The infant hip
What are the clinical indication of hip effusion
Localized pain, limping, refusal to bear weight, limited movement, fever
During development, what contributes to the laxity of fetal ligaments
Maternal hormones
What causes DDH
Mechanical: position in utero Physiologic: response to maternal hormone
Which germ cell layer are bones, connective tissue's, & muscles derived from?
Mesoderm
What is adduct
Move toward midline
What are the bones of the hip
Pelvic girdle and femur
What is proximal for moral focal deficiency
Rare anomaly involving prox femur & acetabulum
What bacterial infection is considered an emergency requiring rapid treatment to avoid long-term sequelae including avascular necrosis to the femoral head
Septic arthritis
what term defines the incomplete displacement of the femoral head from the acetabulum
Subluxation
Be a hip that demonstrates posterior, superior, and lateral displacement of the for moral head during flexion imaging is what
Subluxed
For hip imaging of older children, the following patient position is best
Supine
The hip is categorized as a
Synovial joint
While scanning the hip of a 2-month-baby boy, the sonographer notes that the from femoral is hypoechoic, while the ischium & femoral shafts are hyper quick. This indicates
That the for moral head is still cartilaginous at this age
What is the beta angle?
The angle between the baseline & the inclination line, evaluates The formation & size of the cartilaginous acetabulum Normalee less than 55°
In the Barlow test;
The hilt is placed in flexión & addiction
To measure the beta angle of the hip, The sonographer need to determine the inclination line. This line connects
The lateral aspect of the bony acetabular rim with the lateral aspect of the cartilaginous acetabluar labrum
After a breech delivery, the newborn girl with deformed feet is brought in for a scan of her hip. And additional indication for the scan is that the baby was born to a primigravid uterus. This term means.
The uterus in a women's first pregnancy
What is abduct
To move away from midline
A three-year-old patient presents with a low-grade fever and refusal to bear weight on her left hip. She had an upper respiratory infection. What is the likely diagnosed
Transient synovitis
How is the Ortolani used to assist the hip stability
Used to reduce the dislocated hip
Strength maneuvers are performed in what plane
transverse
What is a positive Allí or Galeazzi sign?
-Discrepancy of leg lengths -patient supine, knees are flexed & or one appears shorter than the other
What type of transistor is use for this exam
-Neonates up to three months of age-7.5 MHz -infants 3-7 months- 5.0 MHz - after 7 months- 3.0 MHz Linear array
What is the Alpha angle
-the angle between the baseline & the acetabular roofline & represents the osseous acetabulum - normally less than 55°
What is the frequency of DDH
10 in 1000
How many hip joint exams in with a sonographer perform to repair dues and accurate evaluation of the infant hip joint
100
An abnormal appearance is defined as a capsule thickness greater than?
2 to 5 mm
When does the femoral head begin to ossify
2 to 8 months of age
When should the sonographic examine of the hip be performed
4 to 6 weeks of age
What is the normal limit for for moral head coverage
45%
After approximately what age does sonography evaluation of the infant hip become less reliable
6 months
While examining the femoral head of a neonate, the sonographer determined that the maximum diameter of the femoral head is 40mm & the perpendicular distance between the baseline & lateral border of the acetabulum is 30mm. What is the for moral head coverage
75%
Graf's classification of neonatal hips: type 1?
A normal hip has an alpha angle of less than 60°
Ultrasound examination of the hip of a 6 month old boy shows a correctly located & stable femoral head. The Alpha angle is 65°, the beta angle is 52°, & the femoral head coverage is 56%. The acetabulum has a bony roof & sharp ossified rim. The labrum has a long & narrow Cartlidge roof, & extends far over the femoral head. These findings indicate
A normal mature hip
In the coronal plane how should the iliac line appear
As a straight line
When does DDH occur most commonly
At birth
When do the bones of the legs and arms begin to ossify
At the end of the third week
What is the long-term effects of septic arthritis not treated
Avascular necrosis of for moral head, osteomyelitis, systemic sepsis, leg length discrepancy, osteoarthritis of the hip joint.
What is the name of the maneuver with the examiner attempted to push the tomorrow head out of socket
Barlow's maneuver
What is defined by the alpha angle
Bony or osseous roof of the acetabulum
What is the risk factor of DDH
Born in breech, positive family history, swaddling infants in extension & adduction, high birth weight, oligohydramnios
What do patience with the septic arthritis present with
Elevated erythrocytes sedimentation, elevated WBC
When drawing the lines on the infant join, where is the location of the second line
Extends from ilium along the labrum
An increased incidence of development of DDH is associated with what factors
Female
Using infant hip line drawings, where is the formation of the beta angle
Formed between first and third line
What Alpha angle is the primary measure of what
Hip dysplasia
Graf's classification of neonatal hips: type 2?
Hip has an alpha angle between 43 and 60°
Graf's classification of neonatal hips: type 4?
Hip has an alpha angle less than 43° at the beta angle is immeasurable
Graf's classification of neonatal hips: type 3?
Hip has an alpha angle of less than 43° & a beta angle greater than 77°
What are the parts of the hipbone
Illium, ischium, pubis
Developmental dysplasia of the hip describe the range of dysplasia including
Inability, subluxation, & frank dislocation
What is oligohydramnios
Decreased amount of amniotic fluid around fetus
What is the range of PFFD
Decreased ossification to absence of the hip joint & shortening to absence of femur
When do the joints of the body begin to develop
During the sixth week
What is felt as the dislocated femoral head reduces into the
A palpable physical movement called a clunk
What is septic arthritis
A serious bacterial infection that can present with more serious complications than transient synovitis
What is developmental dislocation of the hip (DDH)
Abnormal formation of the hip joint in which the ball on top of the thigh bone (femur) is not held firmly in the socket
What is the Cartilage at the tip of the acetabulum
Acetabular labrum
When drawing the lines on the infant joint, where is the location of the first line
Aligned with the ilium & extends through the femoral head
What is that pavlik harness
Allows movement but keeps femur rotated outward to maintain position in the acetabulum
In neonates; the normal hip biometrical values are
Alpha angle >60 degrees, beta <55 degrees
What is considered a strong positive Barlow & ortolani sign?
An audible clunk
What are the two most common methods used to evaluate for DDH
Clinical assessment and sonography
What is transient synovitis?
Common cause of painful hip in children Can be treated with anti-inflammatory meds
When evaluating for hip effusion, the normal hip capsule has what appearance
Concave
what plane is used to asses how well the for moral head is contained in the acetabulum
Coronal plane
The transverse scan plane can be updated in what position
Neutral or flexed
What is that impression of the hip if the Alpha angle is greater than or equal to 60
Normal
When evaluating for hip effusion, abnormal hip capsule has a what a parent
Outward bulge
How do you perform the Barlow maneuver
Patient lives in supine position with the hip flexed 90° & adducted, down word & outward pressure is applied, if the hip is dislocated, the examiner will feel the for moral head move out of the acetabulum