Pathology of the musculoskeletal system, such as hip dysplasia, with which the concept of the acetabular angle is directly related, is not a sentence. For several months, this symptomatology can be removed, following the recommendations of a specialist. Consider the causes and signs of dysplasia in children and the norms for the development of hip joints in babies up to a year, 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 defectively or incorrectly.
The femoral head is adjacent to the pelvic bone in 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, parents of children up to a year face this kind of pathology. This is due to the fact that the ligaments of the baby are very elastic. This allows him to go through the birth canal of the mother without consequences. Therefore, any newborn baby has an immaturity of the hip joint. As soon as it is born, articulation takes place actively, 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 the norm, 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 the hormonal changes that most affect a woman in her first pregnancy, the ligaments can be too elastic.
Degrees and types of illness
It is customary to talk about dysplasia depending on the degree of pathology:
- The first (pre-dislocation) - minor disorders that do not lead to a displacement of the hip joint, that is, a deviation of the acetabular angle from the norm.
- The second (subluxation) - the femoral head partially exits the acetabulum.
- The third (congenital dislocation of the thigh) - the femoral head completely leaves the acetabulum, and the space that is freed is filled with connective tissue (such a pathology requires immediate treatment - reduction).
With the help of ultrasound, minor disturbances in the process of joint development can be detected.
Types of hip dysplasia:
- Acetabular is a pathology that is directly related to the acetabulum.
- Rotational - bones are not located correctly.
- At the proximal femur, underdevelopment of the joints is observed.
Adults do not suffer from this pathology. If in the first year of life there were disturbances in the development of the hip joint and appropriate treatment measures were not taken, this can affect the normal well-being of an adult, up to disability.
Congenital hip dislocation
If the joint is inferior, a congenital dislocation of the hip is diagnosed. It is the most complex and requires immediate treatment. In the absence of therapy, lameness in the child may later manifest. It is most effective to treat pathology at 3-4 months of a baby's life. It is 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. More often affects girls and is one-sided 2 times more often. Since the hip joints are deep, the pathology can be diagnosed by indirect signs. Most often, this is a limitation of abduction. In a healthy baby, the acetabular angle of the hip joint is 25-29 degrees at birth, and the legs are 80-90 degrees apart. If the evidence is less accepted 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.
- The weight of the fetus is more than 3.5 kg. Such a child is considered large. During passage through the birth canal, he has more pressure on the hip joints (moreover, the left side suffers more often).
- The birth of a girl. Nature is arranged so that it is the female body that is more plastic, therefore more prone to dysplasia.
- Pelvic presentation of the fetus.
- Hereditary predisposition - more often transmitted through the maternal line.
Symptomatology
If you notice a deviation from the norm of the acetabular angle is possible only with the help of ultrasound or X-ray, then dysplasia (depending on the degree) can be diagnosed by visual inspection. Both an expert and a mother can do this.
Signs that indicate hip dysplasia:
- The folds on the legs are asymmetrical. They can differ in shape, depth and be located at different levels, which becomes noticeable at the age of 2-3 months (deeper than the folds on the very side where there is a dislocation or subluxation). But asymmetry can be observed in healthy children.
- Hip shortening. The femoral head is shifted back relative to the acetabulum. This is a severe form of dysplasia, which can be checked by placing the baby on the back and bending the legs in the knees. If they are at different levels, the diagnosis is confirmed.
- Symptom of Marx-Ortolani slipping. It is not a direct sign of dysplasia, since 60% of children with this symptom are absolutely healthy, but they are used as indirect evidence of pathology and only in the first month of life.
- Hip abduction restriction. 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.
Diagnostics
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 an illness is suspected, an x-ray is prescribed, which can reflect the full picture of the pathology. Moreover, in newborn babies, the thigh bone consists of cartilage, which may not be visible on the radiograph. Therefore, certain schemes and calculations are used.
It is with the help of an X-ray study that the acetabular angle is calculated, that is, the slope of the acetabular roof and its deviation from the norm. But in the first months of the baby’s life, such an examination is not carried out. As prevention, therapeutic massages and swaddling are practiced.
