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DDH Flashcards

1
Q

What are risk factors for DDH?

A

Mat HTN, FGR, oligo, PROM, prolonged gestation, increased birth weight, Potter’s syndrome

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2
Q

How much more likely are breech babies to develop DDH?

A

four times

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3
Q

How much more likely are females to develop DDH than males?

A

2.5 times

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4
Q

How often is the left hip affected by DDH? How often is it unilateral?

A

Both 64% of the time

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5
Q

How does birth order affect DDH?

A

more common in first born

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6
Q

What ethnicities is DDH more common in?

A

Caucasians/North American tribes due to swaddling

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7
Q

What causes DDH?

A

Unknown, possibly increased laxity within joint capsule

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8
Q

What is the hormonal theory of DDH development?

A

Hormones affect connective tissue, maternal estrogen increase can increase muscle laxity

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9
Q

What is the mechanical theory of DDH development?

A

Restricted mobility: Swaddling, oligo, breech, primigravid uterus

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10
Q

What is the highest risk fetal position for DDH?

A

Frank breech

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11
Q

What is the genetic theory of DDH development?

A

Higher risk with family history

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12
Q

What clinical sign warrants hip US?

A

clicking sound

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13
Q

What is hip dysplasia?

A

Acetabulum is too shallow in socket

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14
Q

What age can the hips be evaluated until?

A

Until femoral head ossifies, up to 6 months, over 6mo xray

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15
Q

What forms the pelvic girdle?

A

Ilium, ischium, pubis

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16
Q

What is triradiate cartilage?

A

Connects 3 pelvic bones, made of growth plates that ossify at adulthood

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17
Q

What does the triradiate cartilage become after ossification?

A

Part of acetabulum

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18
Q

What forms the hip joint?

A

Femur and acetabulum

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19
Q

What is the labrum?

A

Fibrocartilage surrounding acetabulum, forms extension of acetabular “roof”

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20
Q

How much of the femoral head should be covered by labrum?

A

2/3

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21
Q

Where does blood supply travel to the pelvis?

A

Acetabular notch, nerves & vessels travel through

22
Q

What is the transverse ligament?

A

Band of fibrous tissue surrounding nerves & vessels traveling through acetabular notch

23
Q

Where does the gluteus maximus lie?

A

Superior to other muscles and posterior to hip

24
Q

Where is the gluteus minimus located?

A

Immediate covering to upper hip joint

25
Q

Where is the gluteus medius located?

A

Starts superior to minimus, both travel to greater trochanter, covers minimus

26
Q

What is the Barlow maneuver?

A

Determines whether hip can be dislocated
- Pt supine, hip flexed 90 deg, adducted
- Press down & out
- Feel femoral head move out of acetabulum

27
Q

What is Ortolani maneuver?

A

Determines whether dislocated femur head can be reduced back into place
- Supine pt, hip flexed 90 deg, abducted

28
Q

What does a click during Ortolani maneuver indicate?

A

Does not indicate DDH

29
Q

What does a clunk during Ortolani maneuver suggest?

A

DDH

30
Q

What is the probe and patient position for transverse images?

A

Posterolateral over hip joint, hip flexed

31
Q

How should the normal transverse hip appear?

A

Femoral head centered between metaphysis and ischium, triradiate cartilage b/w M & I

32
Q

How does an abnormal hip appear in transverse?

A

Stress displaces femoral head, gap b/w fem head & ischium

33
Q

What does the coronal view determine?

A

Degree of labrum covering fem head and position of fem head within acetabulum

34
Q

What is the landmark for coronal flexion view?

A

gluteus medius

35
Q

What needs to be visualized in the coronal view?

A

Ilium: straight and parallel
Labrum: included
Femoral head: sitting in acetabular roof and covered at least half by ilium

36
Q

What are the appearances of the acetabular roof in coronal?

A

Sloped, irregular, rounded

37
Q

How should the femoral head sit in relation to the acetabular roof?

A

FH shouldn’t be above AR, AR should cover FH by at least half

38
Q

Where is line 1 drawn?

A

Baseline, drawn along ilium extending through femur

39
Q

Where is line 2 drawn?

A

Drawn from bony edge of acetabulum at triradiate cartilage to lowest part of ilium

40
Q

Where is line 3 drawn?

A

From ilium along labrum

41
Q

What does alpha angle measure?

A

Acetabular depth, normal >60 degrees, between lines 1 & 3

42
Q

What is the normal beta angle?

A

Between 1 & 2, normal <55 degrees

43
Q

What are the Graf measurements for Type 1 hips? Modified & Graf classification

A

Modified: alpha >60 deg
Graf: alpha >60 deg, beta <55 deg

44
Q

What are the modified and Graf classification measurements of a Type II hip?

A

Modified: alpha >50, <60
Graf: alpha >43, <60

45
Q

What is a Type IIa hip?

A

normal from 0-3 mo, may be physiological laxity, f/u

46
Q

What is type IIb hip?

A

up to 3 mo, indicates delayed development, f/u

47
Q

What are the modified and Graf measurements of Type III hips?

A

Modified: alpha >43, <50, mild dysplasia
Graf: alpha <43, beta >77

48
Q

What are the modified and Graf measurements of type IV hips

A

Modified: alpha <43, significant dysplasia
Graf: alpha <43, beta immeasurable

49
Q

How does the Pavlik harness treat DDH?

A

Subluxed hip in neutral position will reinsert itself with constant flexion and abduction, harness keeps femur in place

50
Q
A

Advanced Proc (1 decks)

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