newborn unstable DDH help

newborn unstable DDH  Help              :            Niestabilne stawy biodrowe Pomoc

 

especially true newborn  dislocation (ball of hip outside socket)  niestabilne stawy u noworodka( głowa poza panewką)

 

call or send sms  immediaitely  zadzwoń albo wyslij sms natychmiast  + 48 609 999 000

 

and mail  kulej@ozzl.org.pl  or Fb michal kulej or Developmental Dysplasia of the Hip

I help you free of charge ; pomogę bezpłatnie.

 

below cause of Helen with unstable newborn DDH ; ponizej  historia Helen  urodzona z niestabilnym stawem biodrowym DDH

 

                                        

  3 days y.o (dni)  true newborn unstable hip; had started treatment                    4days y.o (dni)  stable hip                                                                      

 right hip (prawe biodro) IIIa   left hip (lewe biodro) IV by Graf                    right hip (prawe biodro) IIIa   left hip (lewe biodro) IIIA by Graf                                         

                                                   The Ortolani test positive                                                               The Ortolani test negative

 

 

           9 months(miesiecy)    right hip (prawe biodro) I   left hip (lewe biodro) I (by Graf )

 

 

10m

                  po leczeniu bez gipsu  (  after 3 months treatment only modification of Frejka pillow without plaster)    10 miesiecy (months)

Complication of treatment

Destruction (avascular necrosis) of the ball shaped head of the thigh bone is the most frequent complication due to of DDH treatment which causes a blood vessel disturbance in the hip joint.(full abduction causes malfunction of blood supplies in the hips of the each newborn baby) The crying (that cannot be stopped) is due to the painful dying cartilage cells in the thigh head .The crying stops after a few hours, when all cells with lack of blood have destroyed (avn).


It occurs most often when there is too big pressure or elongation of the nutritious vessel of the femoral head toward cup shaped socket during not gentle traumatic treatment or manipulations, for example during placing the head in or out of the socket. It cause elongation and shortening of all hip joint structure at the same time.

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Not gentle and too long clinical examination may also lead to worsening of defect through mechanical damages and blood supply disturbances in femoral head. Clinical examination also lasts much more longer (even up to almost an hour)than ultrasound, which lasts only several seconds and it totally safe for patient.

 

That is why , in case of severe contractures caused by head dislocation, these contractures first need to be delicately eliminated (ex by Vojta technique) and then femoral head should be positioned properly in the acetabulum, or the contracture should be treated by an over- head extension, even with possibility delaying of treatment.

Medical statistics show a close correlation between an early diagnosis and complications due to traumatic treatment.Avascular necrosis of the hip (AVN) is reported in 0% to 60% of children who are treated for DDH.

Th

Rehabilitation of contracuture muscles in DDH

Rehabilitation of contracuture muscles with DDH .Practical guide.


Prevention of contractions of hip joints in persons with DDHRehabilitation practice, Dr M. Matyja, Sosnowiec, Poland Racławicka 23, phone no. +48 501 540 201.

M. Sc. Sebastian Sroczyński, certified NDT-Bobath therapist.e-mail address: sebastian.sroczynski@poczta.fm

 

 


Contractions of thigh adductor muscles constitute a particularly tough issue in case of need to use orthopaedic equipment. When we are dealing with contractions of the hip joint, the baby is distressed, it cries, because it experiences visible discomfort.
Prevention of contractions of hip joints is taken care of in Sosnowiec, Poland, at the rehabilitation practice of Dr M. Matyja.
Neurodevelopment therapy techniques according to the NDT-Bobath concept are applied for this purpose, aiming to reduce the tension of the contracted muscles, as well as fascial techniques to relax the muscles.
The elimination of contractions of the hip joint is an indispensable condition of effective and quick treatment of hip joint dysplasia.
Short description of the therapy:

1

2


Here we see photographs showing one of the techniques of the neurodevelopmental therapy according to the NDT-Bobath method, called dissociation. In this case the part undergoing therapy is the left hip.
1. We grab the hip so that the patient's knee rests on our palm, and the fingers should hold the thigh and be positioned parallel to the direction of the femur.
2. We execute the dissociation, or a slight movement in axial direction towards the hip joint (a push), and release (not drag it back!). This motion should be rhythmical and done at a constant pace (three pushes per second), while at the same time we should abduct the contracted hip to the point of resistance from the hip, after which we return to the intermediate position, and repeat the same cycle. The entire cycle should be executed until the hip reaches a threshold which one cannot cross (the hip will not allow for more).

 3

 

 

Here we also have shown fascial techniques. The difference is another technique to keep. 

 

4

Here a fascial technique is applied to the adductor muscles.

 

1. Grab the patient's thigh with the hand gently, so as to feel the taut muscle.

2. Execute slight supination, but not of the thigh! We are working here with the muscle fasciae, thus the rotation takes place only on the level of the muscle fasciae.

3. Gently stretch the fascia of the adductor muscle specifically through rotation, and hold for several seconds. After that, release the rotation, and repeat the same, but adding thighsupination this time.

4. Repeat entire exercise until we see that the supination is not progressing further, or when we reach full supination.

 

 

The final technique. It entails stretching the adductor muscles.

