in one newborn out of 7000 examined. Girls are subject to the development of intrauterine anomalies 5 times more often than boys. Bilateral lesion of the hip joint is detected almost two times less often than unilateral.

If congenital dislocation is not diagnosed, or medical care has not been provided, then conservative therapy will not be successful. In this case, it is possible to avoid disability of the child only with the help of a surgical operation.

Characteristic features of pathology

The anatomical elements of the hip joint are the femur and the acetabulum of the pelvic bone, the shape of which resembles a bowl. Its surface is lined with elastic, but strong hyaline cartilage, which performs a shock-absorbing function. This connective tissue with elastic intercellular substance is designed to keep the femoral head inside the joint, limiting movements with too high amplitude, which can damage the joint. Cartilaginous tissues completely cover the head of the femoral bone, ensuring its smooth sliding, the ability to withstand severe loads. The anatomical elements of the hip joint are connected by a ligament equipped with many blood vessels through which nutrients enter the tissues. The structure of the hip joint also includes:

synovial bag;
muscle fibers;
extra-articular ligaments.

Anatomy of a healthy hip.

Such a complex structure contributes to reliable attachment of the femoral head, full extension and flexion of the joint. With dysplasia, some structures develop incorrectly, which causes the femoral head to shift in relation to the acetabular cavity, and it slips. More often with congenital dislocation of the hip in children, such anatomical defects are found:

flattening the cavity, leveling its surface, modifying the cup-shaped shape;
defective cartilage structure at the edges of the cavity, its inability to hold the femoral head;
anatomically incorrect angle formed by the head and neck of the femur;
excessively elongated ligaments, their weakness, provoked by an abnormal structure.

Any defect causes dislocations, subluxations of the femoral head. When combined with poorly developed muscles, the situation is even more aggravated.

Causes and provoking factors

Why there is a congenital dislocation of the hip joint, scientists still argue. There are various versions of the development of pathology, but each of them does not yet have a sufficiently convincing evidence base. It has been established that approximately 2-3% of anomalies are teratogenic, that is, they form at a certain stage of embryogenesis. Several theories have been put forward about what can serve as an anatomical prerequisite for the occurrence of orthopedic pathology:

premature birth, provoked by circulatory disorders between the placenta and the fetus;
deficiency of trace elements, fat- and water-soluble vitamins in a woman's body during childbearing;
hereditary predisposition, joint hypermobility caused by the peculiarities of collagen biosynthesis;
injury to a woman during pregnancy, exposure to radiation, heavy metals, acids, alkalis and other chemicals;
trauma to the newborn during its passage through the birth canal;
violations of the proper development and functioning of individual organs and systems of the fetus due to inadequate tissue trophism;
sharp fluctuations in hormonal levels, insufficient or excessive production of hormones that affect the production of bone and cartilage tissue cells;
a woman taking pharmacological preparations of various groups, especially in the first trimester, when the main organs of all vital systems are formed in the fetus.

All these factors cause the femur to fall out of the acetabular cavity with a certain movement. Congenital dislocation of the hip joint should be differentiated from an acquired pathology, usually resulting from trauma or the development of bone and joint diseases.

Classification

Congenital dislocation of the hip in newborns is preceded by dysplasia. This term refers to the consequences of a violation of the formation of individual parts, organs or tissues after birth or during the period of embryonic development. Dysplasia is an anatomical prerequisite for dislocation, which has not yet occurred, since the shapes of the contacting articular surfaces correspond to each other. There are no symptoms of pathology, and it is possible to diagnose changes in tissues only with the help of instrumental studies (ultrasound, radiography). The presence of a clinical picture is typical for such stages of the disease:

When choosing a method of therapy, the location of the anatomical defect must be taken into account. With acetabular dysplasia, it is localized in the acetabular inset. The anomaly is also found on the femoral head.

Clinical picture

Signs of congenital hip dislocation are not specific. Even an experienced orthopedist does not diagnose the disease only after examining the patient. Pathology may be indicated by different leg lengths due to displacement of the femoral head. To detect it, the pediatric orthopedist lays the newborn on a horizontal surface and bends the legs at the knees, placing the heels at the same level. If one knee is higher than the other, then the child is shown further instrumental diagnostics. For pathology, the following clinical manifestations are characteristic:

asymmetrical arrangement of the gluteal and leg folds. For examination, the doctor lays the newborn first on his back, then turns over on his stomach. In violation of the asymmetric arrangement of the folds and their unequal depth, there is a high probability of dysplasia. This symptom is also non-specific, and sometimes even an anatomical feature. Large babies always have a lot of folds on the body, which makes diagnosis somewhat difficult. In addition, sometimes subcutaneous fatty tissue develops unevenly, and subsequently its distribution is normalized (usually after 2-3 months);
an objective sign of the disease is a sharp, slightly muffled click. This symptom manifests itself in the supine position with legs apart. A characteristic click is heard when the injured limb is abducted to the side. The reason for its occurrence is the reduction of the femur into the acetabulum, the adoption of an anatomically correct position by the hip joint. The click also accompanies the reverse process, when the child makes a passive or active movement, and the head of the bucket slips out of the acetabulum. When children reach 2-3 months, this symptom loses its information content;
in children with congenital dislocation of the femoral joint, after 2 weeks of life, there is a restriction when trying to take the leg to the side. In a newborn, the ligaments and tendons are elastic, therefore, normally, its limbs can be abducted so that they lie on the surface. When the joint is damaged, abduction is limited. Sometimes there is a pseudo-restriction, especially when examining infants up to 4 months. It occurs due to the occurrence of physiological hypertonicity, which also requires correction, but is not as dangerous as dislocation.

If for some reason the pathology was not diagnosed in a timely manner, then it can affect the soft tissues located near the thigh. For example, congenital dislocation in children older than one and a half years is clinically manifested by poor development of the muscles of the buttocks. The child tries to stabilize the hip joint and sways during movement, his gait resembles a "duck".

Diagnosis

In addition to a clinical examination, instrumental studies are carried out to make a diagnosis. Despite the information content of radiography in detecting pathologies of the musculoskeletal system, ultrasound is indicated for newborns. Firstly, it is absolutely safe, since there is no radiation load on the body. Secondly, during ultrasound, it is possible to assess the state of all connective tissue structures with maximum reliability. On the obtained images, the bone roof, the location of the cartilaginous protrusion, and the localization of the bone head are well visualized. The results are interpreted using special tables, and the angle of inclination of the acetabular cavity serves as the evaluation criterion.

Radiography is shown from 6 months, when the anatomical structures begin to ossify. When making a diagnosis, the angle of inclination of the cavity is also calculated. Using X-ray images, it is possible to assess the degree of displacement of the femoral head, to detect a delay in its ossification.

Basic therapies

Treatment of congenital dislocation of the hip is carried out by conservative and surgical methods. When a pathology is detected, splints are used in therapy to completely immobilize the limb. The orthopedic device is applied during abduction and flexion of the hip and knee joints. The head of the femur is compared with the cavity, and this allows the joint to form and develop correctly. Treatment performed on a newborn immediately after the detection of pathology is almost always successful.

Treatment of children up to 3 months is considered timely. As tissue ossifies, the likelihood of a favorable outcome of conservative treatment decreases. But with a combination of certain factors with the help of a splint, a complete recovery of a child older than 12 months is possible.

Surgery is also performed immediately after diagnosis. Orthopedists insist on intervention until the child is five years old. Children under 13-14 years of age are shown intra-articular surgery with deepening of the acetabular cavity. When operating on adolescents and adults by the extra-articular method, a cartilaginous rim is created. If a congenital dislocation is diagnosed late, complicated by impaired functioning of the joint, then endoprosthesis replacement is performed.

The consequences of untreated congenital hip dislocation in adults are early. Pathology usually manifests itself after 25 years of pain, stiffness of the hip joint, and often leads to loss of working capacity. To avoid such a development of events, only an examination of the newborn by a pediatric orthopedist, immediately carried out therapy, allows.

Congenital dislocation of the hip joint in children and newborns

To understand what pathology is, it is necessary to delve into the anatomy of the hip joint. It consists of the acetabulum of the pelvic bone, which is adjacent to the head of the femur. The acetabulum is a cup-shaped depression in the ilium.

From the inside, the acetabular recess is lined with hyaline cartilage and fatty tissue. The cartilaginous rim also covers the head of the femur. A ligament at the top of the femoral head connects it to the acetabulum and is responsible for nutrition. The joint capsule, muscles and extra-articular ligaments strengthen the joint from above.

All of the above structures guarantee a secure fixation of the femoral head in the acetabulum. And thanks to the spherical structure, the joint can move in different directions.

With improper development of the joint, all these structures are defective, as a result, the head is not securely attached to the acetabular recess and dislocation occurs.

In most cases, dysplasia is manifested by the following anatomical defects:

Wrong size or shape (flattening) of the glenoid cavity;
Underdevelopment of cartilaginous tissue along the edge of the acetabular recess;
Pathological angle between the head and neck of the femur;
Joint ligaments are weak or too long.

All of the above anatomical defects with poorly developed muscles in a newborn provoke hip dislocation.

