definition

The term hip dislocation describes a condition in which in the baby's hip joint the head of the thigh no longer grips into the socket of the hip and has slipped out of it, so that the joint partners involved are no longer physiologically connected. This definition of a hip dislocation can be translated as "dislocated hip", similar to the shoulder.

In babies, hip dislocation is one of the most common most common congenital deformities and is usually based on one Undesirable development the acetabulum during pregnancy (Hip dysplasia in the child), which encourages the head of the femur to slip out. The joint socket is not sufficiently formed so that the femoral head has too much freedom of movement. As a result, he slips out of the intended socket even with small movements.

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About hip dislocation in babies are Girls 5-6 times more likely affected as boys. In about 60% of the cases, the hip dislocation occurs on one side in the baby. The causes are varied and are often based on incorrect positions in the baby during pregnancy. Due to the frequency of hip dislocation in the baby, the Preventive medical check-up U3 routinely one for the first month Ultrasound scan of the hip performed in order to detect malpositions early. With a therapy initiated promptly, the hip dislocation in babies can be treated well and permanent damage can be prevented.

causes

A Hip dislocation in the baby is an expression insufficiently formed hip socket as part of a Hip dysplasia in the child, one of the most common congenital disorders of the musculoskeletal system. The cause of this hip dysplasia, which leads to hip dislocation, is multifactorial. Play first hereditary factors a not unimportant role. The risk is particularly higher in girls whose mothers have already had a hip dislocation. In very rare cases this can Ehlers-Danlos syndrome be a cause of a hip dislocation. Another cause is one different course of pregnancy, as this is where the normal formation of the joints takes place.

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Postures of the baby in the womb that lead to constriction and thus difficult growth are one of the main causes. For example, twin pregnancies can cause constrained postures, which can cause hip dislocation in the baby. But also one decreased amount of amniotic fluide.g. Transferred pregnancies or a malposition of the fetal kidneys can lead to a narrowing of the fetus.

Another cause of hip dislocation on the bottom of hip dysplasia is one Abnormal position of the baby in the uterus.
Especially one Breech position, in which the hip joints are strongly flexed, often goes hand in hand with a hip dislocation in the baby, as strong pressure is exerted on the growing joint sockets in the baby over a long period of time, which prevents them from assuming their physiological shape. Likewise, for reasons that are not yet fully understood, the risk of having a misaligned hip is with Presence of other misalignments like that Clubfoot or raised on the spine.

Symptoms

The hip dislocation in the baby causes some outwardly visible symptomsthat indicate the presence of a malalignment. Most of the time, however, these visible signs appear without symptoms such as pain, inflammation or something like that, so with the baby first no suffering arises. These symptoms also serve as diagnostic clues in the clinical examination.

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A hip dislocation in the baby already falls in the first days of life due to symptoms such as Leg length differencesin which the dislocated leg is shortened compared to the healthy one, or a limited mobility on. The baby cannot spread the affected leg to the normal extent, which is also made more difficult by passive movements by the doctor.

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The hip dislocation in the baby also shows symptoms that only come to light on closer inspection or targeted testing. Usually on the thighs or buttocks asymmetrical skin folds visible, which for the experienced doctor can be an indication of the hip dislocation in the baby. The Instability of the hip joint is one of the main signs of hip dislocation in babies and is noticeable in that when the leg is spread apart or apart, the femoral head noticeably slips out of the socket and back again. This phenomenon is also called the Barlow's sign. In a weakened form, a click in the hip joint can be felt during similar movements, if hip dysplasia is still present without hip dislocation, which is called the Ortalani sign. However, these tests continue to damage the joint, causing you to Avoid triggering in the baby if possible should. In addition, hip dislocation does not initially cause symptoms in the baby.

However it does untreated to a number typical sequelaethat become noticeable in toddlerhood. The frequent jumping out of the femoral head becomes the Articular cartilage continues to be damaged. It comes early to arthrosis, which is associated with difficult walking and pain. The growth of the hip socket in the child is also impaired, so that the Misalignment causes other symptoms as the child develops. It comes to one hobbling gait and a weakness in the hip muscles. Hip dysplasia with hip dislocation is often the primary failure in young children Knee pain on.

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Also read our topic Bow legs on the baby

diagnosis

The diagnosis of hip dislocation is usually made early in the baby because the hip is under the Checkups (U-examinations) is routinely examined. A hip dislocation in the baby is shown relatively clearly by a shortened leg and a number of other unspecific clinical signs such that the diagnosis is clinical.

However, since this is not sufficient to establish a diagnosis of hip dislocation or hip dysplasia in the baby, the Diagnosis using ultrasound objectified. This can also be used to determine changes in the hips that favor hip dislocation in the baby without this having already occurred. By default, the hip as part of the preventive medical check-up U3 in the 4th-5th Week of life for a hip dislocation.

The Position of the femoral head in relation to the joint roof the hip according to Graf is divided into 4 stages: 1: normally developed hip; 2: maturation delay (Dysplasia); 3: decentered joints (Subluxation); 4: complete dislocation. These examinations are sufficient to establish the diagnosis of hip dislocation in the baby and to initiate appropriate therapy based on the severity. At Diagnosis after the 1st year of life is also the roentgen used to better show bony parts.

