Congenital dislocation of the hip joint in newborns occurs infrequently (in 0.5% of cases). Disappointing statistics also lie 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 a passenger in the front seat bumps his knees on the dashboard. When the leg is in a bent position, the vibration easily reaches the femur, which leads to its displacement back. In addition, often such injuries occur due to a fall. In this case, older people are most often affected.
Nevertheless, doctors most of all have to treat just small patients. If you do not take therapeutic measures, 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 of its treatment exist. The success of the restoration of functions will depend on this.
ICD 10 Congenital Dislocation of the Hip Joint
Dysplasia of this type can develop in babies, even in the period when they are in the womb. Pathology is characterized by a displacement of the femoral joint, 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 abnormal bone development, it takes the wrong place, which leads to numerous problems after the birth of the baby.
To date, there are no methods that would allow to diagnose this anomaly 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 before childbirth.
Varieties
Such dislocations (congenital dysplasia of the hip joints) do not develop in one day. Certain stages pass, which are characterized by different manifestations of the anomaly. Dysplasia may vary in its symptoms and severity. Based on this, doctors distinguish several phases of 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, no dislocation is 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, an asymmetry of the structures of the hip apparatus appears.
- Stage of subluxation. During this period, a fairly easy abduction of the head and neck of the thigh to the side occurs. However, after this, the bone returns to its original, correct position on its own. Nevertheless, this stage in no case can not be ignored.
- Stage subluxation. In this case, a more serious change in the hip head occurs. Deformations can be observed both on the upper 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 apparent. The so-called slip syndrome is manifested. In this case, if the parents begin to raise the legs of the baby, then they will hear a pretty loud crunch in the place where the hip joints are located.
However, this is not all varieties of the manifestation of the disease. There is also an additional symptomatology. Depending on a particular syndrome, it is easier for a doctor to make the 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 are not always able to notice it. As a rule, this diagnosis is made in a few weeks.
Symptomatology
If we consider a congenital dislocation of the hip joint (ICD code 10 Q65.2), then the pathology can manifest itself in the form of multiple folds. Although they are always present on the baby's legs, there will be noticeably more on the affected limb. Also, rotation of the damaged hip is noted, which slightly goes inside. Additionally, lameness and clubfoot develop. Adults suffer from severe dull pain, and children begin to cry continuously. In addition, doctors note the appearance of muscle atrophy.
Much depends on the degree of congenital dislocation of the hip joints. It becomes more difficult to diagnose the pathology, since in this zone there are many muscle fibers that hide the affected area.
Doctors distinguish several main symptoms characteristic of this pathology:
- Instability Syndrome. In this case, a congenital dislocation of the hip joint in a newborn is detected up to 3 months of age. For diagnosis, the doctor puts the baby on a flat surface and begins to bend his legs in turn. If he hears a fairly loud click, then this indicates the presence of this problem.
- Shortened leg. With the manifestation of this pathology, one of the limbs is slightly deformed. It is difficult to notice such a symptom with the naked eye, since the baby has not walked yet. In this case, the doctor also puts the newborn in a horizontal position and applies both 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 assumes an X-shape or a specialist notes the deformation of this zone, then he also suspects a pathology of the congenital type. In addition, the doctor draws attention to other features of the appearance of the buttocks of the baby. However, the first months of life, all babies have a lot of folds. Therefore, before he begins to walk, it is not always possible to make the necessary 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 visual inspection.
Reasons for the development of pathology
Since this ailment is not so common, specialists have not had the opportunity to fully study it for a long time. However, after numerous studies, it was possible to make an approximate list of problems that could lead to the appearance of such an anomaly.
According to doctors and their reviews, a congenital dislocation of the hip joint may occur if:
- During childbirth, obstetricians acted incorrectly or made a mistake.
- Too much relaxin was produced in the woman’s body. This hormone begins to be secreted immediately before labor.
- During intrauterine development, the fetus encountered various pathologies.
- The pregnant lady took too many drugs or preferred potent drugs that are not recommended for women in position and nursing mothers.
- In the process of bearing the baby, the girl had to face an infectious disease.
- The impact of the negative environmental situation. For example, if a pregnant woman works in hazardous work or does not live in the cleanest region.
- The fetus has long been in the so-called pelvic presentation. In this case, too much load refused to his hip apparatus, which could not pass without a trace. It can also cause other pathologies associated with improper functioning of the musculoskeletal system.
The cause of a congenital dislocation of the hip joint in a newborn may also be that the woman's body had too little amniotic fluid. Strong toxicosis could also provoke the anomaly. Also, mothers who give birth too soon 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 the newborn was about 4-5 kg. However, the normal weight of the babies should be significantly less.
