Specific signs of hip dysplasia in children

When parents come to see a surgeon with a newborn child, the first thing a specialist examines him for signs of hip dysplasia. Unfortunately, this pathology is often found among children, which is associated with many factors that provoke the abnormal development of the hip joints in the womb. Let us consider in more detail the causes of development and signs of hip dysplasia in children, as well as methods of treating this pathology.

Causes of hip dysplasia in children

Such a condition as hip dysplasia is an independent malformation of the fetus. Against the background of hypoplasia of the acetabulum and underdevelopment of all elements of the joint, conditions are created for its further inferior development. The reasons for this can be endo- and exogenous. Exogenous causes of hip dysplasia in children include:

• mechanical damage to the embryo;
• the effect of X-ray and gamma rays on the fetus;
• the action of physical factors (high temperature, pressure, current) and chemicals;
• maternal infectious diseases and malnutrition.

Endogenous causes of joint dysplasia include:

• pathological changes in the uterus, increased pressure in it;
• oligohydramnios, amnion diseases, cord entanglement;
• local mechanical pressure from a narrow uterus, pelvis, or tumor;
• maternal comorbidities (diabetes mellitus, hypertension).

There are also genetic factors that contribute to the development of hip dysplasia in children. These include chromosomal aberrations and a violation of the code of hereditary information.

What are the symptoms of hip dysplasia in children?

It is possible to suspect, identify and confirm the diagnosis of hip dysplasia in children after some specific studies and tests. Based on the data of the clinical examination of the child, the doctor makes a diagnosis, and it can be confirmed radiographically, but only when the child is already 3 months old. Before 3 months, it makes no sense to do x-rays and ultrasound, because during this time, ossification nuclei are only formed, by which one can judge the pathologies of joint development.

Specific signs and symptoms of hip dysplasia in children:

• positive click symptom or Ortholon - Marx – when the hip is abducted, the sound of the head slipping out of the joint is heard;
• restriction of movement during hip abduction;
• presence of asymmetry of skin folds on the thigh (gluteal, popliteal, patella, adductor and inguinal);
• flattening of the gluteal region due to muscle atrophy;
• shortening of the limb on the side of the lesion;
• external limb rotation;
• positive Trendelenburg sign – when standing on a sore leg, the child's pelvis is skewed to the healthy side. This is because the thigh muscles do not support weight due to their weakness and lack of attachment points.

What is detection  hip dysplasia in children?

As stated above, before 3 months of age, the diagnosis is based on symptoms alone on examination. When the child reaches 3 months of age, the diagnosis is clarified by conducting an x-ray examination. X-ray shows specific signs of hip dysplasia in children.

There is a Putti triad that characterizes the presence of hip dysplasia in children:

• slope of the roof of the swivel recesses;
• displacement of the proximal ends of the thigh;
• late detection of ossification nuclei of the femoral head.

The following changes are also considered a specific sign on the radiograph: lateroposition – the diseased joint is higher and outside in relation to the healthy joint, the acetabular angle is increased -  at its norm 26-28⁰. They also look at the passage of the Shelton and Calve lines, which normally should not be interrupted. Shelton's line runs along the inner medial surface of the thigh to the medial surface of the pelvis. The Calvet line runs along the lateral surface of the ilium and up to the lateral part of the thigh.

What is the treatment for hip dysplasia in children?

Treatment of hip dysplasia should begin as soon as it is diagnosed. From 3 weeks to 3 months, the child needs to wear wide pants, and also use the wide swaddling method - that is, the child's legs should be in a free position. It is also necessary to perform immobilization in the abduction position, when the head of the joint is in the acetabulum.

For the correct position of the femoral head, Pavlik's stirrups and staged traction are used. Surgical treatment consists in deepening the acetabulum. Surgical treatment is used for late diagnosis of hip dysplasia in children.