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