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What is it about ?
The hip joint connects the thigh bone (the femur) to the pelvic bone (the iliac bone). The upper end of the femur (head of the femur) fits perfectly into a cavity of the iliac bone (acetabular cavity or acetabulum). This ensures normal mobility of the hip. Dislocation is the dislocation of the joint. This means that the head of the femur is no longer in its socket.
With a congenital dislocation of the hip, the head of the femur is out of its socket at birth. The cause is not well known, but there are a number of risk factors that are very often associated with hip dislocation:
- Female baby;
- Hip dislocation in the family;
- Breech presentation at birth;
- Developmental abnormalities of the lower limbs.
In many newborns, the hips are not yet fully mature, and the hip joint is not yet well formed. As a result, the head of the femur is not perfectly positioned in the acetabulum and moves easily. In 6 to 8 in 10 newborns with immature hip joints, the hip joint develops normally before the age of 8 weeks. This is not the case for the remaining 2 to 4 babies.
What is its frequency?
Congenital hip dislocation affects about 1 in 100 newborns.
How to recognize it?
Most cases of congenital hip dislocation are detected by the pediatrician when the baby is examined. Parents may notice a difference in hip spacing when changing baby’s diaper. Correct positioning of the head of the femur in its socket is very important for the normal development of the hip joint.
Left untreated, this condition leads to abnormal growth and developmental problems as well as premature wear and tear of the hip joint. This can cause lameness and chronic pain in the hip, knee and back. Lameness in a child always requires further examination.
How is the diagnosis made?
The ONE doctor examines each child for a dislocated hip until they can walk normally. The general practitioner and the pediatrician are also attentive to this. From the first examination, immediately after birth, he examines the baby’s hips. The doctor will ask if there are any hip problems in the family, if the child came through the breech during childbirth and if, when the diaper is changed, a hip may be wider than the one. other. Some tests are performed during the clinical examination:
- Look for the possibility of hip spacing;
- Look for asymmetry in the folds of the buttocks and / or thighs;
- Look for a difference in leg length;
- Detect hip instability: by turning the hip, the head of the femur dislocates and then returns to its place. This is accompanied by a noise, and the doctor feels it in the hand too.
If hip dislocation is suspected before the age of 6 months, an ultrasound is performed to confirm the diagnosis; after 6 months of age, the diagnosis is confirmed by an x-ray.
In breech-born children and in the case of hip dislocation in the family, an ultrasound is automatically performed at the age of 6 weeks.
Once the child is walking, their way of walking will be examined. An untreated hip dislocation causes lameness and excessive curvature of the back with the pelvis tilted forward. Walking on the toes or a difference in the length of the legs can also be signs of a dislocation.
What can you do ?
It is essential to detect and treat early. So don’t miss the ONE visits planned for your child.
What can the doctor do?
Until the age of 6 months, the treatment of choice is the wearing of the Pavlik harness. It keeps the thighs flexed and apart. The follow-up is carried out by a doctor specializing in children’s joints (a pediatric orthopedist). If the follow-up x-ray after 2 weeks does not show a good position of the head of the femur in its cavity, surgical treatment will be necessary. Surgical treatment is also necessary when the dislocation is discovered late. In this case, the operation is more complex, and the prognosis less favorable.
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