Chapter 25- Neonatal Hip
laterally, superiorly
In the subluxed/ dislocated coronal neutral view, the femoral head gradually migrates ____ and _____ with decreased coverage of the femoral head
developmental displacement of the hip
Indications for neonatal hip sonography include the presence of risk factor for __________, and abnormal hip examination, and the need to evaluate the response to treatment
yes
Is displacement of the hip common?
dynamic
Is the static or dynamic approach more commonly used in the diagnosis of DDH?
hyaline cartilage
Most common type of cartilage; it is found on the ends of long bones, ribs, and nose
acquired, teratogenic, developmental
Neonatal hip dislocation can be _____, _____, or ______
hypertension, growth, membranes, gestation, weight
Other risk factors for DDH include: *maternal _____ *fetal _____ restriction *oligohydramnios *premature rupture of ______ *prolonged ________ *increased birth ______ *potter's syndrome *neonatal intensive care
static
Professor Reinhard Graf, an Austrian orthopedic surgeon, introduced the _____ technique in the United States in 1980
alpha angle
The _____ is used in ultrasonographic assessment of developmental dysplasia of the hip. The angle is formed by the acetabular roof and the vertical cortex of the ilium
primigravid
The _____ uterus is smaller than the multigravida uterus and is therefore more confining and offers less mobility.
beta, labrum
The ______ angle is formed by the baseline iliac bone and the inclination of the anterior cartilaginous acetabular roof with the ______ as the key landmark
femoral artery, external iliac artery, profunda femoris
The ______ is the principal artery of the upper thigh. It is a continuation of the _______. The femoral artery branches into the _____, which is the main artery supply for the thigh muscles
sacroiliac, pubic symphysis
The ______ joints unite the two hip bones with the sacral part of the vertebral column. The _______ is where the two hip bones unite with each other anteriorly
piriformis
The ______ muscle is immediately posterior to the hip joint, and the obturator internus and the gemelli and quadrates femoris are lower down
coronal/neutral
The ______ view is performed with the infant in the supine position from the lateral aspect of the hip joint with the place of the transducer oriented coronally with respect to the hip joint
saphenous opening, great saphenous
The _______ is the gap in the fascia lata that is found about 4 cm inferior and lateral to the pubic tubercle. The ______ vein passes through this opening to enter the femoral vein
sciatic nerve
The _______ is the largest nerve in the upper thigh. It enters the gluteal region from the pelvis to run caudally down the back of the thigh
Barlow, ortolani
The ________ test determines whether the hip can be dislocated, and the ______ test determines the opposite if the dislocated hip can be reduced
alpha
The acetabulum may be assessed visually with the _____ and beta angles, noting the depth and angulation of the acetabular roof as well as the appearance of the labrum.
ace tabular roof, ilium
The alpha angle is composed of the _______ and the vertical cortex of the ______
alpha
The angle between the baseline and the acetabular roofline that represents the osseous acetabulum is the _______ angle
beta
The angle between the baseline and the inclination line is the _____ angle
acetabulum
The articulation of the head of the femur with the ______ of the hip bone forms the hip joint
neutral, flexion, flexion, neutral
The basic hip anatomy is imaged in four different views 1. coronal/ _______ 2. coronal/ ______ 3. transverse/ _______ 4. transverse/ ________
normal, subluxed, dislocated
The sonographic appearance of the femoral head is described as ____, ____, or _____
motion, stress
The stability of the hip os determined through guided _____ and the application of gentle _____
barlow, ortolani
The stress maneuvers of the sonographic exam are the imaging counterparts of the clinical ____ and ____ maneuvers
inguinal, gluteal
The thigh is the upper part of the lower extremity. The anterior surface of the thigh is continuous with the ______ region of the abdomen. The posterior surface of the thigh is inferior to the ______ region, which is at the back of the pelvis and hip joint
coronal/flexion
The transducer is maintained in the lateral position while the hip is moved into a 90 degree angle of flexion in the ______ view. During this assessment, the transducer is moved in an anteroposterior direction with respect to the body to allow visualization of the entire hip
femur, head
The upper part of the thigh is the ____, which is surrounded by muscles, ligaments, and tendons. The upper part of the femur, the _____, articulates with the hip bone to make a hip joint
developmental displacement of the hip
What is DDH?
closed reduction
What is the initial treatment of uncomplicated DDH?
