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