Congenital dislocation of the hip joint in newborns is rare (in 0.5% of cases). The disappointing statistics also lies in the fact that most often such problems are observed in girls. If we are talking about adults, then they most often get dislocations of this type against the background of injuries. For example, a typical situation when a car gets into an accident, most often the passenger in the front seat hits his knees on the dashboard. When the leg is in a bent position, the vibration easily reaches the femur, causing it to move backward. In addition, often such injuries occur due to a fall. In this case, the elderly are most often affected.
However, doctors have to treat the little patients the most. If therapeutic measures are not taken, then with congenital dislocation of the hip joint, the consequences in adult children will be much more serious. Therefore, it is worth learning more about this pathology and understanding what methods exist for it.treatment. The success of the restoration of functions will depend on this.
Congenital dislocation of the hip joint according to ICD 10
Dysplasia of this type can develop in babies, even while they are in the womb. Pathology is characterized by displacement of the femoral joint of the fetus, against which it begins to form in the wrong way.
Congenital dislocation of the hip joint according to ICD 10 is indicated under the number Q65.2. This pathology refers to anomalies. Against the background of improper development of the bone, it takes the wrong place, which leads to numerous problems after the birth of the baby.
Today, there are no methods that would allow diagnosing this anomaly even during a woman's pregnancy. Ultrasound is not able to show such high detail so that the doctor can note the appearance of a defect. Therefore, usually the anomaly goes unnoticed until delivery.
Varieties
Such dislocations (congenital hip dysplasia) do not develop overnight. Certain stages pass, which are characterized by different manifestations of the anomaly. Dysplasia can differ in its symptoms and severity. Based on this, doctors distinguish several phases in the development of this unpleasant pathology:
- The period of dysplasia. In fact, this is the initial form of the disease. In this case, as such, dislocation is not observed. However, an experienced specialist will be able to notice the first "bells" indicating the beginning of an undesirable process. First of all, with congenital dislocations of the hip joints, asymmetry of structures appearship apparatus.
- Stage of subluxation. During this period, there is a fairly easy abduction of the head and neck of the femur to the sides. However, after that, the bone independently returns to its original, correct position. However, this stage should by no means be ignored.
- Stage of subluxation. In this case, a more serious change in the hip head occurs. Deformations can be observed both on the top and on the side. Additionally, patients suffer from pain due to severe sprains.
- Dislocation. At this stage, congenital dislocations of the hip joints become even more obvious. There is a so-called slip syndrome. In this case, if the parents begin to spread the baby's legs, they will hear a rather loud crunch in the place where the hip joints are located.
However, these are not all varieties of the manifestation of the disease. There are also additional symptoms. Depending on a particular syndrome, it is easier for a doctor to make a correct diagnosis and start timely treatment. It depends on how quickly the baby can recover and begin to fully develop.
It is noteworthy that even after the birth of a baby with a similar anomaly, doctors do not always manage to notice it. As a rule, this diagnosis is made after a few weeks.
Symptomatics
If we consider congenital dislocation of the hip joint (ICD code 10 Q65.2), then the pathology can manifest itself in the form of multiplefolds. Although they are always present on the baby's legs, there will be noticeably more of them on the affected limb. There is also a rotation of the injured hip, which goes slightly inward. In addition, lameness and clubfoot develop. Adults suffer from severe dull pains, and children begin to cry incessantly. In addition, doctors note the appearance of muscle atrophy.
Much depends on the degree of congenital dislocation of the hip joints. Diagnosing a pathology becomes more difficult, since this zone contains many muscle fibers that hide the affected area.
Doctors identify several main symptoms characteristic of this pathology:
- Instability Syndrome. In this case, congenital dislocation of the hip joint in a newborn is detected before the age of 3 months. For diagnosis, the doctor lays the baby on a flat surface and begins to alternately bend his legs. If he hears a rather loud click, then this indicates the presence of this problem.
