Diagnostics and treatment of hip dysplasia and congenital hip dislocation in children

Abstract

Hip dysplasia and congenital hip dislocation are caused by prenatal developmental disorder of the fetus and are dependent on many endogenous and exogenous factors, such as inheritance, sex, influence of feminine sexual hormones and relaxin hormone. The process of hip joints formation is also influenced by mechanical factors, limiting fetal movements and impeding his normal position in uterus (breech, foot and transverse presentation) namely: multifetal pregnancy, uterine abnormalities and diseases (bicornuate uterus, arcuate uterus, uterine tumors), different deformations of pelvic bones, hypohydramnios, polyhydramnios. Teratogenous hip dislocation is a separate pathology. The following symptoms characteristic for hip dysplasia and congenital hip dislocation are present during clinical assessment: Ioachimstal, Marx-Ortholani, Barlow, Pelteson, Dupuitren, Duchennes-Tredelenburg symptoms, asymentric skin folds, extremital shortening on a sick side. Diagnosis should be confirmed with ultrasound (for children younger than 5 m.o.) or X-ray (for children older than 5 m.o.). the earliest possible start of treatment ensures the effectiveness of conservative treatment that includes physiotherapy, massage, the use of special devices (prophylactic braces, Pavlik harness, Koshley frame, Freyka pillow, Gnevkovskyy type apparatus), over head extension, closed reduction of hip dislocation under general anesthesia. The indications for surgical treatment are: lack of the possibility of a closed reduction of congenital hip dislocation (high dislocation, a significant degree of anthetorcia and valgus deformity of the femoral neck, significant degree of acetabulum underdevelopment), reluxation after a closed reduction of congenital hip dislocation; diagnosis of congenital hip dislocation over the age of 2 years old.

The following types of surgical operations are used: open reduction of congenital hip dislocation, open reduction of hip dislocation with plastics of acetabulum (Solter. Pemberton, Chiari operations, triple osteotomy of pelvic bones) and reconstruction of proximal hip; palliative surgeries. Patients with hip dysplasia and congenital hip dislocation is to be observed by orthopedic surgeon until the end of growth period.