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Causes of congenital dislocation of the hip

Orthopedists have not yet determined the exact causes of joint dysplasia. However, there are several versions:

The influence of relaxin. This hormone is produced in the female body before childbirth. Thanks to him, the ligaments soften so that the fetus leaves the pelvis. Relaxin enters the child's bloodstream, affects his hip joint, the ligaments of which are stretched. Women are more susceptible to the effects of this hormone, for this reason girls suffer from dysplasia more often than boys;
breech presentation. If the fetus is in this position for a long time, then its hip joint is subjected to strong pressure. Blood circulation in the pelvis worsens, the development of the structural components of the joint is disrupted. In addition, the joint can be damaged during childbirth;
Insufficient amount of amniotic fluid. If in the early stages the volume of amniotic fluid is less than 1 liter, then the movement of the child becomes difficult and the likelihood of malformations of the musculoskeletal system increases;
Toxicosis. The hormonal, digestive and nervous systems are rebuilt, pregnancy is complicated, as a result, the development of the fetus is disturbed;
Fetal weight from 4 kg and above. In this case, the hip joint may be damaged during the passage of the child through the narrow birth canal;
Early pregnancy. In a woman who gives birth for the first time before the age of 18, the concentration of relaxin is the highest;
late pregnancy. Women over 35 are more likely to suffer from chronic diseases, pelvic circulation disorders, and toxicosis;
Infections. If a pregnant woman has had an infectious disease, then the risk of fetal developmental disorders increases;
Thyroid pathologies. Diseases of the thyroid gland disrupt the development of joints in a child;
genetic predisposition. If close relatives were diagnosed with hip dysplasia, then the likelihood of developing a pathology in a child increases;
External influence. If a pregnant woman is exposed to radioactive radiation, takes medications or drinks alcohol, then the development of the joints in the fetus is disturbed.

If at least one of these factors is present, then the newborn should be examined by an orthopedist.

Etiology

Despite the existence of a wide range of predisposing factors, the causes of congenital hip dislocation in children remain unknown. Nevertheless, specialists from the field of orthopedics and pediatrics distinguish as provocateurs:

incorrect position of the fetus in the womb, namely its breech presentation;
severe toxicosis during pregnancy;
bearing a large fetus;
young age category of the mother - less than 18 years;
a wide range of infectious diseases suffered by the expectant mother;
delayed intrauterine development of the baby;
unfavorable ecological situation;
specific working conditions;
the effect on the pregnant woman's body of exhaust gases or ionizing radiation;
addiction to bad habits - passive smoking should also be included here;
the presence of a female representative of gynecological pathologies, for example, uterine fibroids or the development of an adhesive process. Such ailments adversely affect the intrauterine movement of the child;
excessively short umbilical cord;
the birth of a baby before the predetermined date;
entanglement of the fetus with the umbilical cord;
trauma to the newborn during labor or after childbirth.

In addition, the cause of hip dislocation in infants can be a genetic predisposition. Moreover, congenital hip dislocation is inherited in an autosomal dominant manner. This means that in order for a child to be born with a similar diagnosis, such a pathology must be diagnosed in at least one of the parents.

Symptoms and degrees of congenital dislocation of the hip

Hip dysplasia can be identified by the following signs and symptoms:

Different leg lengths. To determine this parameter, the child's legs are bent at the knees, and the heels are pressed against the buttocks. If the knees are at different levels, then the length of the legs is different;
Asymmetric skin folds on the lower body. In a healthy child, skin folds are symmetrical and have the same depth. Otherwise, the baby should be examined by an orthopedist;
slip symptom. This is the most objective diagnostic method up to 3 weeks after the birth of a child. During the breeding of the legs in the hip joint, a click is heard, which resembles the reduction of a bone. If the leg is released, it will return to its original position, and with a repeated sharp movement, the head will again slip out of the articular cavity with a characteristic click;
Difficulty in moving the hip joint. This symptom is present in sick children after 3 weeks of life. At the moment the leg is abducted to the side at an angle of 80–90 °, movement becomes difficult, while normally the limb can almost be put on the surface.

A little later, dysplasia can manifest itself as a gait disorder, a more noticeable difference in the length of the legs. If the child has a bilateral dislocation, then a "duck" gait develops.

Symptoms

With congenital dislocation of the hip, the presence of quite pronounced clinical signs is observed, which parents pay attention to. However, sometimes the pathology is not diagnosed in infancy, which causes irreparable consequences in adults.

Thus, the symptoms of congenital dislocation are presented:

high tone of the back muscles;
visual shortening of the affected limb;
the presence of an extra fold on the buttock;
asymmetry of the buttocks;
C-shaped position of the torso of newborns;
squeezing one hand into a fist, often from the side of the sore leg;
the appearance of a characteristic crunch in the process of bending the leg;
X-shaped installation of the foot;
the baby's habit of standing and walking, relying only on his fingers;
a pronounced curvature of the spine in the lumbar region - while there is a "duck" gait;
stoop;
restriction of movement of the affected limb.

In those situations where the pathology was not cured in childhood, in adults, signs of congenital hip dislocation will be lameness, rollover from side to side while walking, and shortening of the affected leg.

Diagnosis of hip dysplasia

If congenital hip dislocation is suspected, it is necessary to conduct a whole range of diagnostics: examination by a pediatric orthopedist, X-ray or ultrasound examination.

With timely detection, the pathology can be completely cured, but for this, therapy must be started no later than 6 months. To do this, the doctor must examine the newborn in the hospital, after that - at 1 month, and then - at 3, 6 and 12 months. If you suspect dysplasia, the doctor will prescribe an ultrasound or x-ray.

An x-ray of the hip joint is performed for children from 3 months. This is due to the fact that some parts of the femur and pelvic bone have not yet ossified in patients up to 3 months.

In their place is cartilaginous tissue, which is not displayed by x-rays. Therefore, the results of the study in a child younger than 3 months will be unreliable.

It is possible to detect hip dysplasia and dislocation in an infant from birth to 3 months using ultrasound. It is a safe and highly informative diagnostic method.

Prevention and prognosis

The best prevention of congenital hip dislocation should be considered early diagnosis and regular monitoring by medical specialists. If pathology is detected in the first weeks of a child's life and timely treatment, the probability of complete recovery reaches 100%. The later a defect is detected and the later measures are taken to eliminate it, the lower the likelihood of a favorable outcome.

The lack of proper treatment entails the development of irreversible degenerative changes in the articular and bone tissues, and, as a result, causes a deep disability of the patient, associated with the impossibility of independent movement.

Conservative treatment of congenital hip dislocation

Congenital dislocation of the hip is treated conservatively or surgically. The decision on the choice of treatment method is made by the doctor after the examination.

If hip dysplasia is detected immediately after birth, then wide swaddling is used. This technique is more prophylactic than therapeutic, and therefore it is used for grade 1 dysplasia.

Wide swaddling for hip dysplasia:

Lay the child on his back;
Place 2 diapers between the legs so that the baby cannot connect them;
Fix the diaper roll on the belt with the 3rd diaper.

After swaddling, the legs are separated, and the head of the thigh is in place.

For the treatment of serious hip pathologies, the following orthopedic structures are used:

Pavlik's stirrups are a soft design that consists of a bandage on the chest, lower legs, connected by straps. The stirrups fix the legs in a bent position and do not interfere with their spread;
The Frejka tire is used for wide swaddling with dysplasia without dislocation or subluxation of the hip. Thanks to this bandage, the legs are constantly separated by 90 ° or more;
The Vilensky tire is put on for the first time by an orthopedist; it consists of belts and spacers between them. It must be constantly worn, clearly regulate the length of the strut, it is forbidden to remove it even while changing clothes. It is recommended to use clothing with buttons;
The Tubinger cut is a combination of the Vilensky bus and Pavlik stirrups. It consists of 2 saddle struts connected by a metal rod, shoulder pads and "strings of pearls". And with Velcro, you can fix the tire. The size of the structure depends on the age of the patient;
Volkov's tire is a plastic construction that consists of a crib, upper part and side parts for the legs. The tire is intended for children from 1 month to 3 years.

In addition, massage is used to treat dysplasia, but only as directed by a doctor. For this, the child is placed on a flat surface, stroked, rubbed and slightly kneaded the muscles of the lower back. Then in the same way you need to massage the buttocks and thighs.

Therapeutic massage for hip dysplasia in children can only be performed by a professional.

Parents are allowed to have a general relaxing massage. One course consists of 10 sessions.

Exercise therapy for congenital hip dislocation restores the normal configuration of the hip joint, strengthens muscles, ensures normal physical activity of the baby, improves blood circulation and prevents complications (necrosis of the femoral head).

Therapeutic exercises for hip dysplasia for children under 3 years old:

The child is placed on his back and the hips are bent in a divorced state;
The baby independently changes position from lying to sitting;
The child must crawl;
The patient must independently change the position from sitting to standing;
Walk;
Build throwing skills.

In addition, a whole range of exercises for the legs, the press, as well as breathing exercises are performed. The specialist will develop a set of exercises for each patient individually.

How to help a child?

There are two possible methods of treatment of congenital dislocation of the hip joint - conservative and surgical. Fortunately, even in severe cases of bilateral dislocation, with timely diagnosis, as a rule, it is possible to manage with a conservative method.

That is why it is considered the leader and consists in individual selection special tire, which fixes the legs of the newborn in one position: bent at the knees and at the hip joints and divorced slightly to the side.

Thus, the head of the femoral joint is gradually reduced into place. It is important that this happens slowly, without haste and abruptness. Otherwise, you can damage the bone tissue, which will lead to even greater problems.

It is believed that in a year the dislocation is already thoroughly launched, but even in such a situation, they try to correct it with conservative methods. Only in very old cases resort to surgery.

What else can you advise parents who are faced with the problem of congenital dislocation of the hip joint in their young child? First of all, be careful. Now various gymnastics and massage for children have come into fashion, but it is important to understand that not all exercises and massage techniques are suitable for babies with congenital dislocation.

