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Hip dysplasia in the baby, also known as congenital dysplasia, is a condition where the baby is born with an imperfect fit between the femur and the hip bone, which causes the joint to become looser and cause decreased mobility of the legs and legs of different lengths.
This type of alteration is more common in girls and babies who stayed most of the pregnancy in a sitting position, which can end up affecting the development of the joint.
Since it can affect the baby's development and cause difficulty in walking, the diagnosis by a pediatrician should be made as soon as possible, so that the treatment can be started and it is possible to cure the dysplasia completely.
Types of hip dysplasias
How to identify dysplasia
In many cases, hip dysplasia does not cause any visible signs and, therefore, the most important thing is to keep regular visits to the pediatrician after birth, as the doctor will assess over time how the baby is developing. , identifying any problems that may arise.
However, there are also babies who may show signs of hip dysplasia, such as:
- Legs with different lengths;
- Less mobility and flexibility of one of the legs;
- Skin folds on the thigh with very different sizes.
If dysplasia is suspected, the doctor may order an ultrasound or an X-ray of the hip region to confirm the diagnosis.
How the doctor identifies dysplasia
There are 2 orthopedic tests that the pediatrician must do in the first 3 days after birth, but these tests must also be repeated in the consultation of the 8 and 15 days of birth.
The tests performed to diagnose hip dysplasia are called the Barlow test and the Ortolani test. In the Barlow test the doctor holds the baby's legs together and folded and presses upwards and in the Ortolani test the doctor holds the baby's legs and checks the amplitude of the hip opening movement. The doctor may conclude that the hip fit is not perfect if you hear a click during the test or feel a bounce, which indicates that the joint has been placed in the correct position.
How the treatment is done
Treatment for congenital hip dysplasia can be done with the use of a special type of brace, using a cast from the chest to the feet or surgery, and should always be guided by the pediatrician.
Usually, treatment is selected according to the baby's age:
1. Up to 3 months of life
When dysplasia is discovered shortly after birth, the first choice of treatment is the Pavlik brace that attaches to the baby's legs and chest.With this brace the baby's leg is always folded and open, as this position is ideal for the hip joint to develop normally.
After 2 to 3 weeks of placing this brace, the baby should be reexamined so that the doctor can see if the joint is properly positioned. If not, the brace is removed and plaster is placed, but if the joint is properly positioned, the brace should be maintained until the child no longer has a change in the hip, which can happen in 1 month or even 6 months.
These suspenders must be kept all day and all night, they can be removed only to bathe the baby and must be put on again right afterwards. The use of Pavlik braces does not cause any pain and the baby gets used to it in a few days, so it is not necessary to remove the brace if you think the baby is irritated or crying.
2. Between 3 months to 1 year
When dysplasia is only discovered when the baby is more than 3 months old, treatment can be done by manually placing the joint in place by the orthopedist and using plaster immediately afterwards to maintain the correct positioning of the joint.
The plaster must be kept for 2 to 3 months and then another device, such as Milgram, must be used for another 2 to 3 months. After this period, the child must be re-evaluated to verify that the development is happening correctly. If not, the doctor may recommend surgery.
3. After starting to walk
When the diagnosis is made later, after the child has started walking, treatment is usually done with surgery. This is because the use of plaster and Pavlik suspenders is not effective after the first year of age.
The diagnosis after that age is late and what draws the parents' attention is that the child limps, walks only on the toes or does not like to use one of the legs. Confirmation is made by X-ray, magnetic resonance or ultrasound that show changes in the positioning of the femur in the hip.
Possible complications of dysplasia
When dysplasia is discovered late, months or years after birth, there is a risk of complications and the most common is that one leg is shorter than the other, which makes the child always hobble, making it necessary to wear shoes made tailored to try to adjust the height of both legs.
In addition, the child may develop osteoarthritis of the hip in youth, scoliosis in the spine and suffer from pain in the legs, hip and back, in addition to having to walk with the aid of crutches, requiring physiotherapy for long periods.