Congenital hip dysplasia in the orphan child
Dysplasia -This term is antiquated and the only reference that was found was from literature dating from the 1970s. It does indeed refer to dysplasia of the hip, but that does not necessarily mean that there is true medical disease of the hip. The coxofemoral joint is the hip joint.
Depending on when you do a sonogram of a baby’s hip many children can be incorrectly diagnosed with developmental dysplasia of the hip. This is especially common in Russian medicine because normal developmental variants are "diagnosed" as disease, when in reality this is just a normal developmental variant without medical implications.
Hip Displasia - This diagnosis appears reasonably frequently in Russian many of the Russian Medical reports. Unfortunately, it potentially refers to the western diagnosis of “congenital hip dislocation” and there is no supporting radiological studies performed to support this diagnosis.
This particular diagnosis may indicate a suspected problem or just a normal developmental stage. Of it may just mean almost nothing if it is just written.
The true Western definition of Congenital Hip Dysplasia describes: an abnormal development of the hip joint with instability and possible dislocation of the thigh bone from the hip socket. This condition is also referred to as developmental hip dysplasia. This medical condition generally is present at birth or shortly afterwards.
During normal gestation of the fetus, the head of the thigh bone (femur) should be sitting centered in a shallow socket called the actetabulum. This actetabulum should cover the head of the femur bone as if it were a ball sitting in a cup. When congenital hip dysplasia occurs, the development of the actetabulum in the infant allows the head of the femur (thigh bone) to ride upward and out of the socket. This condition becomes more noticeable especially during weight bearing stages of a child’s development.
The incidence is also higher in infants born via cesarean section and in those born in a breech presentation.
The hip disorder is generally suspected during a physical examination by moving the hips to determine if they the head of the femur moves in and out of the hip socket. During the examination a distinct clicking sound is produced with the motion. This test is performed in the newborn period. In the older babies, there may be a lack of range of motion in one or both hips; while in the older infant hip dislocation is evident if one leg looks shorter than the other.
In the past x-rays were performed to detect abnormal finding of the hip joint. Ultrasound is now performed because it is a safe and diagnostic of hip dysplasia. Ultrasound has advantages over x-rays because it can investigate several positions during the procedure, while x-rays observe only one view. It is very hard to make a diagnosis of hip dysplasia without radiological images to support that diagnosis.
The treatment of hip dysplasia has an objective to replace the head of the femur back into the socket (acetabulum), by applying constant pressure. By doing this, it enlarges and deepens the hip socket.
In the past stabilization was achieved by placing rolled cotton diapers or a pillow between the thighs, thus forcing the knees to remain apart in a frog leg position. With the advances in technology, different harnesses and slings were created to obtain the same effect. These slings are used in infants up to six months of age.
A hard cast can be used to obtain the same effect of spreading the legs apart and forcing the head of the femur into the socket. In older children, surgery may be required to reposition the joint.
Unless this condition is corrected soon after birth, abnormal stresses can cause malformation of the developing femur bone, causing a limp or waddling gait. If cases of congenital hip dysplasia go untreated, this unfortunate child will have difficulty walking, and subsequent pain as the child gets older.
The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's situation and or problem. If your child has a specific problem you need to ask your pediatrician about it - only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.
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© George Rogu, M.D.
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