For massage in the case of such a pathology, a more thorough and intensive treatment of the lumbar and gluteal region is characteristic. Also, attention is paid to the hip joints. However, it is important not to make sudden, jerky movements.

Special mention should be made of swaddling children. For a long time tight swaddling was welcomed when the baby's legs were pulled together. It was believed that in this case the legs would be straighter. In fact, this position of the legs for newborns is unnatural. During the long months in the womb, babies get used to the bent-legged position. Tight swaddling is especially harmful for children with a dislocation of the hip joint, but it does not have a positive effect on healthy children either. Moreover, for development at such a young age, movements are of great importance. Therefore, the ideal option would be to dress the child in sliders. If you still prefer to swaddle, then do not try to twist the legs as tight as possible, leave the child the opportunity to bend and move them at will. Tight swaddling will only aggravate the situation with a dislocation of the hip joint, interfering with the process of repositioning the head into the articular cavity.

Gymnastics for children with congenital hip dislocation

Do not interfere with kids with such an ailment and gymnastics. Below are some simple and effective exercises. Remember that all of them must be performed without any additional effort.

Exercise 1. Put the baby on the tummy. Lightly rub the buttocks and outer thighs. Now gently move the bent leg of the child to the side and fix it in this position.

Exercise 2. The child lies on his stomach. Take him by the ankles and bring the feet together, while the knees at this time, on the contrary, should be divorced. Press the pelvis against the support.

Exercise 3 Lay the child on the ball with his tummy, so that he has to keep his legs on the weight.

Exercise 4 Lay the child on the back. Gently and slowly bend and unbend your legs at the hip joints, and also spread them apart. This must be done carefully, in no case do not rush, do not pull the child and do not press on the legs with force. Movement should be natural.

As you can see, this gymnastics is aimed at relaxing the muscles. It has a lot of static positions, fixations and slow, smooth movements. But fast and sharp are completely excluded. This is associated with the risk of further damage to the weakened joint.

Due to the deterioration of the environmental situation, the negligent attitude of many women to bearing a child, congenital dislocation of the hip is becoming more common. Doctors pay a lot of attention to the timely diagnosis of this problem in children. However, parents should fully rely not only on the opinion of doctors, but also on their own discretion.

Closely monitor your baby and at the slightest suspicion of a congenital dislocation of the hip, contact the pediatrician immediately. The doctor will examine the child and, if necessary, refer him to an orthopedist for examination. Only an attentive attitude to the child from the first days of life guarantees the timely identification of the problem and the cure of the baby before the development of serious complications.

Fortunately, congenital dislocation of the hip is a violation, although frequent, but quite easily corrected. Therefore, do not panic when you hear this diagnosis. Just follow the doctor's instructions clearly, and everything will be fine with your child very soon.

Surgical intervention

Surgical treatment of hip dysplasia is performed in the following cases:

Hip dislocation was diagnosed in a 2-year-old patient;
There are anatomical pathologies due to which the closed reduction of the dislocation cannot be performed;
Pinched cartilage in the cavity of the hip joint;
Intense displacement of the femoral head, which cannot be reduced by the closed method.

The method of treatment is chosen by the doctor for each patient individually.

In the presence of the above indications, the doctor performs surgical treatment of hip dislocation:

Open reduction of dislocation. To do this, the surgeon dissects the tissues, the joint capsule and sets the head into place. If necessary, the acetabular recess is enlarged with a cutter. After the operation, a cast is applied to the leg, which is worn for 2-3 weeks;
The second method of reducing the dislocation is an osteotomy. To do this, the doctor cuts the skin and gives the end of the femur closest to the pelvis the necessary configuration;
Operations on the pelvic bones. There are several methods of such treatment, but their main goal is to create a stop over the head of the femur so that it does not move;
Palliative operations are used when it is impossible to correct the configuration of the hip joint. They are used to improve the general condition of the patient and restore his performance.

Diagnosis

Rehabilitation

After surgery, it is necessary to strengthen the muscles and restore the range of motion in the damaged limb.

Rehabilitation is divided into 3 periods:

During immobilization, the affected leg is bent at an angle of 30° and fixed with a bandage, which can be removed after 2 weeks;
The bandage is removed, the Vilensky splint is put on with a load of 1 kg. The recovery period begins 5 weeks after surgery. During this period, you need to perform therapeutic exercises, alternate passive movements with active ones. This is necessary to strengthen the femoral, dorsal and abdominal muscles;
In the final period, which lasts 1.5 years, the child is taught to walk correctly. For this purpose, a special path is used, on which small feet are depicted. The duration of the exercises is from 10 to 30 minutes.

If a pathology is detected in a child of 1-2 years old, then surgical treatment is performed, which does not always end successfully. That is why it is necessary to control the condition of the baby from birth.

Therapeutic measures

To eliminate the pathology, two types of treatment are used: conservative and surgical. If the dislocation is diagnosed at an early stage, a conservative method is sufficient. In more severe forms, surgical treatment is prescribed.

Conservative treatment

Conservative treatment includes several types of procedures to correct the affected joint. These procedures include:

Application of the method of wide swaddling. The child's legs are retracted to the sides at an angle of 70–80 °. Two folded diapers are placed between the legs and fixed on the belt of the third. With such swaddling, the movements of the child are not limited.
To correct the joint, special devices are used to help fix the child's legs in a divorced position and with bent knees. Such devices include: Pavlik's stirrups, Volkov's tire, Freik's pillow. The size of the devices should be selected according to height. The period of wearing tires varies between 4-8 months.
Therapeutic physical culture (LFK) and massage. These techniques help strengthen and develop the muscles of the legs and buttocks.

Surgery

In case of insufficient effectiveness of conservative treatment, doctors prescribe surgical intervention. To eliminate the pathology, the following types of surgery are used: extra-articular, intra-articular and combined.

Extra-articular operations include a simple open reduction of the hip joint. This method is used for soft tissue changes. During the operation, tissues that interfere with the connection of the head of the joint with the acetabulum are removed. Sometimes correction of the acetabulum is required. For its proper formation, special medical instruments are used. The operation is performed under anesthesia.

In cases of unreduced dislocations, intra-articular operations are used, in which the joint cavity is opened. This type of treatment can be prescribed for children older than 2 years.

Complications and consequences of congenital dislocation of the hip in adults

In the absence of competent treatment of hip dysplasia in infants, the likelihood of dangerous complications at an older age increases:

Due to the constant friction and pressure of the femoral head on the joint bag, it becomes thinner, deformed and atrophied;
The femoral head flattens, the acetabular recess decreases. In the place where the femoral head rests against the bone, a false joint is formed. This defect is called neoarthrosis;
If you do not treat hip dysplasia in a child, then at the age of 25, coxarthrosis develops. Most often, this complication occurs due to hormonal imbalance, an inactive lifestyle, or being overweight. Coxarthrosis is manifested by pain in the hip joint, limitation of movement, as a result, the thigh bends, turns outward and remains in this position. In this case, only endoprosthetics (replacement of the hip joint with a prosthesis) will help.

Thus, hip dysplasia in newborns and children is a dangerous pathology that requires treatment at an early age. Otherwise, the likelihood of complications that are much harder to cure increases. Therefore, it is important to monitor the condition of your child and, if suspicious symptoms occur, consult a doctor.

Possible Complications

The lack of treatment of such a disease in infancy increases the likelihood of the child acquiring consequences.

The most common complication is dysplastic coxarthrosis - this is a serious disease that leads to disability of the patient, accompanied by:

intense pain syndrome;
wrong gait;
dysfunction of the joint.

Treatment of such an ailment is only surgical, and patients often require nursing care.

Characteristic symptoms

With an injury to the hip joint, negative manifestations depend on the severity of the pathology. When the ligaments are torn, the symptoms are more acute, if the muscle fibers are slightly damaged, recovery from injury is faster.

Doctors distinguish three types of hip dislocation:

posterior (sciatic and posterior pubic). Pathology is fixed in more than two thirds of patients;
central (severe damage occurs when the bottom of the acetabulum is fractured);
anterior (suprapubic and obturator).

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The main signs of damage to a large joint in the pelvic area:

the direction of the affected joint - with a posterior dislocation, the displacement of the bones occurs inward, with the anterior one they protrude outward. The unnatural position of the bone is easy to determine visually, the hip joint is deformed;
the pain syndrome is pronounced, when you try to move the leg, a sharp pain appears;
hematomas, swelling of tissues in the affected area appear;
rupture of the articular bag;
soft tissue injury occurs.

With congenital hip dysplasia, the symptoms are as follows:

limitation of movements on the part of the affected limb;
lameness;
when moving, pain is felt;
violation of posture, with a severe degree of dysplasia, scoliosis develops.

Statistics for this disease

Child disability due to this disease is growing every year. Over the past few years, the number of patients with congenital hip dislocation has increased by 60%. In children aged seven to eight and twelve to fifteen, the condition worsens. Pain appears, lameness intensifies, which is caused by hormonal changes.

Congenital dislocation of the hip is common in all countries, but there are also racial distribution patterns. For example, in the United States, the number of cases among the white population is higher than among African Americans. In Germany, children with this disease are born less than in the Scandinavian countries.

There is a certain connection with the ecological situation. For example, the disease of children in our country fluctuates between two and three percent, and in countries with less favorable conditions it reaches twelve percent.

The development of the disease is also affected by tight swaddling of the baby's legs in a straightened state. In peoples where it is customary to swaddle children in this way, hip dysplasia is more common than in others. Confirmation of this fact is that in the 70s in Japan the tradition of tightly swaddling newborns was changed, and the result was not long in coming. Congenital hip dislocation decreased from 3.5% to 0.2%.

