The Neonatal Hip (Chapter 23)

Transverse with Flexion

- Dynamic assessment of the femoral head. - Transducer rotated 90 degrees from coronal place and directed to the mid portion of the femoral head. - Demonstrates femoral head in relation to the acetabulum Leg is flexed. - Adduct the hip (appx 15 degrees)

Coronal (long) Scanning Plane Technique

- Hip in neutral position - Decubitus or supine position - Transducer in lateral aspect of hip (longitudinal image) - Femoral head seen in the acetabulum - Iliac line in a superior position - Femoral shaft in the inferior aspect -measure Alpha and Beta angles

Transverse Scanning Plane Technique

- Transducer is 90 degrees from the coronal plane. - Obtain transverse on neutral and flexed positions. - Sonographic image TRV FLEXED

4

Newborns have minimal subluxation which corrects itself by ______ weeks

2; 8

Once the femoral head ossifies, which begins between _____ months and _____ months of age, it is difficult to obtain adequate sonographic images.

reduction

Ortolani is a ________ test.

ilium; ischium; pubis

The acetabulum is made up of the _______, _______, and ________.

- Both hips are in the acetabulum - The acetabulum has normal morphology - There is good and satisfactory femoral head coverage on the right and left (Lower minimum: 45%; Males: 54%; Females: 56%; Upper normal: 60%) - Both hips are stable on stressing

What information should a report look like/contain?

- Asymmetry of gluteal skin folds - Limited abduction / poor movement - Limb maintaining position of outward rotation - Shortening of the thigh

What are other visual assessment signs?

- Transient synovitis - Septic arthritis - Arthrocentesis

What are some causes of Hip Effusions?

- Females more affected (4:1) - Breech positions at birth - Oligohydraminos affected pregnancy - Positive family History - Firstborns/ High birth weights - Neuromuscular abnormalities - Caucasians, Native Americans -Swaddling

What are some risk factors for DDH?

- Gluteus minimus muscle - Gluteus medius muscle - Fascia lata - Iliotibial tract - Tensor fascia lata muscle

What are the ABDUCTOR muscles of the hip? (GGFIT)

- Adductor magnus muscle - Adductor hiatus - Adductor brevis - Adductor longus - Pectineus muscle - Gracilis muscle

What are the ADDUCTOR muscles of the hip? (AAAAPG)

- Hamstring muscles - Semimembranosus muscle - Semitendinosus muscle - Biceps Femoris muscle - Gluteus Maximus muscle

What are the EXTENSOR muscles of the hip? (HSSBG)

- Psoas major - Iliacus muscle - Rectus femoris - Quadriceps femoris - Sartorius

What are the FLEXOR muscles of the hip? (PIRQS)

- Piriformis muscle - Obturator externes muscle - Obturator interns muscle - Gemellus muscles, superior and inferior - Quadratus femoris muscle

What are the ROTATOR muscles of the short hip? (POOGQ)

clinical assessment and sonography

What are the two most common methods to evaluate DDH?

the labrum

What extends outward from acetabulum, forming the cup that holds the femoral head.

Labrum

What fibrocartilage helps stabilize the hip?

Developmental Dysplasia of the Hip; wide range from mild to severe of dysplasia and dislocation

What is DDH?

infant is in supine position with knees flexed where dislocation can be observed if one knee appears lower than the other

What is the Galeazzi sign?

hypoechoic circle

What is the sonographic apperance of the femoral head?

the labrum

What part of the hip joint provides cartilaginous coverage of the femoral head?

the acetabulum

What part of the hip joint provides osseous coverage of the femoral head?

femoral head

What sits in the center of the acetabulum?

Linear; 12 MHz; 7.5; 5

When evaluating a neonate hip you use a ______ transducer, for premature use a _____MHz, for up to 3 months use a ____ MHz, for 3-6 months use a ___MHz.

4-6 weeks

When is the ideal time to scan a neonate hip?

Type II

Which Graff classification can newborns present with?

mesoderm

Which germ cell layer are the bones, connective tissue, and muscles derived from?

late 3rd week or beginning of 4th week

Which week post-conception marks the beginning of bone formation and ossification of bones of arms and legs?

Maternal Hormones

___________________ favors laxity of femoral ligaments and causes a predisposition to subluxation or dislocation

arthrocentesis

a procedure where fluid is drained from a joint using a needle and syringe

Dislocated

Femoral Head is completely displaced from acetabulum

Subluxated

Femoral Head moves posteriorly and remains intact with the posterior aspect of the acetabulum

Dislocatable

Femoral Head properly positioned within acetabulum but easily displaces when pressure is applied

Taking the Alpha and Beta angle measurements

1st line: along ilium across femoral head 2nd line: from ilium along the labrum 3rd line: from bony edge of acetabulum (tri-radiate cartilage) to the inferior edge of the ilium.

Dysplastic

Acetabulum irregular & labrum is abnormal (thickened)

6th week

At which gestational week the joints of the body begin to develop?

dislocation

Barlow is a ______ test.

coronal; alpha

Both the alpha and beta angle can be obtained in the ___________ scan plane with higher reliance on the _________ angle.

- Hip pain - Limping - Unable to bear weight - Movement restriction - Fever

Hip Effusion Indications

6 months or older (ossification centers are more evident)

Radiographs are more effective when?

Greater than or equal to 60 degrees

The Alpha angle (between 1st and 2nd lines) should be ______________.

ball on a spoon

The Coronal/ flexion view of the hip looks like?

U confiuration

The Transverse/ flexion view of the hip looks like?

flower apperarance

The Transverse/ neutral view of the hip looks like?

Ortolani, Barlow

The clinical exams for DDH consist of a _________ test and a _________ test.

Coronal: Flexion&Neutral Transverse: Flexion & Neutral

The hip anatomy's four views?

54%; 56%, 45%

The mean femoral head coverage with respect to how well it is contained in the acetabulum should be _____ in females, and _____ in males with the lower end being about ______.

False : Both hips must be included in assessment

True or False: You should only scan the hip that is of concern.

Graff Classification

Type I: Normal α angle is greater than 60 degrees Type II: more than 3-months. Old α angle is b/w 40-60 degrees Type III: Dislocated hip α angle less than 43 degrees Type IV: Gross dislocation α angle not measurable

Graf assessment

dynamic technique for measurement of the acetabular depth with static images with/without stress to assess femoral stability