 

1. Supinate the patient's thigh so that we distinctly feel the adductor muscle taut.

2. Gently press with the thumb (pushing the code) this muscle on the side in the direction of supination.

3. Hold for several seconds; if the child protests, for a shorter period.

4. Release and repeat after a few seconds.

5. Execute approximately 10 repetitions.

 

The entire therapy takes approx. 20 minutes. Observations show that the minimum number of treatments before the application of orthopaedic equipment is three sessions, 20 minuteseach, over the course of a week.

 

In addition, the parents receive advice on caring for the child, to support the therapy. This is even more important, because even if one applies the best possible therapy, the lack ofproper care at home will render the work of the therapist useless, and will hinder reaching the ultimate goal of eliminating the contractions as much as possible before usingorthopaedic equipment.

 

 

 

 

What is treatment for CDH ?

What mother should known about treatment in DDH What are the differences between prevention and treatment in infants with DDH? The lengh of the time in where the proper hip position must be maintained . The biggest femoral head migration usually occurs in the Upper- Lateran part of acetabulum , therefore, femoral flexion must be bigger than 90 degrees(knees above the buttocks line) and abduction should be minimum 45 degrees ( both spread thighs lying on the basis in symmetrical position), but less then the border of contracture, if it exists;,(full abduction causes malfunction of blood supplies in the hips of the each newborn baby). It does not matter, what we use for proper femoral and hip alignment to an end of socket restoration. On the other hand, the duration of proper hip alignment is crucial, and it is sufficient for good hip development in 97% of infants. The more delicate, earlier, and less traumatic treatment, the better results of treatment we achieve. Only a specialized medical doctor with appropriate knowledge and experience can properly diagnose of CDH and applied adequate treatment In order to guarantee successful treatment, the Congenital Dyslocation of The Hip (CDH )must be detected in the newborn Unit right after the Birth and rebuilding of Hip instability must be completed,by 5th week of age(when the regeneration process is the fastest The only secret to improve the results of treatment of congenital dislocation and subluxation Of the hip is early recognition and atraumatic treatment during the first six months of life before weight bearing. Failure to detect CDH in time or inappropriate treatment will result in complication many year later,when for prevention is too late. We should always begin treatment with the attempt of prevention, which is applied by parents(. Pict 1,2) after verify the clinical diagnosis of DDH by usg examination If there is no improvement(down to50%) at the next examination (after from 3 days with type D to 14 days with small dysplasia ), we use orthoses, for stable hips in older infants , for example Pavlik harnesses.( Pict.3) Attention! If a baby keeps crying after applying orthosis for the first 3 days, you should remove the orthosis and put it on after a while, but with a smaller abduction. If after several attempts of using an orthosis the child still cries, the orthosis should be taken off and parents should contact the doctor for checking the treatment option . Inadequate traumatic treatment causes a blood vessel disturbance in the Hip Joint and baby cry (that cannot te cry be stopped) due to a pain of the dying cartilage cells in the thigh head .The cry stops after a few hours, when all cells with lack of blood are sustained the avascular necrosis. During every control examination in the course of CDH treatment the doctor has to observe improvement in hip restoration in comparison with the last examination, which certificates the proper course of hip restoration and treatment means. It there is no improvement the cause should be found, or the consultation in the other specialized medical center should be considered. Continuation ineffective treatment increases the risk of surgery, because the older the child, the slower restoration. Pict.1 Pict.2 Pict.3 Correct position Pavlik Harnes

Guide for Mother to prevent DDH

Guide for Mother to prevent DDH What should every Mother know to prevent abnormal hip development in a babyThe most important thing in preventive examination is to find the babies with the most severe deformity and to start treatment immediately .Each day of delayed treatment worsens the deformity and a seemingly short period of 2 weeksof delayehances of some babies for a complete recovery and for avoiding surgery and femur necrosis.Up till now, it is estimated, that  the same number of newborns  babies with CDH requires the hip joint replacement as about 60 years ago ,when  the clinical examin.

This shows also that if you do not detect DDH as soon after birth as possible and allow to develop of secondary changes, comes into permanent dysfunction of the hip joint. 


Every mother may increase the chances of proper development of her babies hip joints by putting it in a position that enables joint surgery

The best conditions for a joint rebuilding occurs when the flexion of the femur is above 90 degree(knees the buttocks line) and abduction above 45 ( both spread thigs lying on the basis in symmetrical position);full abduction causes malfunction of blood supplies in the hips of the each newborn baby .

 and using a body of parents to obtain a favorable alignment of the hip . This is the finest method of reconstruction of  the Hip Joint , the most convenient for your baby because the parents react immediately to any ailment of his child .

Nature itself makes proper development of hip joint possible through a protective ,physiological muscles contracture which enables proper limb position .Therefore bent legs of a baby shouldn,T be straightened while nursing or dressing ,but helped to remain in this beneficial for hips position.

More recent specialist literature considers screening of neonates as early as possible to be ideal [1–3,
7, 11, 12].

 The rules for treatment and prevention are similar: hip bending over 90 degrees and an abduction of over 45 degrees. In treatment, however, we use different kinds of orthopaedic equipment. 


Due to significant hip regeneration capacity in newborns, it is recommended that, for preventive reasons, newborns should be lifted and placed with their legs wide astride and bent in the hips, and with their knees above the buttock line, at least until they are 6 months old.

We also recommend that the newborn should be placed on the stomach under supervision (due to cases of Sudden Infant Death Syndrome) or, even better, be placed and carried on an adult.

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