- Short leg. With the manifestation of this pathology, one of the limbs is slightly deformed. With the naked eye, such a symptom is difficult to notice, since the baby does not walk yet. In this case, the doctor also lays the newborn in a horizontal position and applies both of his legs to the stomach. If he notes asymmetry in the movement of the hip and a change in its shape, then this becomes a clear sign of congenital dislocation of the hip joint in children.
- The shape of the buttocks. If the baby's ass acquires an X-shape or the specialist notes the deformation of this zone, then he also suspectscongenital pathology. In addition, the doctor pays attention to other features of the appearance of the baby's buttocks. However, the first months of life, all babies have quite a lot of folds. Therefore, before he starts walking, it is not always possible to make the right diagnosis. If the child is already moving independently, then with dysplasia, his gait will be curved.
Of course, the diagnosis of congenital dislocations of the hip joints in children is based not only on a visual examination.
Causes for the development of pathology
Since this ailment is not so common, specialists for a long time did not have the opportunity to fully study it. However, after numerous studies, it was possible to compile an approximate list of problems that can lead to the appearance of such an anomaly.
According to the opinion of doctors and their reviews, congenital dislocation of the hip joint can occur if:
- During the delivery, the obstetricians acted incorrectly or made a mistake.
- The woman's body produced too much relaxin. This hormone begins to be released just before labor.
- During fetal development, the fetus encountered various pathologies.
- The pregnant lady took too many drugs or preferred strong drugs that are not recommended for pregnant women and nursing mothers.
- In the process of carrying a baby, the girl had to face an infectiousdisease.
- It was influenced by the negative environmental situation. For example, if a pregnant woman works in a hazardous industry or does not live in the cleanest region.
- The fetus has been in the so-called breech presentation for a long time. In this case, too much load on his hip apparatus refused, which could not pass without a trace. It can also cause other pathologies associated with improper functioning of the musculoskeletal system.
The cause of congenital dislocation of the hip joint in a newborn may also be that the woman's body had too little amniotic fluid. Severe toxicosis could also provoke an anomaly. Also, mothers who gave birth too early or, conversely, late, face a similar problem. Congenital dislocations of the hip joints can also develop against the background of the fact that the child is too large. For example, alarming symptoms were often noted when the weight of a newborn was about 4-5 kg. However, the normal weight of babies should be significantly less.
Possible consequences
What are the consequences of congenital dislocation of the hip joint in adults and children? This pathology is considered very serious, as it can disrupt the entire musculoskeletal system. Therefore, it is better to start treating the pathology as soon as the first opportunity appears. If this is not done, then the baby may remain disabled or face more serious consequences of congenital dislocation of the hip joint.
Bfirst of all, you need to understand that this ailment has a strong impact on the formation of the musculoskeletal system. Against the background of pathology, children begin to move independently much later than their peers, their gait is also very different. It is called "duck walk". This means that the baby is constantly limping and cannot put the injured leg in the correct position. This can lead to scoliosis.
If the disease is not treated in infancy, it will lead to pathological deformity. Over time, the joint will completely lose activity. A person will have to live with a constant feeling of pain and the manifestation of spasms.
If more gentle treatment is not carried out, then surgery may be required in the future. Since it is very difficult to find a qualified specialist, parents sometimes have to spend huge amounts of money for a congenital dislocation of the hip joint in Germany and other countries.
Features of the treatment of dysplasia in children
Earlier, therapeutic procedures were quite aggressive. For example, doctors practiced the Lorenz method, which consisted in the almost forcible reduction of the affected joint. Of course, this led to incredible pain, so this treatment of congenital dislocation of the hip joint was carried out exclusively with the use of anesthesia. Today, doctors do not dare to take such desperate measures. This is also explained by the fact that it was possible to prove that the Lorentz method not only helps to temporarily solve the problem, but alsoadditionally leads to the appearance of necrosis of the hip joint.
Therefore, it is worth considering more modern methods of solving the problem.
