Musculoskeletal pathology, such as hip dysplasia, with which the concept of the acetabular angle is directly related, is not a sentence. For several months, these symptoms can be removed by following the recommendations of a specialist. Consider the causes and signs of dysplasia in children and the developmental norms of the hip joints in babies up to a year old, we will provide information on what treatment is used, how to prevent pathology.
Features of the disease
Hip dysplasia is a destructive process during which the ligamentous apparatus that holds the pelvic bone (the largest joint in the human body) develops incompletely or incorrectly.
The head of the femur rests against the pelvic bone at a place called the acetabulum. If any of the elements of the joint is underdeveloped, then there is no proper articulation, as a result of which the ligaments are stretched and the head falls out of the cavity.
Most often with thispathology confront parents of children up to a year. This is due to the fact that the ligaments of the baby are very elastic. This allows him to pass through the birth canal of the mother without consequences. Therefore, in any newborn baby, the immaturity of the hip joint is noted. As soon as he is born, an active articulation occurs, which lasts for one year (more actively in the first month of life). If at this time the joint develops incorrectly, and the acetabular angle deviates more than normal, it is customary to talk about dysplasia.
In 9 cases out of 10, dysplasia affects girls, although there is no exact cause of this pathology. Most often it is associated with the period of the baby in the womb. It is as a result of hormonal changes that most strongly affect a woman in her first pregnancy that the ligaments can be too elastic.
Degrees and types of disease
It is customary to talk about dysplasia depending on the degree of pathology:
- First (pre-luxation) - minor violations that do not lead to displacement of the hip joint, that is, deviation of the acetabular angle from the norm.
- Second (subluxation) - the femoral head is partially out of the acetabulum.
- Third (congenital dislocation of the hip) - the femoral head completely comes out of the acetabulum, and the space that is freed is filled with connective tissue (such a pathology requires immediate treatment - reduction).
Ultrasound can detect minor abnormalities in the development of the joint.
Types of dysplasiahip:
- Acetabular - a pathology that is directly related to the acetabulum.
- Rotary - the bones are not positioned correctly.
- On the proximal part of the femur bone, underdevelopment of the joints is observed.
Adults do not suffer from such a pathology. If in the first year of life there were violations in the development of the hip joint and appropriate therapy measures were not taken, this can affect the normal well-being of an already adult person, up to disability.
Congenital dislocation of the hip
When a joint is inferior, a congenital dislocation of the hip is diagnosed. It is the most difficult and requires immediate treatment. In the absence of therapy, lameness in the child may occur in the future. It is most effective to treat pathology at 3-4 months of a baby's life. It was during this period that it is customary to talk about the norm of the acetabular angle of 3 months. Only a specialist can diagnose a pathology or deviation from normal values.
If the pathology is diagnosed late or the treatment was ineffective, surgery is performed. Lack of timely therapy can lead to the development of coxarthrosis and disability in the future.
According to statistics, congenital hip dislocation occurs in one child out of 7 thousand newborns. It affects girls more often and is unilateral 2 times more often. Since the hip joints are deep, pathology can be diagnosed by indirect signs. Most often this is a limitation of abduction. In a he althy baby, the acetabular angle of the hip jointis 25-29 degrees at birth, and the legs are retracted 80-90 degrees. If the readings are less, it is customary to talk about dysplasia.
Causes of pathology
Modern science cannot say exactly why hip dysplasia occurs. But there are factors that increase the risk of developing pathology:
- First birth. The hormone relaxin, which is produced in large quantities during the first pregnancy, makes the joints more elastic and soft, as if preparing a woman for childbirth, but this affects not only the mother, but also the baby.
- Fetal weight over 3.5 kg. Such a child is considered large. During the passage through the birth canal, the pressure on the hip joints is greater (in this case, the left side suffers more often).
- The birth of a girl. Nature is arranged in such a way that it is the female body that is more plastic, therefore it is more prone to dysplasia.
- breech presentation.
- Hereditary predisposition - more often passed down the maternal side.
Symptomatics
If you notice a deviation from the norm of the acetabular angle only with the help of ultrasound or x-rays, then dysplasia (depending on the degree) can be diagnosed by visual examination. Both a specialist and a mother can do this.
Signs that indicate hip dysplasia:
- The folds on the legs are not symmetrical. They can differ in shape, depth and be located at different levels, which becomes noticeable at the age of 2-3months (deeper than the fold on the side where the dislocation or subluxation is observed). But asymmetry can also be observed in he althy children.
- Thigh shortening. The femoral head is displaced posteriorly relative to the acetabulum. This is a severe form of hip dysplasia that can be tested by laying the baby on its back and bending the legs at the knees. If they are at different levels, the diagnosis is confirmed.
- Marx-Orttolani slip symptom. It is not a direct sign of dysplasia, since 60% of children with such a symptom are absolutely he althy, but it is used as indirect evidence of pathology and only in the first month of life.
- Restriction in hip abduction. Dysplasia is diagnosed if the legs are bred at an angle of less than 80-90 degrees. In a seven-month-old baby, the norm is 60-70 degrees.
Diagnosis
An orthopedist can diagnose dysplasia. Ultrasound is performed, although this is not an accurate diagnostic method for pathology. With it, you can control how the therapy process goes.
Most often, if a disease is suspected, an x-ray is prescribed, which can display a complete picture of the pathology. At the same time, in newborn babies, the femoral bone consists of cartilage, which may not be visible on the x-ray. Therefore, certain schemes and calculations are used.
