Hip

If a hip joint is not correctly positioned in a harness during treatment, the most severe complication would be: A. Dislocation B. Subluxation C. Avascular necrosis (AVN) D. Osteomyelitis

C. Avascular necrosis (AVN) Circulation to femoral head is partially or completely blocked, causing death to bone.

Femoral head coverage should be at least A. 30% B. 40% C. 50% D. 90%

C. 50% **Normal coverage should be at least 50%, meaning 50% of femoral head is resting within the hip socket. Less than 50% is termed laxity, subluxation, or dislocation.

A normal beta angle is _________

less than 55 degrees

DDH is the abnormal development of the: A. Acetabulum and femur B. Acetabulum and ischium C. Ilium and femur D. Ilium and ischium

A. Acetabulum and femur

Which of the following is a risk factor for congenital hip dysplasia? A. Family history B. Male gender C. Polyhydramnios D. Vertex presentation

A. Family history Family history, female, first born, breech, hip clunk on exam, skull deformities, foot deformities, oligohydramnios (vertex is normal birth position)

The harness used to treat DDH holds the legs in what position? A. Flexed and abducted B. Flexed and adducted C. Neutral and abducted D. Neutral and adducted

A. Flexed and abducted *Will push femoral head back within hip socket, toward the triradiate cartilage and stimulate development of the acetabulum while avoiding ischemic necrosis. Acetabulum-to-femoral head coverage usually become normal within 6-8 weeks of harness treatment.

What is the maneuver performed during a physical exam involving a 90-degree flexion and frog-leg abduction of the hip? A. Ortolani B. Barlow C. Pavlik D. Graf

A. Ortolani (abduction, away, adduction to body) *Assesses whether a dislocated hip can be reduced.

What is the name of the fibrofatty tissue that fills the space between the abnormal acetabulum and the formal head? A. Pulvinar B. Hip capsule C. Triradiate cartilate D. Ilipsoas tendon

A. Pulvinar *Echogenic, but not as bright as bone. Pulvinar thickness can fill the acetabulum and be an obstacle to the dysplastic hip. Triradiate cartilage, like pulvinar, lies medial to the femoral head but is hypo. Hip capsule is space within the synovial linings of the joint. Iliopsoas tendon is located anterior to the femoral head and acetabulum.

Is the hip abducted, or adducted with the Barlow maneuver?

Adducted

The alpha angle is the angle formed by the ilium and the: A. Ischium B. Acetabulum C. Labrum D. Femur

B. Acetabulum aka "bony roof angle"

What is the name of the maneuver whereby the infant hip is flexed, adducted, and pushed posteriorly? A. Ortolani B. Barlow C. Pavlik D. Graf

B. Barlow

Which scanning plane is used to evaluate and measure for developmental dysplasia of the hip (DDH)? A. Sagittal B. Coronal C. Transverse D. Oblique

B. Coronal

Who discovered the first method and technique for measuring hip dysplasia? A. Griffin B. Graf C. Grady D. Gregor

B. Graf

The beta angle is the angle between the ilium and the: A. Acetabulum B. Labrum C. Ischium D. Femur

B. Labrum aka cartilaginous roof angle (fibrocartilaginous roof line) Normal is less than 55* Angles increase with lateral and superior luxation of femoral head which pushes cartilaginous acetabular roof and labrum with it. Important for distinguishing among the more dysplastic hip types.

What hypoechoic structure lies centrally within the acetabulum on a transverse view of the infant hip joint? A. Iliopsoas muscle B. Triradiate cartilage C. Ilium D. Labrum

B. Triradiate cartilage

What are the 4 Graf classification of hips?

Based on coronal scan plane and angles of cartilage component of root of acetabulum. Describes depth and shape of acetabulum. I: Normal, alpha greater than or equal to 60*. II: Alpha ranging from 43-59* III: Alpha angle less than 43* IV: Gross dislocation, inability to measure

In what pediatric age group does transient synovitis most commonly occur? A. Infants B. Toddlers C. Children D. Teenagers

C. Children *Transient synovitis (aseptic effusion), aka irritable hip. MC children 5-10 years old **Afebrile or low grade. Often follows viral infection If pain during rest, elevated WBC and high fever, consider septic arthritis.

Compared to the bone, the infant femoral head is cartilaginous and: A. Hyperechoic B. Isoechoic C. Hypoechoic D. Anechoic

C. Hypoechoic

Which bone is not one of the bones that make up the acetabulum? A. Pubis C. Ilium C. Labrum D. Ischium

C. Labrum Cartilage that lines the cup of the acetabulum to hold the femoral head.

Which congenital abnormality is usually characterized by a unilateral short lower extremity? A. Dislocated hip B. DDH C. Proximal focal femoral deficiency (PFFD) D. Idiopathic avascular necrosis

C. PFFD

What is the name of the harness used for treating DDH? A. Ortolani B. Barlow C. Pavlik D. Graf

C. Pavlik

Imaging of an infant for DDH should be done with the patient in primarily what position? A. LLD B. RLD C. Supine D. Prone

C. Supine

What is the one clinical sign that could help differentiate transient synovitis from osteomyelitis? A. Fever B. Hip pain C. Swelling D. Hip effusion

C. Swelling *Similar symptoms, but osteomyelitis tend to be more severe and include a hot, erythematous swollen area.

The exam to detect DDH should be performed prior to: A. 4 weeks B. 6 weeks C. 8 weeks D. 12 weeks

D. 12 weeks Best 4-6 weeks

The alpha angle is considered normal when it is greater than or equal to: A. 30 degrees B. 45 degrees C. 50 degrees D. 60 degrees

D. 60 degrees

What muscle lies immediately anteromedial to the hip capsule? A. Rectus femoris B. Psoas major C. Iliacus D. Iliopsas

D. Iliopsoas Inserts on lesser trochanter of femur, crossing over hip joint. Work together for hip flexion and rotation. Psoas major arises from lumbar vertebrae. Iliacus arises from ilium of pelvis. Rectus femoris is one of four quad muscles of thigh and lies anterior to iliopsoas.

What are the 3 bones that form the pelvis?

Ilium, Ischium, Pubis Ilium and ischium are part of the large pelvic bone. Ilium is upper crest of hip. Ischium is the "site bone" and provides stability for the hip. All 3 join to form the acetabulum.