Realities and myths about hip dysplasia.

We all know that in the wild all animals are born, as a rule, ready to walk, i.e. with sufficiently mature organs and systems for this. A human cub is born with somewhat immature organs and systems, which is why it cannot walk, talk, and independently obtain food. One of the signs of such immaturity is the concept of "Hip Dysplasia" (HJ) (dis - violation, plasia - maturation), i.e. in fact, all born children have signs of dysplasia, tk. unable to walk or talk on their own. Prominent pediatric orthopedist - traumatologist Professor P.T. Syagailo in his lectures conditionally divided dysplasia into 5 degrees:

0 degree - dysplasia, as a sign of natural immaturity present from birth, which is independently eliminated with the growth of the child at angles of departure of the roof of the acetabulum 19-21 degrees (normal);

Grade 1 - dysplasia itself, accompanied by a greater degree of lag in the maturation of the structures of the hip joint, the angle of departure of the roof of the acetabulum is more than 21 degrees, but not more than 30 degrees, while the femoral head is within the acetabulum, and the lag in the rate of maturation requires therapeutic measures aimed at accelerating the metabolism in the hip joints (dysplasia as a painful condition).

Grade 2 - dysplastic processes in the area of ​​the hip joints have such pronounced phenomena of lag in the rate of maturation that there is a threat of hip joint dislocation, the cartilaginous component of the roof of the acetabulum cannot provide an angle of inclination of less than 30 degrees, while the femoral head does not extend more than a third beyond limits of the acetabulum, and there is a need for complex, multifaceted treatment (pre-dislocation).

Grade 3 - dysplastic processes in the area of ​​the hip joints have such pronounced phenomena of retardation in the rate of maturation that there are initial manifestations of hip joint dislocation, the cartilaginous component of the roof of the acetabulum cannot provide an angle of inclination of less than 35 degrees, while the femoral head extends more than a third beyond the limits of the acetabulum, and there is a need for a complex inpatient, multifaceted treatment (subluxation).

Grade 4 - dysplastic processes in the hip joints lead to hip dislocation, the roof of the acetabulum cannot provide a support function for the femoral head, which goes beyond the articular surface, and despite all the versatility of treatment, there is a threat of disability (dislocation of the hip joint).

The happiness lies in the fact that about 90% of all children are within the 0 degree of dysplasia.

About 9% of children are still within the 1st degree of dysplasia, and only less than 1% of children fall into all 3 remaining degrees.

How to recognize what is happening with your baby?

1. With dysplasia, it is impossible to "scroll" the hips freely in the hip joints.

2. When folding the legs in front, there is a sharp asymmetry of the inguinal folds.

3. On the tummy, when comparing the gluteal folds, there is a divergence of the popliteal folds (asymmetry) and a feeling that one buttock is larger than the other.

4. When the legs are abducted, the child screams, worries, strains the legs (not to be confused with the condition after the "cross-armed" massage therapist).

What is being done to find out the cause of the problems?

1. An exceptional trip to an experienced pediatric surgeon (he is, by definition, an orthopedic traumatologist and urologist in our country)

2. X-ray of the hip joints.

Why X-ray, and not, God forbid, not ultrasound.

1. In all countries of Europe and America, ultrasound of the hip joint is still (more than 15 years) a "near-medical procedure", like a naturopathic doctor or diagnostics according to Fol. Even in developed countries, they could not prove the harmlessness of such a study, and most importantly, its effectiveness.

2. To obtain information about the state of TBS throughout the world, standardized indicators that have proven their effectiveness are used. These are the Shenton Line, and the position of the femoral head, and the angle of departure of the roof of the acetabulum, and hundreds more of the same indicators, freely determined on the radiograph, because the picture contains an overview image of two joints, the sacrum and the lower lumbar vertebrae at the same time.

3. The myth about the harmlessness of ultrasound, which is widely told in our country, is not true. The frequency of operation of a special sensor for ultrasound of bones (read stones) is only 1-2 orders of magnitude lower than the frequency of a microwave oven, and the examination time is within 5 minutes for each joint. So calculate the radiation (or rather, ultrasonic and thermal loads on the baby's tissues).

4. All ultrasound examinations are carried out separately for each of the joints, and it is not possible to calculate internationally recognized indices, because all indexes known in orthopedics and traumatology are calculated from a horizontal line drawn from one ischial tuberosity to another.

5. It is impossible to see the causes that often cause dysplasia on hip ultrasound: subluxation and disposition of the sacrum, disposition of the 5th lumbar vertebra, etc.

6. Any doctor, seeing signs of real dysplasia, will always protect himself with an x-ray

From life: colleagues discuss a child who came for a consultation with an ultrasound of hip joint: A. - "what is in the picture?", B. - "he has an ultrasound", A. - "it means he is healthy, prescribe calcium and warming up." :-)