Congenital hip dislocation is the most common disorder in children. Of course, this disease does not constitute a serious problem if it is diagnosed and treated early in Turkey.
Congenital hip dislocation
The term Congenital Dislocation of the Hip (CDH) or what is known as “Developmental Dysplasia of the Hip (DDH)” refers to a health problem that occurs in the hip joint that connects the thigh bone and the hip bone that leads to a dysfunction The joint.
Most cases of developmental hip dislocation appear from birth and result from the joint not being fully formed and the femur out of its place, so doctors examine children shortly after birth and make sure that there are no signs of congenital hip dislocation.
Several genetic and obstetric factors combine to cause congenital hip dislocation in infants, and its incidence is estimated at only 1-2 per 1000 births.
In most cases, a soft brace is sufficient to correct the problem in Turkey, but when the dislocation does not cause symptoms and is not discovered until a later age, the treatment is mainly surgical to return the joint to its place and restore its soft and smooth movement.
The degree of congenital hip dislocation
In all cases of hip dislocation that affect children, the joint cavity is shallow, meaning that the femoral head of a spherical shape does not fit tightly to the acetabular cavity, and loosening of the ligaments responsible for fixing the joint in place may occur. The degrees of joint looseness in children with congenital hip dislocation are divided into several types :
- Partial dislocation: In mild cases of congenital dislocation, the femoral head can move freely within the acetabulum, but it is not separated from it.
- Low-grade dislocation: In this case, the femoral head is located within the acetabulum, but it may come out easily during a physical examination.
- High degree dislocation: It is the most severe case of congenital dislocation; The femoral head is completely outside the glenoid cavity.
Causes of congenital hip dislocation
In the normal hip joint, the spherical femoral head fits perfectly into the acetabulum, but in some children, the spherical head of the thigh is not well fixed and the acetabular cavity is shallow, which increases the possibility of the spherical head slipping out of the cavity due to the pressure of the mother’s uterus on her fetus Or during childbirth, and this congenital deformity is one of the most important causes of congenital hip dislocation.
The incidence of congenital hip dislocation increases when the uterus is small and hinders the growth of the fetus, as in the first pregnancy, twin pregnancy, a defective fetus, or when amniotic fluid is scarce. Doctors have found that congenital hip dislocation occurs more when:
- Having a family history of hip dislocation or very loose ligaments
- female gender; Breech presentation occurs more often in females than males
- abnormal postures during childbirth; Especially the breech coming
Developmental hip dislocation after birth can occur during the first year of life in some babies who are severely coiled with their lower limbs upright, so parents should learn how to swaddle their children safely.
Symptoms of congenital hip dislocation
Symptoms may vary from child to child. The most common congenital hip dislocation symptoms and signs include:
- The difference in the number of skin folds between the thighs
- The hip joint is loose or unstable on one side
- Legs of unequal length
- When the child begins to walk, he appears limp while walking
- pelvic pain
Hip dislocation in adolescents and young adults can also cause painful complications such as osteoarthritis in the pelvis and back or rupture of the glenoid labrum, and this may lead to pain associated with movement.
Diagnosis of congenital hip dislocation in Turkey
The pelvic examination in newborns is part of the routine medical examinations following birth in Turkey to ensure the integrity of the hip joint. The examination includes denying the presence of any abnormal “click” when moving the child’s feet in many directions, doctors currently perform the Barlow maneuver and Bartolani maneuver without causing any inconvenience to the child.
The doctor may order a hip ultrasound between the fourth and sixth week if he feels that the joint is not stable or if there is a family history of congenital hip dislocation or at birth with breech presentation. to make sure.
Mild congenital hip dislocations may be difficult to detect and may not cause any abnormalities until adolescence, when a doctor suspects a congenital dislocation of the hip in children older than 6 months of age may order X-rays, CT scans, or MRI of the pelvis may be ordered.
The early detection of congenital sciatic dislocation in a newborn is extremely important studies On the necessity of early detection of congenital hip dislocation to obtain the best treatment results.
Congenital hip dislocation treatment in Turkey
There are many ways to treat congenital hip dislocation in Turkey according to the age of the affected child and the degree of injury, and the treatment generally aims to return the femoral head into the acetabulum cavity and fix it in its place until the joint grows naturally and protect it from any additional damage, the dislocation treatment may require the application of a soft brace or a splint Solid or surgery in severe cases.
Babies under 6 months diagnosed with congenital hip dislocation are often treated with a fabric support called a “Pavlik harness” that secures the femoral head in a tight fit that helps shape the socket and make it into a ball, while allowing free movement of the feet and easy nappy change for the child.
This saddle should be worn on your child continuously for several weeks and removed only by the doctor himself. The doctor may adjust the saddle during subsequent visits, and will provide you with full instructions on how to care for your child while wearing the saddle.
I have found Study The effectiveness of the Pavlik saddle is reduced if it is started after the child is over 4 months old and if the congenital hip dislocation is severe.
Saddle application is usually sufficient to treat congenital hip dislocation, but sometimes the hip joint remains completely or partially dislocated even after the child is over 6 months old.
Sometimes the brace may not do the job, so the doctor has to perform a closed reduction procedure under anesthesia to return the thigh bone to its normal position and then apply a spica cast to hold the child’s bones in the appropriate position and prevent any movement of the joint for several weeks.
Taking care of your child while he is in this cast requires special instructions. The doctor will teach you how to do daily activities, maintain the cast, and identify any problems if they arise.
When closed reduction procedure fails to put the femur back into place after the child is over 6 months old, open surgery is necessary; Where the surgeon makes an incision in the child's hip to provide a clear view of the joint, bones and soft tissues.
In some cases, the femur is shortened to fit the acetabulum cavity, and simple x-rays are taken during the operation to ensure that the femoral head is in its normal position. After that, a splint with a thorn is placed to fix the child’s pelvis until the bones settle in their position and the wound heals.
The child may need to do more than one surgery during growth, because the hip joint can be dislocated again, and it should be noted that in very rare cases the hip joint as a whole is replaced with another artificial joint by Surgery or by android or Stem cell treatment.
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