labrum
When a hip is frankly dislocated, the _____ may be deformed
medially, laterally
When the trochanter moves forward, the femur rotates _____, and when the trochanter moves backward the femur rotates ______
iliac
With superior dislocations, the femoral head may rest against the _____ bone
2/3
____ of the femoral head should be covered by the acetabulum
stability
_____ testing is reported as normal, lax, subluxable, dislocatable, and reducible or irreducible
closed reduction
______ is accomplished by placing two diapers on the neonate or by using a spica cast, Pavlik harness, or brace.
extension
______ is bending backward
adduction
______ is moving sideways inward
abduction
______ is moving sideways outward
teratogenic
_______ dislocations occur in utero and are associated with neuromuscular disorders
flexion
_______ is bending forward
lateral rotation
_______ is turning outward
medial rotation
________ is turning inward
developmental displacement of the hip
__________ is a new term that includes dysplastic, sublimated, dislocatable, and dislocated hips.
breech, low
A _____ birth and _____ birth weight are also risk factors for DDH
acetabulum
A dislocated hip has no contact with or coverage by the _______
plane, position
A two word combination is used to label the views of the hip according to the ______ of the body and the ______ or the hips
traumatic, nontraumatic
Acquired causes of hip dislocation can be _____ or _____
adduction
An example of hip _____ is crossing your legs when in a seated position
galeazzi sign
By visual inspection, the dislocated hip shows asymmetric skin folds and shortening of the affected thigh. The knee is lower in position on the affected side when the patient is supine and the knees are flexed. This is called _______
labrum
Cartilage that forms a rim around the socket of the hip joint
20, hamstrings, gluteus maximus
Extension of the hip is limited to _____ degrees by tension in the iliofemoral ligament and the flexor muscles, and it is brought about by the ______ and _____
caucasians
DDH affects _____ more than african americans
firstborn, females
Developmental displacement of the hip usually affects the _____ child, with _____ affected more frequently
4
During the neonatal period, the first ____ weeks of life, there is a physiologic laxity of the ligaments about the hip that makes the hip unstable
60, 43, 30, 43, 77, 43
Graf's classification of neonatal hips: Type 1= normal; alpha angle less than ____ degrees Type 2= alpha angle between ___ and ___ degrees Type 3= alpha angle of less than _____ degrees and beta angle greater than ____ degrees Type 4= alpha angle less than _____ degrees, beta angle immeasurable
lazy "y"
Graf's standard sonographic image is acquired in the coronal plane at the midacetabular level. This image includes: 1. femoral head 2. acetabulum 3. labrum 4. iliac bone as it meets the triradiate cartilage *This produces a coronal image of the hip, which has a configuration of a _____
dynamic, lateral, posterolateral, orthogonal, adduction, abduction
Harcke and Graf formulated basic standards for ______ hip sonography, which is currently used in most clinical situations today. *All scanning is performed from the _____ or _____ aspect of the hip. The hip is imaged in _____ planes (coronal and transverse) *Images of the hip are obtained in the coronal/extension/flexion and transverse/extension/flexion positions *When the hip is flexed, the femur is moved through a range of ____ and _____, with stress views performed in the flexed position
4
How many different classifications are there in Graf's classification of neonatal hips?
1, 2
If the physical exam is abnormal at birth, sonography of the hip should be done within ___ to ___ weeks of age
sacrum, left, frank
In breech presentation, the fetus' hip rests against the maternal _______ and is usually flexed, which limits movement. This usually affects the _____ hip. The _____ breech presentation of the fetus is the highest risk because the hips are maximally flexed and the knees are extended.
triradiate
In posterior dislocations, the femoral head is seen lateral to the posterior lip of the _______ cartilage
posteriorly, laterally
In subluxation, the femoral head is displaced ______, ______, or both with respect to the acetabulum.
femoral head, acetabulum, iliac line
In the ball on a spoon description of the normal infant hip in the coronal plane, the _______ is the ball and the _______ forms the spoon. The _______ is the handle
irregular, angled, echogenic
In the case of hip dysplasia in the coronal/neutral view, the acetabular roof is _____ and ______. The labrum is defected superiorly and becomes _____ and thickened
femoral head, stretch, acetabulum
In the newborn period, the femoral head may dislocate in the lateral and posterosuperior position relative to the acetabulum. When this occurs, the femoral head can usually be reduced without deformity to the joint. When the dislocation is not recognized early, the muscles tighten and limit movements, which causes the acetabulum to become dysplastic because it lacks the stimulation of the _______. In turn, the ligamentous structures ______ and fibrofatty tissue occupies the _______, making it impossible to return the femoral head into the acetabulum.
subluxation
In the normal infant, the femoral head is congruently positioned within the acetabulum. Mild displacement, or _______, is when the head is either in contact with part of the acetabulum or is displaced, but partly covered.