What is considered the norm
If you suspect a dysplasia or congenital dislocation of the hip, an x-ray is prescribed. Using this method, the acetabular angle is determined, that is, how far the lid of the acetabulum is inclined to the Hilgenreiner line. In the first three to four months of his life, his testimony is maximum. The optimal size of the angle can vary between 25-30 degrees. As the child grows older and the body grows as a whole, this angle begins to gradually decrease.
By the year, the angle 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.
Below are the normal indicators and deviations, according to the graph table:
- 3-4 months - the norm is 25-30 degrees, the 1st degree of dysplasia (subluxation) is 30-35 degrees, dislocation is 35-40, with an angle of more than 40 degrees they indicate a 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 - the norm is 18-23 degrees, 1 degree - 23-28, 2 degrees - 28-33, 3 degrees - more than 33.
If the acetabular angle of 1 year in the baby exceeds the norm, this may indicate congenital dysplasia of the hip joint or neuromuscular disorders. The indicator below the norm is characteristic for babies with Down syndrome and achondroplasia.
Normally, in an adult, the angle varies between 33-38 degrees. The intermediate values include indicators of 39 and 46 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 routine 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, having performed a visual examination, may notice dysplasia. If it is detected in the hospital, the baby immediately goes to the orthopedist.
The head of the femur, which is located incorrectly, can shift relative to the acetabulum, while changing the structure of the joint. That is how pre-dislocation, 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 disturbing the correct structure of the hip joint.
For example, if normal values 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. Moreover, 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. Often dysplasia in children is one-sided.
At an early age, pathology may not manifest in any way, so not all mothers notice a deviation. If you determine the pathology in 3-4 months, you can achieve 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 was not detected on 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 identify violations in the structure of the hip joint. The following factors may indicate this:
- The child is one year old, but he still does not show a desire to walk or not to stand on his feet at all.
- The kid is already walking, but at the same time the gait is “duck” (it is being transferred from one side to the other).
- Significantly expressed lumbar bend.
- Restriction of movements when breeding legs, asymmetric folds or lower limbs different in length.
The norm of acetabular angles per year in children should be 20-25 degrees. Girls have a slope (i.e. angle) more than boys, which depends on the anatomical features of the body. The larger the index, the brighter 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 indicators of acetabular angles at 6 months, conservative therapy is performed. It consists in the use of special orthopedic devices with which the child’s legs will be fixed in a divorced position. This can be Frey’s pillow, swaddling with two diapers between the legs, Pavlik stirrups, dressings, Becker’s pants, elastic tires.
It is also important to conduct medical gymnastics and special massages, which will not only help strengthen muscles and joints, but also improve the health of the small body as a whole. These methods are used at all stages of therapy and during the recovery period.
If a severe dislocation is diagnosed (grade 3 dysplasia), coxite dressings, Volkov or Vilensky tires are indicated for use. Corrective surgery is also carried out with the ineffectiveness of conservative therapy.
How to warn
The absence of tight swaddling can reduce the risk of dysplasia at times. Wide swaddling is possible when the baby's legs do not come together. If it doesn’t work, then you can put a soft toy or a pillow between them.
A good preventive method and a modern assistant for parents are diapers. They do not allow the legs to close (especially filled), which is an excellent prevention of dysplasia. You can also take diapers several sizes larger.
Backpacks for carrying, car seats are also an excellent preventive measure. It is time to undergo an examination (no later than the six-month-old age of the baby). If you do not identify and fix the problem in a timely manner, in the future the child may develop improper upset and gait, he will feel serious difficulties with the musculoskeletal system.
Conclusion
Dysplasia, which was detected before the age of one year, subject to treatment measures, in almost 100% of cases ends in a complete cure. It is worth paying attention to the development of your baby and in time to undergo an examination with an orthopedic surgeon, who will not only conduct a comprehensive study, but also prescribe the appropriate treatment.