Possible consequences
What are the consequences of a congenital dislocation of the hip joint in adults and children? This pathology is considered very serious, since it can disrupt the functioning of the entire musculoskeletal system. Therefore, it is better to begin treatment of 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 a congenital dislocation of the hip joint.
First of all, you need to understand that this ailment has a strong effect 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 the duck walk. This means that the baby is constantly limping and cannot put his sore foot in the correct position. This can lead to scoliosis.
If the disease is not started to be treated in infancy, then this will lead to pathological deformation. Over time, the joint will completely lose activity. A person will have to live with a constant sensation of pain and cramping.
If you do not conduct more gentle treatment, then surgical intervention may be required in the future. Since finding a qualified specialist is very difficult, parents sometimes have to spend huge sums of money on the operation of a congenital dislocation of the hip joint in Germany and other countries.
Features of the treatment of dysplasia in children
Previously, therapeutic procedures were quite aggressive. For example, doctors practiced the Lorentz method, which consisted in almost violent 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 due to the fact that it was possible to prove that the Lorentz method not only helps to temporarily solve the problem, but also additionally leads to the appearance of necrosis of the hip joint.
Therefore, it is worth considering more modern methods of solving the problem.
Traction and splinting
Today, orthopedists give more preference to this method of treatment. It is considered the most conservative. Such events, as a rule, are carried out even before the baby is six months old. In this case, special orthopedic tires are used or a specialist carries out the extension of the affected joint using adhesive tape 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 extension of the affected joint passes almost imperceptibly for him.
However, before this, the child must undergo a course of exercise therapy. Hip muscles need to be prepared for subsequent therapeutic measures. After this, splinting is performed. For this, a special flexible spacer is installed between the child's legs. It prevents the mixing of joints. Such tires come in different designs. The desired type is selected by the attending physician. As a result, the femur bones are gradually bred into position.
However, such events are not always effective. In this case, methods of stretching with adhesive rods are used. Such procedures are recommended to be performed until the baby reaches the age of three months (sometimes later).
How to treat older children and adults
If, for one reason or another, it was not possible to carry out therapeutic measures at an early age, then in this case it is performed:
- Reconstructive surgery. In this case, autografts or allografts are often used.
- The combined method. It implies a rough (open) reduction and subsequent reconstruction of the ilium.
- Palliative surgery.
- Capsular arthroplasty.
The latter method is most suitable for children under 8 years old. 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, the thigh head is wrapped with a capsule. Then it is inserted into the necessary cavity so that the previously left fibrous tissue is in contact with its surface.
If we talk about the 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 done 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 scroll the thigh inward, outward and to the sides. As a rule, in the process of this not very pleasant procedure, the thigh independently rises to the correct position and emits a characteristic click.
Some doctors prefer the Morgan method. In this case, it is necessary to fix the patient's hips well with reliable straps. After this, the hip joint bends at a right angle, and the patient’s hip is placed on the specialist’s knee. At the next stage, the doctor raises the affected leg of the patient and with effort (vertical) presses on the thigh.
Operations for children over 8 years old
If we are talking about children, then doctors prefer to first try all the methods of conservative therapy. However, when it does not give serious results, you have to resort to surgical intervention. Children of this age category most often perform:
- Horizontal osteotomy. The doctor uses a proximal ileal fragment to create an improvised roof out of it, located above the affected femoral head.
- Operation Salter. In this case, a transplant is made from the crest of the patient’s bone or donor tissue.
There are also palliative surgeries that are often used to treat both adults and children. The main objective of such a surgical intervention is to preserve the supporting functions and reduce pain for the patient. However, you should not wait for a full recovery. Some of the TBS functions will still be violated.
Features of dislocation of TBS in adults
As mentioned earlier, most of these injuries occur due to injury, in an accident, falling from a high height, etc. Often there is a displacement of the hip joint, which additionally leads to:
- Rupture of the posterior cruciate ligaments.
- Damage to the acetabulum.
- Patella fractures.
- Pinched sciatic nerves and much more.
Symptoms can also be manifested in the form of visual shortening of the limb. The leg turns a little inward, which is visible to the naked eye. Also, with any attempt to lean on a sore thigh, the patient begins to experience severe pain.
In adults, additional symptoms may be observed. The knee swells, and ugly hematomas appear on the surface of the lower leg and thigh itself. A person suffers from a 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 straighten the affected joint. However, you need to understand that this procedure brings severe pain. Therefore, all manipulations are performed using anesthesia, muscle relaxants and sedative agents. Of course, you should not carry out such procedures yourself in any case. You need to contact an experienced orthopedist and consult with him first.