ABD Chapter 23
Proximal focal femoral deficiency
Rare congenital anomaly involving the proximal femur and the acetabulum. Severity ranges from decreased ossification to absence of the hip joint with significant shortening or absence of the femur.
Hip effusion
Swelling of the hip joint caused by an increase in synovial fluid surrounding the joint. Patient presents with localized pain, limping or refusal to bear weight, limited movement, and fever.
Mesoderm
The middle germ cell layer that contributes to the embryologic development of connective tissue, bone, blood, muscle, vessels, and lymphatics.
Abduct
To move away from the midline.
Adduct
To move toward the midline.
Arthrocentesis
To remove fluid from a joint through a needle.
dislocated hip will sit completely out of the ______
acetabulum
the round femoral head sits in the
acetabulum
in the coronal scan plane, the femoral head is seen sitting in the ______. The ____ ____ should appear as a straight line.
acetabulum; iliac line
DDH (developmental dysplasia of the hip) occurs most often at what age?
at birth
an ___ ____ is considered a strong positive Barlow and Ortolani sign
audible clunk
the femoral head is composed of _____ at birth. It begins to ossify from the center outward between _____ months
cartilage; 2-8 months
when evaluating for a hip effusion, the normal hip capsule has a _____ appearance, whereas if an effusion is present, the capsule bulges ______. An abnormal appearance is defined as a capsular thickness greater than _____ mm.
concave; outward; 2-5mm
in a coronal/flexion image of the hip, the hip has a ball on a spoon appearance. The ball is the _____ ____, the _____ ______ represents the handle of the spoon, and the scoop of the spoon is the ______.
femoral head; iliac line; acetabulum
in the transverse scan plane, the _____ ___ and the _____ form a U or V configuration around the _____ ____
femoral shaft; ischium; femoral head
when a child presents with hip pain, fever, limited movement, and refusal to bear weight, sonography can be used to evaluate the presence of a ____ _____
hip effusion (abnormal buildup of joint fluid)
hip bone/ coxal bone composed of
ilium, ischium, and pubis
during fetal development, ______ ______ contribute to the laxity of fetal ligaments
maternal hormones
germ cell layer that the bones, connective tissues, and muscles derive from
mesoderm
imaging is performed with and without ______. Imaging planes include _____ plane without _____ and the _____ plane with and without ______
stress; coronal; stress; transverse; stress
a hip that demonstrates posterior, superior, and lateral displacement of the femoral head during flexion imaging is
subluxed
a 3 year old patient presents with a low grade fever and refusal to bear weight on her left hip. She recently had an upper respiratory infection. What is the MOST likely diagnosis?
transient synovitis
_____ _____ can be treated with anti-inflammatory medication and rest, whereas ____ _____ is a more serious bacterial infection that is typically treated with intravenous antibiotics
transient synovitis; septic arthritis
alpha angle
-angle formed between the first and second line (first line is aligned with ilium and extends through the head of the femur, second line extends from the ilium along the labum) -bony or osseous roof of the acetabulum -primary measure for hip displasia -greater than or equal to 60 degrees is considered normal -obtained in a coronal scan plane
beta angle
-angle formed between the first and third line (first line is aligned with ilium and extends through the head of the femur, third line extends from the bony edge of the acetabulum at the triradiate cartilage to the lowest point of the ilium) -cartilaginous roof of the acetebulum -less than 55 degrees is normal
Risk factors of developing DDH (developmental dysplasia of the hip)
-babies born in breech position -positive family history -those living in cultures that swaddle infants in the extension and hip adduction -those with an abnormal physical examinations -oligohydramnios -females -whites -high birth weight -Native North American populations -first pregnancy/first born
the two most common methods used to evalutate DDH (developmental dysplasia of the hip)
-clinical assessment -sonography
Range of developmental dysplasia of the hip includes
-instability -subluxation -frank dislocation
transverse scan plane of the hip
-may be obtained in a neutral or flexed position -stress maneuvers are performed in this plane -if the hip is located, the normal U configuration will not be identified
bones of hip joint
-pelvic girdle and femur
evaluation of the hip
-the coronal plane can be used to assess how well the femoral head is contained within the acetabulum -a dislocated hip will sit completely out of the acetabulum -the lower limit for normal femoral head coverage is 45%
the frequency of DDH is ____ in ______
10 in 1000
Oligohydramnios
A decreased amount of amniotic fluid around the fetus.
Torticollis
A head that is held sideways due to a muscle contraction.
Erythrocyte sedimentation rate
A nonspecific indicator for inflammation; a measurement of the time it takes for red blood cells to settle in a tube of unclotted blood.
Maneuver that the examiner attempt to push the femoral head out of the socket
Barlow's maneuver
Osteomyelitis
Infection of the bone marrow and bone.
Transient synovitis
A self-limiting condition in which there is an inflammation of the inner lining (the synovium) of the capsule of the hip joint and is a common cause of painful hip in children. Can be treated with anti-inflammatory medication and rest.
Septic arthritis
A serious bacterial infection of the joint. Patients usually presents with a fever and may have elevated erythrocyte sedimentation rate and elevated serum white blood cell count.
Developmental dysplasia of the hip
Abnormal growth and development of the hip. The cause may be mechanical as a result of positioning influences in utero and after birth or physiologic resulting from a response to the maternal hormones in utero or physical makeup after birth.
Maneuver that the examiner attempts to reduce a recently dislocated hip
Ortolani maneuver