Dysplasia of the hip: to treat The Baby well
About three to five percent of all newborns suffer from hip dysplasia. This is an innate maturation disorder of the hip joint pan. Without therapy, it is used in babies and children to a malformation of the hip joint, which can lead in adulthood to premature joint wear. Because of the obvious symptoms of hip dysplasia are usually missing, is performed on all babies within the framework of the preventive medical examinations, an ultrasound of the hip. At an early stage and properly treated, the dysplasia of the hip heals recognized in the rule without consequences – under certain circumstances, however, surgery may be necessary.
Girls are more likely to be affected
The causes of hip dysplasia in babies are not fully understood. A risk factor seems to be the position of the Unborn in the womb: the Fetus with the pelvic in the uterus, it is more likely to be a dysplasia of the hip. Also in the case of twin pregnancies or if there is too little amniotic fluid (Oligohydramnios) seems to be the risk of hip dysplasia increases.
Also unclear is why girls are about to be affected five times more often than boys of hip dysplasia. In addition, the disease occurs within the family: Had the mother of a hip dysplasia, are at increased risk for your child.
Dislocation in an immature hip joint
In the case of a dysplasia of the hip the ossification of the acetabular Cup is held delayed. As a result, the femoral head has not sufficient Grip and does not slip in the joint. A result of an injury to the hip joint pan is because the femoral head deforms the still soft bone.
Under the circumstances, there is even a dislocation (Luxation) of the hip. Then the joint must be put right as quickly as possible (repositioned) in order to prevent permanent damage and to allow normal development of the hip.
Missing signs in babies
In infants with a hip dysplasia have no symptoms do not usually occur, because the babies are still ongoing and therefore no pain. Only if there is a dislocation of the hip is present, signs of hip dysplasia to recognize: As the femoral head slips usually up and out of the pan, it comes to a visible shortening of the affected leg. This leads to an asymmetry of the folds on the thigh and buttocks is also often seen. Some babies also show an eye-catching posture of the legs.
Symptoms in children: pain in the knee
Usually, symptoms of hip dysplasia, however, only when the children begin to run: Typically, for a dislocation of the hip, a crooked pelvis, and a waddling or hinkender. In some cases, the pelvis from tilting to the front is a result of a pronounced hollow back.
In addition, the mobility of the hip is limited. Hip pain, however, are atypical for a hip dysplasia – affected children complain, instead, often of pain in the knee or in the groin.
Characteristic signs of a hip dislocation, the so-called Trendelenburg sign is: The monopod, it comes to a Abkippung of the pelvis to the healthy side stand on the affected leg.
Dysplasia of the hip: ultrasound Screening for U3
Because hip dysplasia in babies often causes no symptoms and the disease was formerly often detected too late, today is integrated in the screening U3 in the fourth to fifth week of life, Screening for hip dysplasia.
It is performed in addition to a physical examination, an ultrasound of the hip. In the ultrasound image of the child’s doctor can evaluate the Position of the femoral head and the angle of the hip joint are measured. This results in a classification of the hip joint is maturity in the so-called
Hüfttypen to count:
- I. a Normally developed hip
- II Maturation retardation (hip dysplasia)
- III. Subluxation (partially dislocated hip, the femoral head is shifted in the pan)
- IV Luxation (complete dislocation – the femoral head is located outside the pan)
Diagnostics: x-ray in children and adults
In babies, the ultrasound examination is best suited for the diagnosis of dysplasia of the hip: The development of the cartilaginous hip in the ultrasound image very well assess. After 1. The age of the joint due to the increasing ossification better in the x-ray image.
A so-called Arthrography may not be necessary, if in the case of a Baby with hip dislocation the hip is straightened out. In contrast agent is injected into the joint and then from different angles x-rays are taken. So it is possible to determine whether, for example, a tendon prevents the Straightening.
Hip dysplasia in babies: treatment with spreader pants
Hip dysplasia without dislocation (type II according to the count), the therapy can be carried out by a spreader pants, Splint or Bandage, the leg in a flexed and splayed Position. As a result, the femoral head is pressed into the pan, allowing the maturation of the joint is promoted. Such a Splint must be worn for several weeks to months of round-the-clock.
Placement of the hip by means of the Overhead Extension
In the case of a dislocation (type III and IV according to Graf) needs to be put right the hip. This can be done by a so-called Overhead Extension: the legs are held in a splayed Position, one on top of the bed-mounted design. By the train of the femoral head may slip within a few days to weeks in the right Position.
SURGERY is sometimes necessary
Another possibility is a adjustment by Hand (manual reduction). For this purpose, a General anesthesia is usually necessary, when the muscles are relaxed. The waist is still not put back in place, is sometimes an obstacle, such as a tendon or fat tissue – is to blame.
Then, surgery may be necessary to put the hip back on track. Sometimes a wire will, in addition to the temporary fixation used. In any case, the Baby must wear a Hüfteinrenkung for a few weeks a so-called seat-Hock-plaster, so that the hip remains in the correct Position.
Surgical correction in older children and adults
Is achieved by treatment with a spreader pants, a Splint or a plaster is not a satisfactory result – one speaks then of a residual dysplasia can be prevented in children from about two years of age and the adult by a Operation result of damage.
There are different surgical procedures with a similar principle: By means of a separation of the bone fragments at the pelvis or the thigh and Reattachment in a different Position of the femoral head to fit into the pan, and that the joint is loaded as naturally as possible and so premature wear is prevented.
Good prognosis with early therapy
Hip dysplasia is detected early and properly treated, in most cases, there is no impact damage. The following applies: the earlier the treatment begins, the shorter the duration of therapy. Because the hip joint is the more malleable, the younger the child is.
If left untreated, hip dysplasia can lead to premature hip wear and tear (coxarthrosis), possibly already in the third decade of life. Not infrequently, an artificial hip joint, in these cases, early is necessary.
Sports with hip dysplasia
After successful completion of treatment, affected children do not have to restrict the rule to the Sport. There is, however, a residual dysplasia or pain the children, depending on the complaints hüftbelastende movements are avoided.
To sports with jerky stresses, such as certain ball games, Sprint, jump, or fight sports include swimming species as well as Breast and downhill skiing. Recommended are Hiking, dynamic movement sequences, such as when Cycling, and front crawl swim, as well as targeted Exercises to strengthen and stretch the hip muscles.
General information on the topic
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