Hip sonography

Fortunately, hip sonography is standard and mandatory in preventive medical check-ups in children. Sometimes this is due to the frequency of this misalignment, but also to the high benefit that is achieved when diagnosis and therapy are carried out as early as possible.

If possible, the first ultrasound examination is carried out after the birth. However, this is mandatory at least for the U3 pension plan in the 4th-5th grade. Week. During the first year of life, the bone structure still allows a good assessment of the structures in sonography. The advantages of the examination are no exposure to X-rays, the dynamics during the examination and availability in most doctor's offices. The angle of the acetabular roof, the cartilage roof and the position of the femoral head are examined using Graf's technique.

treatment

The acute treatment of the hip dislocation in the baby sees one rapid reduction, so before straightening the hip again. Initially, this treatment is attempted in a conservative way under anesthesia and in babies with paralyzed muscles, the femoral head is pressed back into the socket using certain maneuvers. If this does not succeed, an operation may be necessary.

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In the long term, the Treatment of hip dysplasia connect. The goal of this treatment is to correct the cause of the hip dislocation in the baby. The growth the malformed acetabulum, which to a certain extent represents the roofing of the femoral head and thus gives it stability, can do so promoted and directed that a physiological function is achieved again in the joint.

Here too, between conservative treatment and one OP be weighed. In mild cases it is sufficient to have the leg with you Wraps and bandages set so that the leg is slightly bent and spread apart at the hip joint. The leg is held in this position for about 6 weeks, which stimulates the growth of cartilage and bones in the baby above the femoral head. In more severe cases are Spread pants or Orthotics that have to be worn a little longer for up to 3 months. In some cases it is Applying a cast necessary for babies, the last option is one OP for correction the conditions at the joint available.

plaster

In addition to bandages and orthoses, there is a plaster available as an option in the treatment of hip dislocation in babies. The plaster of paris is usually used when after a repositioned hip dislocation, there is still significant instability exists in the baby's hip joint and further hip dislocation cannot be satisfactorily prevented by bandages, wraps or splints. Any further popping out of the femoral head in the baby would damage the joint further and delay healing, which can be effectively prevented with a cast.

In this form of treatment, the plaster of paris is also applied in such a way that the Leg slightly bent at the hip and splayed outwards is, depending on the extent of the dysplasia. In this position there is again sufficient contact between the femoral head and the socket to promote the growth of the joint in the baby towards physiological conditions. The plaster of paris is over a Period of 4-12 weeks created. It is of course important to have the plaster cast to regularly check for the correct position and to ensure that no blood vessels or nerves are pressed off in the baby by a cast that is too tight. The course of treatment should also be checked regularly by ultrasound examinations.

OP

In most cases, a hip dislocation in the baby is well treated with conservative treatment, so that satisfactory results can be expected within the first year of life. In some cases it is Degree of hip dislocation or dysplasia and thus the risk of permanent hip dislocation in the baby larger or was recognized too late. The possibilities of an operation must be considered here.

There are several methods of treating this deformity with surgery. A acute hip dislocation the baby then requires an operation if the manual reduction not possible is. This can be the case if e.g. Obstacles such as bone splinters or tendons in the joint space prevent sliding back. This open reduction by means of surgery only rarely has to be used. A long term treatment The hip dislocation in babies with surgery is the involved bones on the hip so to reshapethat there is sufficient "roofing" of the femoral head by the joint socket. Procedures for this are the intertrochanteric varus osteotomy, the Salter osteotomy or the Tönnis triple osteotomy, which is used in older patients. In principle, all of the procedures have in common that by inserting or removing pieces of bone on the hip above the joint, the joint roof becomes flatter and thus better encompasses the femoral head. This ensures better stability, the femoral head no longer slides out of the joint.

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Prognosis and prophylaxis

The prognosis for a hip dislocation in the baby is usually very good if the misalignment is detected early. The following applies: the earlier it is detected, the better the prognosis. If the hip dislocation is detected and treated in the first few days after birth, the disease almost always heals; with adequate treatment, long-term consequences such as hobbling or pain are not to be expected. The prognosis is worse in older patients.

The prognosis of a hip dislocation therefore depends on the time of diagnosis and intervention. It is also worthwhile to start therapy early because the bones are more malleable at first and a shorter duration of therapy is sufficient.

The possible long-term consequences are characterized by malpositions and poor posture with the resulting premature signs of wear and tear.

One complication is coxa valga. This means that the femoral neck angle of the femur is too steep to meet the acetabulum. In addition, the child may develop a hollow back due to the permanent misalignment in the hip. Due to the incorrect, non-physiological stress, excessive wear and tear of the joints takes place, with the risk of hip arthrosis and femoral head fracture.

Caution is also advised when performing the therapy with contractions and spreading using braces or plaster of paris. If the spread is too strong or not strong enough and the stress on the tissue during the reduction is too massive, there may be insufficient blood supply to the femoral head with the risk of femoral head necrosis.

For prophylaxis, it can be said that hip dysplasia is a congenital malalignment that cannot be prevented. There are, however, methods of prophylaxis that at least reduce the likelihood of hip dislocation. It is important to lay and carry the baby after the birth so that the leg is further bent at the hip. Early stretching is the greatest risk factor for hip dislocation in children. Prone positions should be avoided. Carrying the baby in a sling with the hips slightly bent and spread apart is also suitable as prophylaxis to reduce the risk of hip dislocation in the baby until the hips are fully developed.


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