It is with the help of X-ray examination that the acetabular angle is calculated, that is, the magnitude of the slope of the acetabular roof and its deviation from the norm. But in the first months of a baby's life, such an examination is not carried out. As a preventive practicetherapeutic massages and swaddling.
What is considered normal
If dysplasia or congenital dislocation of the hip is suspected, an X-ray examination is prescribed. Using this method, the acetabular angle is determined, that is, how much the acetabular lid is tilted to the Hilgenreiner line. In the first three to four months of life, his readings are maximum. The optimal angle dimensions can vary between 25-30 degrees. As the child grows older and the body as a whole grows, this angle begins to gradually decrease.
By the year, the angle indicator is already 20-25 degrees, and by 2-3 years - 18-23 degrees. At five years old, an angle of 15 degrees or less is considered the norm.
Normal values and deviations are shown below, according to the Graph table:
- 3-4 months - normal - 25-30 degrees, 1st degree dysplasia (subluxation) 30-35 degrees, dislocation - 35-40, with an angle of more than 40 degrees they say about high dislocation.
- 5 months - 2 years - normal - 20-25 degrees, subluxation - 25-30, dislocation - 30-35, severe dislocation - more than 35 degrees;
- 2-3 years - normal - 18-23 degrees, 1st degree - 23-28, 2nd degree - 28-33, 3rd degree - more than 33.
If the acetabular angle at 1 year old in a baby exceeds the norm, this may indicate congenital hip dysplasia or neuromuscular disorders. The indicator below the norm is typical for babies with Down syndrome and achondroplasia.
Normally, in an adult, the angle varies between 33-38 degrees. Intermediate values include indicators 39 and46 degrees, at 47 it is customary to talk about dysplasia.
Acetabular angles at 3 months
When the baby is 3 months old, the pediatrician sends him for a preventive examination to the orthopedist. Skipping this examination is not recommended, since it is here that much attention is paid to the development of the hip joint. A specialist, after conducting a visual examination, may notice dysplasia. If it is detected in the maternity hospital, the baby is immediately sent to the orthopedist.
The head of the femur, which is not positioned correctly, can move relative to the acetabulum, changing the structure of the joint. This is how pre-luxation, subluxation and dislocation appear, that is, three degrees of dysplasia. The greater the angle of inclination or the acetabular index, the higher the risk of violation of the correct structure of the hip joint in the future.
For example, if normal figures at three months should be 25-30 degrees, then the norm of the acetabular angle at 6 months is slightly lower and varies from 20 to 25 degrees. At the same time, in boys, as a rule, the angle of inclination is a couple of indicators lower than in girls. That is why they are less flexible and plate-like. Often, dysplasia in children is unilateral.
At an early age, the pathology may not manifest itself in any way, so not all mothers notice the deviation. If you determine the pathology in 3-4 months, you can achieve a complete recovery by the least painful method in almost 100% of cases. Therefore, it is important not to miss an orthopedic consultation.
Acetabular angles per year
If dysplasia is not detected in time (before the child reaches the age of one), significant consequences are possible. But even at this age, it is quite difficult for parents to determine violations in the structure of the hip joint. This may be indicated by the following factors:
- Child is 1 year old but not showing any desire to walk or stand up at all.
- The baby is already walking, but at the same time the gait is “duck” (rolls from one side to the other).
- Significantly pronounced lumbar curve.
- Restriction of movement when spreading the legs, asymmetric folds or lower limbs of different lengths.
The norm of acetabular angles per year in children should be 20-25 degrees. In girls, the slope (that is, the angle) is greater than in boys, which depends on the anatomical features of the body. The higher the index, the more pronounced the signs of pathology and the higher the degree of dysplasia.
Treatment
When dysplasia is detected at an early age, for example, with slightly increased acetabular angles at 6 months, conservative therapy is carried out. It consists in the use of special orthopedic devices, with the help of which the child's legs will be fixed in a divorced position. It can be a Frejka pillow, swaddling with two diapers between the legs, Pavlik's stirrups, bandages, Becker panties, elastic splints.
It is also important to carry out therapeutic exercises and special massages, which will not only help strengthen muscles andjoints, but also the improvement of a small organism as a whole. These methods are used at all stages of therapy and during the recovery period.
If severe dislocation is diagnosed (grade 3 dysplasia), coxite dressings, Volkov's or Vilensky's splints are indicated for use. Corrective surgery is also performed if conservative therapy is ineffective.
How to warn
Lack of tight swaddling can reduce the risk of hip dysplasia by several times. Wide swaddling is possible when the baby's legs do not come down. If not, then you can put a soft toy or pillow between them.
Diapers are a good preventive method and a modern helper for parents. They do not allow the legs to close (especially filled ones), which is an excellent prevention of dysplasia. You can also take diapers a few sizes larger.
Carrying backpacks, car seats are also excellent preventive measures. It is worthwhile to undergo an examination on time (no later than the six-month age of the baby). If the problem is not identified and eliminated in a timely manner, in the future the child may develop an incorrect posture and gait, he will experience serious difficulties with the musculoskeletal system.
Conclusion
Dysplasia, which was detected at the age of up to a year, with the observance of therapy measures, in almost 100% of cases ends in a complete cure. It is worth paying attention to the development of your baby and undergoing an examination by an orthopedic doctor in time, who will not onlya comprehensive study, but also prescribe the appropriate treatment.