In 80% of cases, girls suffer from congenital hip dislocation. The disease is ten times more likely to occur in those whose parents had any signs of the disease. The left hip is more commonly affected (in 60%) than the right (20%) or both (20%).

Features of the postoperative period

Prosthetics, technically performed at "5+", is not yet a 100% guarantee of the successful functioning of the implant in the future. After the correct installation of the implant, excellent rehabilitation must be carried out, only in this way the risks of the consequences can be minimized to the maximum. From the first day, they begin systematic physical rehabilitation aimed at:

increasing muscle tone with the help of therapeutic exercises;
early transfer of the patient from a lying position to a standing position;
practicing proper walking on crutches, and later without support;
training in the technique of sitting down, taking a sitting position;
correction of adaptive stereotypes developed in the preoperative period - vicious posture, incorrect manner of walking, sitting, etc .;
acceleration of the regeneration of the surgical wound and stimulation of the integration of the prosthesis with the bone due to physiotherapy procedures;
providing the patient with full information about the mandatory need to limit certain elements of motor activity in order to prevent complications.

The transition from crutches to a cane, an increase in the load on the operated leg and other important points are carried out according to the dynamics of recovery, well-being, age and weight criteria of the patient. Crutches are approximately used for 2.5-3 months, then they walk with a cane. In general, walking without support is usually allowed after 4-6 months after the operation. No self-appointments! A person must strictly adhere to the phased recovery scheme recommended by the physical instructor and surgeon.

Articular dysplasia

There are 4 types of pathology that are collectively called - articular dysplasia.

Table. Symptoms of articular dysplasia:

This pathology is most common in girls. And if it is not diagnosed in time and treatment is not started, it can lead to disorders of the musculoskeletal system in the future. The affected limb will be shorter than the healthy one, every movement of the child may be accompanied by pain.

Reduction of the hip

The decision on such a mini-operation is made by the attending physician. It can be performed only in cases where there are no anatomical abnormalities in the structure of the hip joint. Reduction of dislocation occurs only with high-quality anesthesia. The best option would be anesthesia. As for local anesthesia, it is practically not used due to the low level of effectiveness.

There are two main methods of hip reduction:

Janelidze method. The patient should be placed on the stomach, face down, so that the leg hangs down. One doctor needs to put pressure on the sacrum, thereby pressing the pelvis. Another doctor should bend the leg at the knee joint at a ninety-degree angle and apply pressure to the popliteal fossa. This is not done abruptly, but smoothly, gradually increasing strength. When the charter falls into place, you will hear a characteristic sound.
Kocher-Kefer method. Here the patient must be placed on his back. One of the doctors should fix the pelvis in a position in which the iliac bones are pressed. Another needs to bend the leg at the hip and knee joints at a right angle and draw vertically upwards. This method is perfect for repositioning anterior superior oblique dislocation.

Rehabilitation of congenital hip dislocation is excellent if the joint is corrected in a timely manner. This process is not difficult, but you should not try to perform this action yourself. There are qualified doctors who will set the mobile connection on time, which will significantly reduce the recovery time.

Consequences of dysplasia in childhood

The lack of an appropriate approach to the treatment of children provokes the formation of complications.

Children with hip dysplasia begin to move independently much later than their peers, their gait is unstable, which becomes noticeable by the age of one and a half years. Children with dysplasia have:

Clubfoot.
Flat feet.
Lameness. At the same time, the baby limps on the leg on the affected side, the body is tilted to the side, as a result, scoliosis develops - a curvature of the spine.
Crossing from one leg to another (with bilateral dysplasia).

Posture deteriorates, lumbar lordosis appears (the spine bends forward) or thoracic kyphosis (the spine bends back). Perhaps the development of osteochondrosis (damage to the tissues of the spine, intervertebral discs, associated apparatus of the spine), as an aggravating disease. There are cases when hip dysplasia develops from unilateral to bilateral. It is possible to earn a disability from infancy.

The baby grows, gets older, pathologies that are not eliminated in a timely manner appear - the body cannot withstand prolonged increased stress. Medical cases are known when hip dysplasia treated in infancy, in adolescence, affects complications with the connection. It is observed in 2-3% of cases, unfortunately, medical science is not yet able to influence this fact.

Appropriate intervention will save in the future from expensive, dangerous to health treatment. Trying to cure hip dysplasia with folk methods is simply useless!

After getting rid of dysplasia in childhood, the child is healthy, but doctors do not recommend professional sports. The exception is skiing and water sports, where the load on the lower limbs is otherwise distributed, during training the muscles are strengthened and stabilized. It is extremely important to monitor weight, maintain normal, overweight is harmful to the joints.

How to recognize a dislocation of the endoprosthesis head

Dislocation of the endoprosthesis can be suspected primarily by the sharp appearance of severe pain in the hip and / or in the groin area. She stubbornly keeps even at rest, increases with any attempt to move the joint. Similar symptoms occur with other complications: prosthesis instability, quadriceps tendinitis, isolated gluteal muscle tear, greater trochanter bursitis, etc. Therefore, it is possible to confirm the true etiology of the pain that has arisen only after a clinical examination and X-ray.

Severe soreness is the main, but not always the only symptom. Let's declare the whole symptom complex characteristic of this problem:

sharp incessant pain, increasing with motor activity and palpation of the prosthetic area;
fear and uncertainty in movement, feeling of instability;
shortening of the affected limb;
local muscle tension;
weakness in the leg, stiffness of movements;
redness, swelling, hyperthermia in the area of implant localization;
an increase in the overall body temperature, if the inflammatory process is strongly activated.

Women are more prone to dislocation than men. Experts substantiate this fact by the fact that in women the initial range in hip joint is higher, and the volume and strength of the muscles are lower than in males. Patients of senile age, people with obesity and high growth also fall into the risk category.

Clinical picture

Symptoms of dysplasia are detected by orthopedic specialists in the process of examining a newborn.

The child's legs are of different lengths. To notice this, you should lay the baby on his back, and bend his legs and put the soles on the buttocks. If it is noticeable that his knees are not at the same level, then this indicates that the length of the legs is not the same.
Skin folds are asymmetrical and have different depths. In the normal state, they are symmetrical, their depth is the same on both sides, if there are deviations, then this may indicate the presence of pathology. However, this examination is not accurate enough, as in many newborns the folds are asymmetrical and become the same over time. With bilateral dysplasia, this method of examination is also ineffective.
Slipping symptom, also called "click" symptom. It is considered the most effective method for detecting pathology. The child should be laid on his back, and his hips should be spread in different directions, by 80-90 degrees. The leg with the affected hip will have limited mobility, and the doctor will be able to feel a click: the sound of the femoral head repositioning. If the leg is released, it will return to its original state, and the femoral head will pop out again.

This method will only be useful up to a certain age of the newborn: two to three weeks.

Congenital dislocation of the hip in young children is a deformation of the musculoskeletal structure in newborns, characterized by deformation of the constituent components of the hip joints. The disease is also called hip dysplasia.

Hip deformity, which has a congenital etiology, is one of the most common defects that are quite difficult to diagnose at the initial stages of formation.

It has been scientifically established that it is observed in little girls about 9-10 times more often than in the representatives of the stronger sex. This is due to some differences in the anatomical structure of the female hip apparatus.

Orthopedic specialists are confident that the sooner therapy is started, the greater the likelihood of preventing the development of possible complications of the pathological process.

Congenital (the most severe birth defect) hip dislocation in the most common cases is diagnosed in young girls, since the fundamental joints in the hip system are highly mobile.

The disease affects girls, and the displacement of the articular elements in them can develop even during the period of intrauterine formation and is detected when they are 1-2 years old.

This means that the pathological process may affect one or both articular components in the hip apparatus. Most often, babies are diagnosed with a unilateral pathology.

In order to determine exactly what a congenital hip dislocation is, it is necessary to thoroughly know the specifics of the anatomical structure of the hip apparatus. The main component in their structure is the acetabulum of the bone, which is tightly adjacent to the hip head. It looks like a small cup-shaped depression located in the iliac bone structure.

The inner side of the acetabular recess is covered with cellular tissue with a fatty structure and hyaline cartilage tissue that simultaneously covers the femoral head. It is this connection that provides full nutrition to the hip apparatus.

The correct design of all of the above structures is a guarantee of a reliable adjacency of the hip head in the acetabular foramen. Deformation in the structure of the joint is accompanied by unreliable fastening of its head to the recess.

Classification

Congenital hip dislocation is characterized by several stages and types of formation, each of which has its own symptoms and specific features.

In the modern medical field, several degrees of congenital dislocation of the hip joint are distinguished:

Stage of dysplasia - the initial deformation is not accompanied by dislocation, but at this stage all the prerequisites for the pathological process, the asymmetric structure of the hip apparatus are observed.
Pre-dislocation stage - the head and neck of the femur are easily retracted to the right and left sides, but independently return to their original place.
Stage of subluxation - the hip head and neck are changed, deformed relative to the upper or lateral side, which is accompanied by intense sprain.
Dislocation - a specific feature is a symptom of slipping, characterized by a loud crunch, which can be heard in the process of breeding the legs of a newborn baby in the hip joints.

The variety of such symptoms and changes allows specialists to correctly diagnose pathological deformity and select the most optimal course of treatment based on the level of its severity.

You can detect the pathological process when the newborn is 2 weeks old.