Extension and splinting
Today, orthopedists give more preference to this method of treatment. It is considered the most conservative. Such events, as a rule, are performed even before the baby is six months old. In this case, special orthopedic splints are used or the specialist stretches the affected joint with the help of adhesive traction. Do not be afraid of such a complex name. The advantage of this procedure is that the baby does not lose mobility during treatment. The traction of the affected joint is almost imperceptible for him.
However, before this, the child must take a course of exercise therapy. The hip muscles need to be prepared for subsequent therapeutic measures. After that, splinting is performed. To do this, a special flexible spacer is installed between the legs of the child. It prevents mixing of the joints. These tires come in different designs. The desired type is selected by the attending physician. As a result, the femurs are gradually pulled apart into the desired position.
However, such activities are not always effective. In this case, the methods of stretching with patch traction are used. Such procedures are recommended to be performed before the baby reaches the age of three months (sometimes later).
How older children and adults are treated
If, for one reason or another, therapeutic measures are taken inearly age failed, then in this case is performed:
- Reconstructive surgery. In this case, autografts or allografts are often used.
- Combined method. It involves rough (open) reduction and subsequent reconstruction of the ilium.
- Palliative surgery.
- Capsule arthroplasty.
The last method is most suitable for children under 8 years of age. In this case, the specialist performs a surgical operation, during which part of the layer is removed and the capsule is separated. Due to this, it becomes thinner. The doctor also leaves fibrous fibers. After that, with the help of a capsule, the head of the femur is wrapped. Then it is inserted into the desired cavity so that the previously left fibrous tissue is in contact with its surface.
If we talk about reduction, then these manipulations are more often performed for adult patients. In this case, there are several options for the procedure. For example, reduction can be performed according to the Kocher method. To do this, the pelvic region is securely fixed, and the affected leg is bent at an angle of 90 degrees. The doctor begins to stretch and roll the thigh in, out and to the sides. As a rule, during this not the most pleasant procedure, the thigh independently rises to the correct position and makes a characteristic click.
Some doctors prefer the Morgan method. In this case, it is necessary to fix the patient's hips well with reliable belts. After that, the hip joint is bent at a right angle, and the patient's thighplaced on the specialist's knee. At the next stage, the doctor raises the affected leg of the patient and with an effort (vertical) presses on the thigh.
Surgeries for children over 8 years old
When it comes to children, doctors prefer to first try all the methods of conservative therapy. However, when it does not give serious results, one has to resort to surgical intervention. Children in this age group most often perform:
- Horizontal osteotomy. The doctor uses a proximal iliac bone to create a makeshift roof over the affected femoral head.
- Operation S alter. In this case, a graft is made from the patient's bone crest or donor tissues.
There are also palliative surgeries, which are often used to treat both adults and children. The main task of such a surgical intervention is to preserve the support functions as much as possible and reduce pain for the patient himself. However, don't expect a full recovery. Part of the functions of the TBS will still remain impaired.
Features of hip dislocations in adults
As mentioned earlier, most often such injuries occur due to trauma, accidents, falls from a great height, etc. Often there is a displacement of the hip joint, which additionally leads to:
- Rupture of the posterior cruciate ligaments.
- Injuries to the acetabulum.
- Fractures of the patella.
- Pinched sciatic nerves and more.
Symptomatics in this case can also manifest itself in the form of a visual shortening of the limb. The leg turns slightly inward, which is visible to the naked eye. Also, with any attempt to lean on a sore hip, the patient begins to experience severe pain.
Adults may experience additional symptoms. The knee swells, and ugly hematomas appear on the surfaces of the lower leg and the thigh itself. The person suffers from loss of sensation and other unpleasant sensations.
As already mentioned, if we are talking about an adult patient, then most often the doctor decides to set the affected joint. However, you need to understand that this procedure brings severe pain. Therefore, all manipulations are carried out using anesthesia, muscle relaxants and sedatives. Of course, you should never carry out such procedures on your own. You need to contact an experienced orthopedist and consult with him first.
