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Hip Dysplasia in Babies

Hip Dysplasia in Babies



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The hip dysplasia it is one of the most common lower limb abnormalities in newborns. It appears in 3 out of 1,000 children, it's more common in girls than boys and it occurs more frequently in the left hip than right.

Hip dysplasia occurs when the head of the femur bone and the socket of the pelvis where it resides do not fit together correctly. The abnormality consists of an outward displacement of the head of the femur, the upper bone of the leg that tends to protrude from the hip intermittently. In the most severe cases, the bone is permanently moved out of its natural position. It is what is known asdislocated hip.

The causes of hip dysplasia in the baby are not clear. Predisposing factors are a high weight of the baby, the position of the buttocks, the fact that it is the first child, a multiple pregnancy, maternal arterial hypertension and the baby's macrosomia. Some authors argue that it is due to poor posture of the fetus in the maternal uterus, a low level of amniotic fluid, a family history, a post-term pregnancy, a cesarean section, or a dislocation during delivery.

The neonatologist is the one who realizes this anomaly when examining the newborn at the time of birth, when he performs the Ortolani and Barlow maneuvers. These maneuvers consist of a series of movements carried out with the child lying on his back and as relaxed as possible, gently flexing and opening the newborn's legs to check if the joint is correct. It is done first on one hip and then on the other. The Ortolani maneuver can check for dislocation by rotating the joint, while the Barlow maneuver can check for the possibility of a dislocation. Half of the cases of hip dysplasia are detected in the neonatal period thanks to these maneuvers.

The pediatrician may also observe that the shape of the baby's leg folds is asymmetrical. It is a less accurate sign, but one that can lead to suspicion of hip dysplasia. After three months of the baby, the maneuvers are practically negative in all cases, so we resort to the observation of the asymmetry of the folds or the shortening of one of the extremities to determine it.

The early diagnosis of hip dysplasia is very important and even more so if there is a possible family history. For this reason, when the result of the maneuvers is not clear, an ultrasound of the hips is performed for greater safety. It is important that it can be identified and resolved after the child is born and before he begins to take his first steps. Hip dysplasia prevents the body from being perfectly supported, leading to asymmetry between the two legs.

However, correcting this simple abnormality especially when it is detected early after the baby is born. Treatments vary depending on the severity of the case and the age of the child. To keep the femur inside the cavity of the hip bone, a double crossed diaper is usually placed on the baby to keep the legs open, when the dysplasia is mild. Postural treatment is also recommended, such as straddling the baby and sleeping on his back with his legs spread to try to get the bone back into place naturally.

If the dysplasia is moderate or severe, soft or rigid prostheses or other treatments such as the Pavlik harness are usually used, which consists of straps that keep the hips flexed 100 degrees to reduce dislocation. Before six months, not all cases need to be treated orthopedically. Newborns can recover with positive maneuvers. If orthopedic treatments do not correct the dislocation, surgery may be the last solution.

Early diagnosis is essential to start treatment before the baby begins to crawl and stand up. If hip dysplasia is not treated before the child begins to walk, it can lead to more serious problems such as irreversible lameness, bone damage, asymmetry of the legs, or early osteoarthritis of the hip.

In some cases, until the child begins to walk, no symptoms of hip dysplasia are detected despite having tested negative in pediatric examinations. A delayed start of gait, a limp when walking, or an unsteady gait (more unstable than normal in a baby who starts to walk) may indicate a dislocation.

Marisol New. Copywriter

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Video: Patient Perspective: Congenital hip dysplasia (August 2022).