Causes

For a long time, the causes of the development of the pathology of the hip system have not been finally studied. As a result of numerous studies, doctors have identified factors on the basis of which such a pathology as congenital hip dislocation is formed:

improper actions of the obstetrician during childbirth;
the aggressive action of relaxin, a specific hormone produced in
the body of a woman immediately before the birth of a child;
various pathologies and developmental disorders of the fetus during the prenatal period;
frequent use of drugs by a pregnant woman;
infectious diseases of the expectant mother in the process of bearing children;
negative environmental situation;
pelvic position of the fetus - in the event that the baby is in this state for a long period of time, and an increased load is placed on the articular elements in the pelvic area;
as a result of the pelvic position of the child, the occurrence of many pathologies in the structure of the musculoskeletal system is observed.

Also, the occurrence of congenital dislocation of the hip joints often has a direct relationship with a small volume of amniotic fluid, severe manifestations of toxicosis, too early or late pregnancy, as well as a newborn's body weight of more than 4-5 kg.

Symptoms

Symptoms of hip dysplasia vary significantly depending on the degree and severity of the disease.

Diagnosis of pathology is often difficult also because the deformed tissues are covered with muscle fibers.

The main signs of the disease:

Symptom of instability (Marx-Ortolani). It can be detected in newborns in the age group up to 3 months. The newborn should be placed on a flat surface. The doctor bends the legs, gently brings them together and spreads them in both directions - the disease is determined by a characteristic loud click.
Shortening of the affected leg. The specialist bends the limbs of the crumbs and applies them to the tummy, after which he carefully observes their location. In the presence of dysplasia, you can notice the asymmetry of the movement of the hip, as well as its shape.
Congenital dislocation of the hip apparatus. It is often identified by the stoop, deformed shape of the buttocks. This symptom is accompanied by an X-shaped shape of the lower extremities.
Hip abduction. In the process of abduction of the hip in the area of the hip joint, the angle should vary within 165-180°, in the presence of congenital dislocation of the hip, this figure is significantly less.
Asymmetric folds on the buttocks of children, which are quite difficult to notice even for a specialist in the first days of life. At a later age, hip deformity is characterized by a curvature of the gait, as well as a pronounced difference between the symmetry and length of the lower limbs.

Possible Complications

Congenital dislocation often carries the most dangerous consequences for the body, causing severe complications for the state of the entire musculoskeletal system. The best option is the treatment of violations of the hip system at the earliest stages. In other cases, the likelihood of disability and other dangerous consequences is too high.

With this disease in adults and children, the structure of the musculoskeletal system is seriously affected. This is expressed in the fact that children begin to walk much later, and their gait differs from that of healthy people.

This pathology is called "duck" gait. A small patient with unilateral dysplasia begins to noticeably limp on the affected leg, which contributes to the development of lameness and scoliosis.

If the disease was not cured in infancy, the result of pathological deformity is the formation of dysplastic coxarthrosis (the so-called serious limitation of articular activity, characterized by pain and spasms).

Bilateral congenital dislocation of the joint is often accompanied by gradual deformation of the bone material, pathological displacement, and flattening of the bone apparatus. In case of untimely treatment, therapy is carried out exclusively surgically.

Diagnostics

For the full elimination of congenital deformity of the hip, it is extremely important to seek help from a specialist in a timely manner. The disease is extremely difficult to detect, since the joint in the hip region is covered with an abundant layer of adipose and muscle tissue. That is why it becomes difficult to detect Marx's symptom or other signs of the disease without specific diagnostic procedures.

If congenital dislocation is suspected, diagnostic measures are prescribed:

complex orthopedic examination;
examination by means of radiography;
with the help of ultrasound.

Maximum positive results can be obtained if therapy was started before the time until the infant is 6-7 months old.

X-rays for babies are carried out only after reaching 3 months. It is at this time that almost all parts of the musculoskeletal system are completely ossified in young patients, which makes it possible to obtain accurate and informative results of the study.

In addition, the doctor without fail carefully studies the medical history of all close relatives of the sick child, takes into account the problems that the mother of the baby has during pregnancy, conducts a survey of the mother and father of the crumbs and carefully examines him. These methods help the specialist to correctly diagnose a congenital dislocation in a child and choose a highly effective method for eliminating the defect.

Treatment

Congenital dislocation of the hip is a disease that is treated by two methods: conservative and surgical.

In many cases, even an advanced stage of deformity lends itself well to conservative therapy; therefore, surgical manipulations are resorted to in exceptionally difficult situations.

It must be remembered that the most pronounced positive results from conservative therapy for dysplasia are obtained if it was started before the age of 3 months of the patient.

When it comes to surgery, the optimal time for surgery is considered to be a period of up to 4-5 years. This makes it possible to restore the normal structure of the musculoskeletal system, as well as the hip structure.

conservative

Treatment (traditional) of congenital hip dislocation is prescribed at any stage of deformity. If dysplasia was diagnosed in the first days of a baby's life, a highly effective method of the so-called wide swaddling is used. This technique is most effective only at the initial stage of the development of the disease.

The steps of the procedure are:

the baby needs to be laid on its back;
between his legs put a roller of two twisted diapers so that the baby cannot squeeze the limbs;
the roller between the legs should be fixed on the stomach with the help of a third diaper folded in the form of a triangle.

Wide swaddling allows you to spread the baby's legs to the sides, as well as restore the necessary anatomical position of the hip head.

Therapy at later stages is carried out by applying a correctly selected corrective splint, thanks to which the baby's legs are kept in an anatomically correct form.

The limbs are abducted and fixed in the hip and knee joints. This makes it possible to compare the femoral head with the acetabulum and stimulate the formation of a full-fledged articular structure.

The essence of conservative therapy of patients, given congenital dysplasia, is that the following orthopedic structures are used:

Tire Volkova - is a plastic apparatus, consisting of a kind of
cradle, upper and side elements designed for the lower extremities.
Pavlik's stirrups are a soft textured device with a bandage for the chest and lower legs, connected with special clamps.
Tire Vilensky - looks like belts connected by a spacer.
Frejka tire - used simultaneously with wide swaddling, helps to keep children's legs in a divorced state.
Tubinger's orthosis is a system that is a cross between Pavlik's stirrups and Vilensky's splint.

An additional method of traditional treatment is the use of physiotherapy. One of the effective methods is therapeutic massage. But parents should remember that all sessions are carried out exclusively by an experienced massage therapist and as prescribed by a doctor.

Surgical

The operation on the joint brings a positive effect only if it was performed before the child is 5 years old. Later intervention is considered less effective.

All operations performed for articular dysplasia are divided into two types:

intra-articular;
extra-articular.

It is recommended to treat the congenital form of the disease in young patients under the age of 16 through intra-articular surgery. The main task of the surgeon is to deepen the acetabulum with the most sparing methods.

Treatment of adolescent and adult patients is carried out through extra-articular surgical procedures aimed at creating an anatomically correct system of the acetabular recess.

The main types of surgery for congenital hip deformity:

The method of reduction of dislocation of the open type - consists of dissection of the tissue and the capsule in the joint area, as well as the necessary reduction of the acetabular head.
Surgical manipulations on the pelvic bones - have several varieties, which are accompanied by the creation of a special emphasis on the femoral head so as to prevent its subsequent displacement.
Osteotomy - this is the name of the operation for dissecting the skin, as well as giving the femur the correct anatomical shape.

In the most advanced cases, accompanied by severe pathologies of functioning and flexibility, hip arthroplasty is used.

Forecast

To prevent congenital dislocation of the hip joints, parents need to remember a few simple but very important recommendations:

In the presence of a hereditary tendency to deformity, check the hip joints of the newborn every 3-4 months by ultrasound.
As soon as possible after the birth of the baby, undergo an examination by a pediatric orthopedist, and also do not forget about systematic preventive examinations.
The expectant mother needs to carefully monitor the course of pregnancy, if you have any questions or problems, contact your gynecologist.
Physical therapy classes, which are carried out, starting from the age of the first days of the child.
Parents should carefully ensure that if a hip joint deformity is suspected in a child, the risk of increased stress on the limbs is excluded.

Obtaining positive results from therapy is possible only if it was started at the earliest stages of development, that is, in the first days of a newborn's life.

This surgery is fraught with serious complications, as well as a long recovery period. It is for this reason that the main task of the parents of each child is the early detection of pathology, as well as its treatment from the first days of the baby's birth.

The elimination of hip dysplasia in childhood or adolescence is a rather serious problem, since it does not always bring positive results and can lead to complications that are dangerous for the health of the musculoskeletal system.

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Dislocation of the hip is an injury that is characterized by the displacement of the articular surfaces relative to each other and the exit of the bone beyond the boundaries of the articulation, provided that it is intact. Dislocation is manifested by limitation of motor function and manifestation of pain syndrome. This damage can be congenital or acquired.

Acquired dislocation occurs as a result of intense traumatic impact. And congenital trauma manifests itself even in the period of intrauterine development or during childbirth. Acquired damage is easier to treat than congenital anomalies, provided timely treatment.

In the article, you will learn everything about dislocation, preluxation and subluxation of the hip joint in children and newborns, as well as about the symptoms and treatment of injury.

Reasons for the development of dislocation in children

Physicians distinguish several types depending on the nature of its occurrence:

Traumatic. The joint is subjected to a characteristic mechanical impact (for example, a strong blow or a fall). Often, after a dislocation, a rupture in the joint capsule is formed. Possible complications - infringement of soft tissues or fracture of bones;
Congenital. This pathology occurs as a result of impaired development of the musculoskeletal system during fetal development. This is the most common type of injury. More about congenital dislocation;
Pathological. A dislocation is the result of severe inflammation that causes destruction of the joints. Trauma occurs as a result of tuberculosis, osteomyelitis, etc. To cure the pathology, it is necessary to treat the underlying disease.