normal, immature, dysplastic
Sonographic description of the acetabulum is assessed visually and is described as _____, _____, or ______
hypoechoic, echogenic
Sonographically, the femoral head is ______ because it is cartilaginous and contains focal ______ ossification nucleus
hypoechoic, echogenic
Sonographically, the femoral head is _______ because of its cartilaginous nature and it contains focal ______ ossification nucleus
high, linear
Sonography of the neonatal hip is performed with a ____ frequency _____ array transducer
triradiate cartilage
The Y shaped growth plate that separates the three separate hip bones in childhood is called _______ _____
alpha
The _____ angle measures the inclination of the posterior and superior osseous acetabular rim with respect to the lateral margin of the iliac bone
alpha, beta
The _____ angle reflects changes in the cartilaginous acetabulum, which occur more quickly than do changes in the osseous acetabulum and may therefore be more sensitive than the _____ angle
left
The _____ hip is more commonly affected with DDH, with only a small number of cases affecting both hips
femoral triangle
The _____ is formed by the inguinal ligament, the adductor longs (medially), and the sartorial (laterally)
acetabulum
The _____ is not usually visualized in a dislocation because the bony shaft of the femur blocks the view
labral, echogenic triangle, 77, alpha angle
The beta angle is used in the ultrasonographic assessment of developmental dysplasia of hip. The angle formed between the vertical cortex of the ilium and the triangular _____ firbocartilage, which appears as an _____ _____. The normal value is less than ______ degrees, but is only useful in assessing immature hips when combined with the _______.
ilium, ischium pubis, triradiate cartilage
The bony acetabulum consists of the ____, _____, and _____, which is joined by a growth plate known as the _________
pectineus, iliacis
The contents of the femoral triangle are separated from more deeply lying hip joint by muscles; the _____ is medial and the _______ is lateral
canal, vein, artery
The contents of the femoral triangle include the femoral ____, the femoral ______ and ______, and the femoral nerve
fascia lata
The deep fascia of the thigh, the ______, forms a tough connective tissue surrounding the muscles. The part of the fascia on the lateral part of the thigh is the iliotibial tract as it extends from the iliac crest to the lateral condyle of the tibia
females
The femoral head begins to ossify earlier in ______
cartilagenous, 2, 8
The femoral head is _____ at birth and begins to ossify between ____ and ____ months
echogenic
The femoral head sits within the acetabulum, which is _____ and has a deep concave configuration
echogenic
The femoral head sits within the acetabulum, which is _______ and has a deep concave configuration
sheath
The femoral vein and artery and the femoral canal are enclosed in a connective tissue sleeve called the femoral _____
4
The femur head should be stable within the acetabulum with stress after ____ weeks of age
minimus
The gluteus _____ muscle is the immediate cover for the upper part of the hip joint, whereas the orbturator externus is found winding below it from front to back
ilium, ischium, pubis
The hip bones are the fusion of three separate bones: the ____, ____, and _____
ball and socket
The hip is a _______ joint that is held together by ligaments
hyaline, hypoechoic
The labrum is composed of ______ cartilage and is _____, except at its hip
ball on a spoon
The normal infant hip should have the appearance of a ____________ on the coronal flexion view
60
The normal value for the alpha angle is greater or equal to _____ degrees
2, 8, girls, one
The ossification of the femoral head begins between ___ and ___ months of age, occurs earlier in ____, and is often completed by age __
iliofemoral ligament
The outside of the capsule that surrounds the hip joint is reinforced by ligaments. The most important of these is the ______, which blends with the front of the capsule.
flexors
The primary ______ of the hip are the psoas major, the iliacus, and the rectus femoris
capsule
The primary cause of DDH is thought to be a gradual migration of the femoral head from the acetabulum because of the loose, elastic joint ______. In addition, other factors, such as genetic, mechanical, and physiologic- are thought to play a role
position, stability, acetabulum
The primary objective of the dynamic hip assessment is to determine the ______ and ______ of the femoral head and the development of the _______
lateral, posterolateral
The primary sonographic imaging of the neonatal hip is performed from the _____ or ______ aspect of the hip while moving the hip from the neutral position at rest into one in which the hip is flexed
femur, acetabulum
The rounded shape of the _____ and the cup shape of the ______ form the ball and socket hip joint
dislocation, dysplasia, first, pain
There are two conditions in which sonography offers advantages over other imaging modalities: 1. developmental _____ or _____ (seen in ___ year of life) 2. hip _____, which may be caused by inflammatory or traumatic conditions
position, stability, acetabulum
Throughout the examination, the sonographer is able to assess the _____ and ______ of the femoral head in addition to assessing the development of the _______
pelvic girdle
Together, the ilium, ischium, and pubis form the ______
the patient walks
Treatment for DDH should occur before when?
barlow, ortolani
Two basic maneuvers are helpful in the diagnosis of DDH. The _____ maneuver determines if the hip can be dislocated. The _____ maneuver determines if the dislocated femoral head can be reduced back into the acetabulum.
static, dynamic
Two sonographic techniques are used in the diagnosis of DDH: _____ and ______
labrum
Two thirds of the femur head should be covered by the ________, which is narrow and has a triangular shape
acetabulum
the cup-shaped hollow in the hipbone into which the head of the femur fits to form a ball-and-socket joint