Acquired dislocations occur as a result of a traumatic effect on the thigh or after inflammation of the joint. Congenital trauma is manifested as a result of intrauterine pathologies of development.

The main causes of dislocation:

Strong impact when falling (with a sharp touch of the joint with a hard surface);
A sharp contraction of the muscles during physical impact on the joint or surrounding tissues.

It is these factors that can provoke the onset of the development of a dislocation of the hip joint.

Degrees and symptoms of dislocation

Immediately after the injury, the victim feels severe pain in the hip joint. Other characteristic symptoms of hip dislocation in a child: forced position of the leg, shortening of the injured limb, deformity of the bone in the thigh.

The victim may have difficulty performing passive movements, but at the same time he feels pain and springy resistance. It is impossible to actively move the injured limb.

There are 3 degrees of dislocation of the joint, depending on the displacement of the femoral head relative to the acetabular recess:

Subluxation. The head of the femur moves up and outward, and is located with the acetabular recess at different levels;
Dislocation. The head of the femur is significantly displaced upward and outward, contact between the acetabular recess and the head is lost;
Predislocation. The centering of the head of the hip bone in the recess is disturbed.

The picture shows a dislocation of the hip joint:

In a posterior dislocation, the injured leg will be slightly bent at the knee and turned inward. With posterior inferior injury, the hip joint is deformed. Anterior dislocation is characterized by outward rotation of the limb, flexion at the knee and hip joint. In case of anterior-upper and pre-lower damage, the gluteal part is flattened. Only in the first case, the femoral head is displaced from the coxofemoral artery outward, and in the second - inwards.

Often, with a dislocation of the hip, part of the acetabular recess is torn off, and the cartilage of the head is damaged.. With a posterior inferior injury, the sciatic nerve is damaged. Anterior dislocation threatens with infringement of the femoral vessels, and pre-lower dislocation - damage to the obturator nerve.

With a long-standing dislocation, the clinical picture is not so bright. The pain gradually decreases, the deformation and shortening of the injured leg is compensated due to the inclination of the pelvis. As a result, the curvature of the lumbar spine increases and lordosis appears.

Diagnostic Measures

If you experience the first signs of a dislocation of the hip joint, you need to see a doctor. The specialist will conduct the necessary studies, establish an accurate diagnosis and prescribe competent treatment.

Ultrasound examination of the hip joint will help to identify the pathology. This is a safe and reliable way to detect any degree of injury. If a dislocation of the hip is suspected in children, doctors recommend conducting an examination in order to identify the injury as early as possible and begin treatment.

For patients from 3 months old, an x-ray of the hip joint is performed, which will help to identify subluxation, dislocation or pre-luxation of the hip in a child.

Although it is quite difficult to identify an injury at an early stage, since it manifests itself with hidden symptoms. An x-ray will help make an accurate diagnosis.

An x-ray will reveal a violation of the development of the hip joint and the placement of the femoral head in relation to the acetabular recess.

The main indicator of the stability of the hip joint is the angle of inclination of the apex of the acetabulum. The steeper it is, the more securely the joint is fixed. This indicator will help you choose the most appropriate method of treatment and prevention of hip dislocation.

Conservative treatment

Treatment of dislocation of the hip joint is carried out by a conservative and surgical method. In the first case, orthopedic constructions are used to restore the damaged joint, which correctly fix the femoral head in relation to the pelvic bone. As a result, the joint develops normally.

Methods of conservative treatment of congenital hip dislocation in children:

With timely detection, dislocation and other pathologies of the hip joint can be avoided.

In order for the treatment to be quick and painless, you need to diagnose the problem as early as possible. If you suspect a dislocation, you should consult a doctor who will prescribe an ultrasound or x-ray.

Surgery

If conservative treatment is unsuccessful, then surgical therapy is performed. Operative correction allows to reconstruct the hip joint. This method of treatment is more suitable for older children.

In this way, surgery is appropriate in the following cases:

Conservative treatment was not effective;
Hip dislocation was diagnosed late, and therefore surgery is indispensable.

The decision on the choice of surgical intervention is made by the attending physician based on the studies performed. Sometimes a single procedure is needed for recovery, and in more complex cases, a series of operations is necessary to help restore the hip joint.

Methods of surgical treatment:

closed reduction. During the procedure, the doctor manipulates the injured limb to bring the femoral head back into the acetabulum. In some cases, the tendon in the groin area needs to be enlarged to fit the femoral head into the socket. For this purpose, a cast is applied to the patient (on both limbs, on 1 leg and half of the second, or completely on one limb) to stabilize the tendons and ligaments. After 6 weeks, the cast is removed and the child is examined under anesthesia. If the joint is still not stable, then the cast is reapplied;
Tenotomy is a procedure during which tendons are lengthened;
An open reduction is a procedure in which the head of the femur is placed against the acetabulum. During the procedure, tendons and joint capsules are separated and lengthened. At the moment of stability of the hip joint, the leg is placed in the correct position. Open reduction is carried out only after the appearance of the bone nucleus (the femoral head has been transformed from cartilage into bone);
A rotational osteotomy is a procedure in which the femur is realigned to make it more stable. The thigh is destroyed under the articular head and deployed so that it takes the correct position. Metal plates make the joint more stable;
Pelvic osteotomy. The main goal of the operation is to reshape the pelvis by deepening the cavities and using bolts and bone grafts;
An arthogram is used if Splinter was not effective or the dislocation was diagnosed at an older age, when this method is too late to use. The patient is examined under anesthesia, while an x-ray of the joint is taken. After that, the surgeon decides whether a closed or open reduction will be performed.

After the artogram, the patient is put in a cast and discharged. After surgery, he will have to stay in the hospital for several days.

Rehabilitation after surgery

Physiotherapy during the treatment of dislocation allows you to speed up recovery. It helps to strengthen ligaments, muscles, improve blood circulation, restore tissue elasticity and motor function.

A special place in the rehabilitation period is occupied by physiotherapy exercises, which are carried out in several stages:

Stage I - the patient performs light exercises that prevent muscle atrophy. The following exercises allow you to maintain mobility in the hip joint. They are carried out only if there are no serious injuries to the muscles and ligaments;
Stage II is designed to restore the motor function of the joints and normalize their work. During this period, the patient performs active and passive exercises. If the doctor allows, then the load can be increased by including exercises with weight lifting and swimming in the complex;
Stage III consists of exercises for strength and endurance. The patient is engaged in the simulator, runs, performs special exercises.

With an abnormal dislocation, the victim performs light flexion / extension of the legs at an angle of 90 °. Then he gradually moves to spreading, reducing and rotating movements.

Massage for hip dislocation stimulates metabolism in tissues, prevents their atrophy, strengthens muscles, and restores motor function. Manual therapy is used 24 hours after the bone is set. During the procedure, the specialist massages the healthy area of the hip joint. Over time, the area of massage exposure can be increased, approaching the affected area. Then you need to gently massage those muscles that were injured during the dislocation.

The masseur performs stroking, squeezing (elbows) and kneading (fingers) movements. When pain occurs, reduce the intensity of pressure. One session lasts 5 minutes.

If the massage does not cause pain, then you need to perform concentric stroking movements, sharp tweaks and squeezing. In addition, the specialist supplements the procedure with beak-shaped rubbing of the damaged area with the palm of his hand.

Consequences and complications

Most often, during a traumatic dislocation of the hip joint, blood vessels are damaged, which saturate the femoral head with nutrients. As a result, its aseptic necrosis develops (the tissues of the articular head die due to circulatory failure). The disease is accompanied by pain, the patient is practically unable to move independently. In this case, you can not do without hip arthroplasty.

Besides, during an injury, the sciatic nerve may be pinched, which is located next to the hip joint. This complication is manifested by pain in the back of the limb, movement disorders, sensitivity of the injured limb, up to paralysis (when a nerve is ruptured). The skin dries out, ulcers appear.

If the displaced head of the femur compresses the blood vessels, then blood circulation in the leg is disturbed. It is important to eliminate the injury as early as possible, otherwise, after a while, the bone tissue will begin to die.

When the obturator nerve is damaged, the development of the muscles on the inside of the thigh is disrupted.

Congenital dislocation of the hip joint in children

According to statistics, 3% of newborns are diagnosed with congenital dislocation of the hip. This pathology occurs as a result of a violation of the development of organs and tissues, when the hip joint is not properly formed in the 1st trimester of pregnancy. Dysplasia often occurs due to a genetic predisposition.

Congenital dislocation of the hip in children may occur due to an increase in the concentration of oxytocin in the mother. This hormone provokes hypertonicity of the femoral muscles of the embryo, which causes subluxation. Also, a dislocation of the hip occurs due to an incorrect intrauterine position or difficult childbirth.

Newborns are treated in two ways - conservative and surgical. In the first case, the treatment is carried out using orthopedic structures, which are selected separately for each patient. It is best to start treatment from the first days of life, then the femoral head will quickly get into the articular cavity.

Surgical intervention is necessary when the conservative method was ineffective or 3 months after the birth of the baby. In addition, the operation is performed if the subluxation has transformed into a dislocation.

Sometimes both hip joints are damaged in children.. If untreated, the subluxation turns into a dislocation, and then the femoral head comes out of the acetabular recess. A newborn is not able to crawl, walk, and, having matured, limps. Therefore, noticing something was wrong, you need to immediately take the baby to the hospital to clarify the diagnosis and begin treatment. Otherwise, the child may remain disabled.

Congenital dislocation of the hip joint occurs in 3% of newborns, female infants suffer because of this pathology five to ten times more likely than male infants.

Malfunctions in the development of the hip of one leg are diagnosed twice as often as bilateral ones.

Congenital dislocation of the hip is considered the most severe form of hip dysplasia arising from failures in the intrauterine development of the acetabulum.

Dislocation of the hip due to the underdevelopment of the elements of the hip joint occurs even before the birth of a child or in the very first days of life.

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Types and degrees

Anatomical pathologies in dysplasia:

failures in the process of intrauterine development of the acetabulum: it decreases, becomes less cup-shaped and cannot perform its functions well;
ligaments are underdeveloped and weak, their length may differ from normal;
underdevelopment of the cartilage roller surrounding the acetabulum.

Degrees of hip dysplasia:

Dysplasia

Some time ago, dysplasia was not treated and was not considered a disease.

preluxation. There are stretching of the joint capsule, displacement of the head of the femoral bone, which can still return to its place. Anterior dislocation has a high chance of becoming a dislocation or subluxation.

Subluxation. There is a displacement of the femoral head, it also displaces the cartilaginous roller that surrounds the acetabulum. The presence of a subluxation does not prevent the baby from developing and walking, but he may subsequently begin to limp if he does not receive special treatment.

Dislocation. Complete displacement of the head of the joint in the joint capsule: it is located outside, above and outside. The upper part of the cartilage roller is pressed by the femoral head and is located inside the joint. There is tension and stretching of the ligament of the femoral head and joint capsule.

hip dysplasia. The femoral head is small, antetorsion is observed (a pathological change in the angle of the femoral neck and head in relation to the condyles);
acetabular dysplasia. The acetabulum has a small size and a changed shape, there is an underdevelopment of the cartilaginous ridge;
rotational dysplasia. A rare pathology in which the entire limb is turned inward, clubfoot may develop in the future.

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Causes

Experts cannot currently give a clear answer to the question of why this pathology occurs. But there are certain patterns in which the likelihood of developing certain deviations increases:

The highest incidence of dysplasia in Caucasian children, whereas in children of the Negroid and Mongoloid races, it practically does not occur.
In infants female this deviation is diagnosed more often.
Malnutrition of a woman during pregnancy, devoid of a sufficient amount of nutrients, can lead to the fact that the child's skeletal system cannot develop well enough.

Heredity also has its influence. If one of the parents had dysplasia, the child may also develop it.

tight swaddling contributes to the displacement of the head of the joint, so modern pediatricians recommend swaddling the baby more freely.

Risks increase with a variety of complications during pregnancy: infections, incorrect position of the child during childbirth.

Read more about the symptoms and treatment of arthritis in children here.

Clinical picture

Symptoms of dysplasia are detected by orthopedic specialists in the process of examining a newborn.

The child's legs are of different lengths. To notice this, you should lay the baby on his back, and bend his legs and put the soles on the buttocks. If it is noticeable that his knees are not at the same level, then this indicates that the length of the legs is not the same.
Skin folds are asymmetrical and have different depths. In the normal state, they are symmetrical, their depth is the same on both sides, if there are deviations, then this may indicate the presence of pathology. However, this examination is not accurate enough, as in many newborns the folds are asymmetrical and become the same over time. With bilateral dysplasia, this method of examination is also ineffective.

Slipping symptom, also called "click" symptom. It is considered the most effective method for detecting pathology. The child should be laid on his back, and his hips should be spread in different directions, by 80-90 degrees. The leg with the affected hip will have limited mobility, and the doctor will be able to feel a click: the sound of the femoral head repositioning. If the leg is released, it will return to its original state, and the femoral head will pop out again.

This method will only be useful up to a certain age of the newborn: two to three weeks.

Diagnostics

Newborn babies should be carefully examined by pediatricians. In most cases, the pathology is detected by them, and the child is sent to orthopedist.

The orthopedist examines the baby and, if necessary, also gives a referral for additional research, usually Ultrasound and x-ray.

ultrasound- a completely safe method of examination, but at the same time it does not give such details as can be seen with x-rays. It is well suited for preventive examinations and for monitoring the condition of the joints during treatment.

radiography carried out in cases where it is necessary to confirm the diagnosis.

How to correct the asymmetry of the face in the baby? Pediatric recommendations can be found on our website.

Complications and consequences

If the child does not receive the necessary treatment in infancy, then in the future he will have a variety of complications.

Children with advanced hip dislocation have problems with gait, lameness, they get on their feet much later than healthy children. They also have higher risk of developing scoliosis. Joint pain is rare, but can also occur.

Older age is more likely to develop dysplastic coxarthrosis, this disease is accompanied by severe pain and can lead to disability, as the joint gradually collapses and ceases to perform its functions.

In the later stages, this disease is treated surgically: joint is replaced with a prosthesis. This operation is expensive, and every ten to twenty years it must be repeated, since the prosthesis also becomes unusable over time.

Treatment Methods

Dysplasia in the first three months of life successfully treated with conservative methods Therefore, parents should remember that the health of the child depends only on them.

The sooner they begin treatment, the less likely it is that he will develop complications later on, which will be much more difficult to manage. It is best to start therapy in the first weeks of life.

Conservative treatment includes the following methods:

Wide swaddling. The diaper (or two diapers) is folded and placed between the bent and divorced legs of the baby. This is necessary to fix his legs in the correct position. Another fixing diaper is placed on top. Toddlers tolerate this method easily and quickly begin to hold their legs as they should.

Physiotherapy. Exercise complexes are used for children under three years old and are selected individually by an orthopedist. Usually they include exercises to strengthen the muscles of the legs and abs, crawling, different types of walking, breathing exercises. This helps the formation of the joint.

Pavlik's stirrups. Orthopedic tissue construction that fixes the baby's legs in the correct position for correction. The orthopedist first puts them on the newborn, who determines the desired level of fixation and gives recommendations to parents on how to put them on.

This design is good for its cheapness, comfort for the newborn and practicality. It is used from three weeks after birth.

Freyka pillow. This design is a roller made of soft material, with the help of which the baby's legs are fixed in the desired position, often has straps that facilitate fixation. It is put on the baby daily for a certain period of time (from twelve to twenty-four hours), use begins from the first month of life.

Spacer tires. Just like other orthopedic structures, spacers fix the baby's legs in a divorced state and are worn for a long time. They have a variety of types and shapes. The Tübinger tire is the most commonly used, it is the most practical, comfortable and efficient.

Physiotherapy used in conjunction with other therapeutic measures, improves blood circulation and normal joint formation. Usually, such physiotherapeutic procedures as electrophoresis (with calcium, with iodine), warm baths, ultraviolet therapy, ozokerite therapy are prescribed.

Massage It is carried out in courses, promotes the reduction of dislocation, strengthens muscles and ligaments and is often used in combination with other procedures. Must be carried out by a special children's masseur. Parents are allowed to do only simple types of massage, including light stroking and rubbing, which will not harm the baby and help keep the muscles in good shape.

Surgical treatment children under one year of age are extremely rare and only in cases where conservative methods of treatment have shown low efficiency.

Read about the treatment of bronchopulmonary dysplasia in preterm infants here.

Forecast and prevention

With the timely start of treatment and compliance with all prescriptions of the orthopedist complete recovery of the baby occurs by one or two years.

Prevention of dysplasia should begin at the very beginning of pregnancy.

The expectant mother should carefully monitor her health, consult a doctor in time, eat right, walk more often and lead a healthy lifestyle in order to the likelihood of developing this defect was minimized.

When the baby is already born, certain rules should be followed so that his joints are normal and develop well, the key ones are the rejection of tight swaddling, due to which the legs are in the wrong position, using larger slings and diapers, conducting preventive courses of massage and gymnastics.

Timely diagnosis is also important, so parents should not miss routine examinations of the child and, at the slightest suspicion, consult specialists.

Despite the duration and difficulty of treatment, the chances of a full recovery are extremely high, and the child, having matured, will not even remember the problems with the joints that he once had.

You can learn about the causes and consequences of a dislocation of the hip joint in newborns from the video:

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Hip subluxations are most common in the younger population in the age range of 0 to 25 years. During this period, the skeletal system continues to form, and there is a risk of developing a mismatch between the parts of the joint. Hip subluxations occur in only 2-3% of practical cases of loss of congruence between surfaces. But it is difficult to recognize the pathology, due to the poor severity of symptoms.

If subluxation of the hip joint is not detected, it will be followed by a violation of the blood supply to the structures, the development of necrosis of the femoral head.

A person will lose the functionality of the lower limb, become disabled.

What is hip subluxation

Anatomical image of a subluxation of the hip joint

A subluxation of the hip joint is an injury that involves an incomplete loss of congruence (conformity) of the articular surfaces. The head of the femur fragmentarily extends beyond the articular, acetabular cavity. This phenomenon occurs only with certain movements or diseases of the body. At the same time, some articular surfaces are still in contact with each other, and the capsule does not lose its integrity, but stretches a little.

Hip subluxations, unlike complete dislocations, can be pathological and not just traumatic. They are more difficult to recognize, since this type of injury can disappear on its own, through self-management. Symptoms are less pronounced than with complete dislocations.

Causes in adults and children

Subluxations in adults, older than 25 years, occur due to pathological processes of bone structures. Traumatic types occur rarely, mainly in athletes, with intense, but incorrect loads on the lower limbs. Rare trauma is explained by a large range of motion (along three axes), as well as a deep acetabular fossa and its protection by the muscular frame and ligaments.

Traumatic situations occur if the limb was bent, brought to the body and somewhat turned inward. Then the subluxation of the head of the hip joint will occur back. If the leg is in a flexed but turned outward position, the head of the bone moves forward. If the traumatic factor was small, traumatic subluxation is possible. The situation also occurs when falling on the lower limb, or during an accident.

Pathological subluxation of the hip joint in adults is formed in 2-6 months against the background of concomitant pathology. The following diseases increase the risk of subluxation:

reactive arthritis;
arthrosis;
ankylosing spondylitis (Bekhterev's disease);
bursitis and synovitis of the joint.

In children The main cause of hip subluxation is congenital structural dysplasia. Dysplasia occurs due to underdevelopment of the femoral head, acetabular fossa, and other congenital malformations of bone tissue. Influence is exerted by birth trauma, presentation of the child, as well as genetic changes (Marfan syndrome with impaired skeletal formation, Ehlers-Danlos with impaired collagen synthesis).

Subluxation of the hip joint in children occurs due to improper (tight) swaddling, a small stroller. If a child takes unnatural positions, starts walking incorrectly, the load on the axis of the limb changes. Then subluxation develops, which progresses to a full-fledged dislocation of the hip joint. This phenomenon is dangerous from 3 to 12 months of life.

Types and stages

There are hip subluxations traumatic(sharp) and pathological(chronic). At the age of 0 to 25 years, traumatic types predominate, and in older patients, pathological ones.

Subluxations of the hip joint are congenital And acquired. If the subluxation is acquired, then in 95% it is unilateral. If the pathology is congenital, then it can be bilateral in 75%.

Subluxation of the hip joint in children is the third stage of hip dysplasia. Read more about congenital pathology here.

Clinical classification based on the position of the displaced femoral head is less commonly used. It is similar to complete dislocations, but the degree of displacement of the structures is less. Allocate posterior-superior, anterior-superior, gluteal, suprapubic, obturator subluxations of the hip joint.

Symptoms

In adults subluxation of the hip joint is manifested by smoothed symptoms. Sometimes the patient himself does not suspect the presence of a pathology, especially if he leads an inactive lifestyle.

A number of clinical signs indicating a possible displacement of the articular surfaces:

Soreness of a dull or aching nature in the hip joint, sometimes radiates (gives off) to the pelvic organs. Feelings are enhanced with high-amplitude movements, swinging the legs.
Clicking and crunching during abduction or adduction of the leg to the body.
Lameness when walking.
Slight swelling, redness in the hip joint. Decrease in limb length, noticeable only when measured with a ruler (rare symptomatology).

In children symptoms depend on age. If subluxation is diagnosed before the age of one year, then it can be seen visually. The symmetry of bone structures changes (different levels of the patella, ankles), folds under the buttocks and on the hips. The position of the child's leg in a calm state will be somewhat unnatural. But pain or other discomfort with subluxation of the hip joint will not be observed. In the supine position on the table, the baby will have only one thigh touching the surface.

In children older than one year, posture is disturbed. Gait with bilateral pathology becomes "duck" (shaky), the child limps. A positive Trendelenburg symptom (weakness of the middle hypogluteal muscle) appears. Read more about the symptoms in children of different ages in this material.

Diagnostics

In adult patients, subluxations are not determined by palpation (by touch). The head rarely moves so much. It may extend somewhat beyond the Roser-Nelaton line (connecting the anterior superior pelvic spine to the gluteal hump). But this is not a reliable sign of subluxation of the hip joint.

Subluxation of the femoral head on x-ray

To verify the diagnosis, radiography pelvis with the capture of the femur. The head and acetabular cavity are well visualized under the rays. Sometimes an additional lateral view is taken to better show the direction of head displacement. Other methods are not performed due to the good information content of X-ray diagnostics. Additionally, you can measure leg length. The affected limb will be shorter, but not more than 0.5 - 1 cm, in 70% of cases the length will not change at all.

In children, an x-ray of the joint is also performed, but with other landmarks in the picture, calculations of the angles between the neck of the bone and the acetabular cavity. Additionally performed ultrasound hip joint. It is also important to examine, collect a birth history, measure the length of the limbs.

Treatment

In adults with subluxations of the hip joint, the following is prescribed:

treatment of the underlying disease in the case of a pathological process;
conservative therapy with further fixation of the joint;
surgery (with the ineffectiveness of conservative methods);
rehabilitation and exercise therapy.

The underlying disease is most often managed by a rheumatologist, which involves taking glucocorticoids (Prednisolone, Dexamethasone), NSAIDs (Diclofenac, Indomethacin, Celecoxib).

In children conservative methods are used, different types of joint fixation (tires, stirrups). The peculiarity lies in the fact that in the first year of life, no one sets the child's joint. Doctors are waiting for results from Schneiderov's splint, Freik's pillow, and Pavlik's stirrups. After two years of age and ineffective conservative therapy, surgery (closed or open reduction) can be prescribed. Dispensary observation for three years of children with this developmental pathology is underway. Read more about all the methods of treating hip subluxations in a newborn and a child aged 1–3 years, read here.

In children with cerebral palsy Treatment of hip subluxation requires more thorough fixation techniques. It is more difficult for them to diagnose subluxations, the instability of the joint develops faster. Dislocations can be traumatic, supplemented by a spastic muscular component. They prevent the child from learning to walk and even sit down. The hip joint requires rigid methods of fixation for 9 months with a device if the pathology was revealed at birth. If subluxation of the joint was diagnosed after a year, reduction under anesthesia and a plaster coxite bandage for 9 months is necessary. To consolidate the result, the Gnevkovsky apparatus is used.

Conservative (initial) methods

In adults, before conservative methods of treatment, it is necessary to provide first aid. Especially if it is an acute traumatic case. The algorithm of actions is as follows:

Anesthetize the affected area. You can drink a tablet of Ketanov, Analgin, Nimesulide, Baralgin. It is recommended to make an intramuscular injection of an anesthetic or NSAID, but in a healthy buttock. Diclofenac, Celecoxib are suitable for these purposes.
injured limb fix, fastened to a solid board (tire), or to a healthy leg. to the affected area apply an ice pack.
Take the patient to the emergency room.

Further treatment of subluxation of the hip joint is to reduce the head of the bone. Actions take place under local anesthesia using the Kocher or Dzhanelidze method.

Kocher method

Reduction method according to Kocher

The patient's position is supine. The traumatologist's assistant fixes the victim's pelvis by pressing it against the table. The surgeon flexes the lower leg and thigh so that they are at 90 degrees to each other. Then, with increasing force, pulls the thigh up, slightly turning it outward. After approaching the femoral head to the acetabulum, the surgeon corrects the subluxation with smooth movements, which is accompanied by a slight click.

Janelidze method

The affected limb of the patient hangs freely from the table, and the person himself lies on his stomach for 10 minutes to relax the muscles. The pelvis does not go beyond the edge of the table. The traumatologist flexes the injured limb at the knee joint to a right angle, slightly abducts and rotates the thigh outward. Then, with his knee, he rests against the back surface of the upper third of the patient's leg, and the thigh pulls down and makes circular movements with it. The head of the bone thus falls into place with a slight click. It should be located on the Roser-Nelaton line.

Subspecies of coxite dressings

The joint after reduction is fixed with special coxite plaster bandages for 3-4 weeks. The correctness of the actions is controlled by x-rays. During the year, the patient is followed up in a dispensary to prevent complications of the injury.

In children conservative treatment consists in wearing preventive panties, as well as Freik pillows or Pavlik stirrups. This must be done daily for at least three months. Then a control x-ray is taken. After reduction of the subluxation, for prophylactic purposes, they wear a Schneiderov splint until the age of six months.

In case of detection of subluxation from the age of one year and older, the hip joint is adjusted by closed methods (according to Lorenz or Goff) under anesthesia. Then the child is put in a plaster cast for a period of 6 to 9 months. Read more about all the methods of treating subluxation of the hip joint in children here.

Surgical correction

Surgical correction of subluxation of the hip joint is indicated in case of failure of conservative treatment, with severe degenerative changes in the articular surfaces. If the acetabular cavity is deformed, or the femoral head is changed, surgery is necessary - joint replacement.

In endoprosthetics, both the surface of the head and the surface of the cavity are replaced. They use metal alloys with nickel, zirconium, expensive ceramic structures. The operation lasts for three hours. The service life of the endoprosthesis is up to 25 years.

Operative interventions for open reduction of subluxation of the hip joint are performed less frequently.

Complications

The complications of trauma are in the transition of hip subluxation to hip dislocation. It's harder to put him in. In addition, the pathology may be accompanied by a gradual destruction of the bone structures of the articulation parts (femoral head and acetabular cavity). This leads to chronic pain, the impossibility of full movement. Inflammation of the joint develops (primary or secondary), called coxarthrosis. In the future, coxarthrosis leads to immobilization of the hip - ankylosis.

Osteonecrosis of the head of the bone on x-ray

After reduction, there may be a violation of the blood supply to the femoral head. This phenomenon leads to aseptic (non-bacterial) necrosis of the bone structure and surrounding tissues. Movement of the lower limb becomes impossible, which leads to disability at any age of the patient. In children, the posture is disturbed, the proportional development of the remaining parts of the skeleton.

conclusions

Key points to take into account:

Subluxation is more common before the age of 25 years.
In the older generation, subluxation is a complication of concomitant pathology, which is formed gradually.
It is not difficult to diagnose subluxation, it is more difficult to suspect it due to the blurring of the clinical picture.
Difficulties in performing hip movements, clicks when abducting the leg are the first alarming symptoms.
In children, the injury should be treated until the first year of life, until the child begins to walk.
Subluxation after reduction requires observation for a year, in case of frequent recurrences - surgical intervention.