hip clinical conditions part 2 Flashcards
Developmental dysplasia of the hip (DDH)
refers to the complete spectrum of pathologic conditions involving the developing hip, ranging from acetabular dysplasia to hip subluxation to irreducible hip dislocation
pseudoacetabulum usually is present
this condition always accompanies other congenital anomalies or neuromuscular conditions, (arthrogryposis and myelomeningocele)
Congenital Hip Dysplasia
most common disorder of the hip in children
Congenital Hip Dysplasia
80% of affected children for Congenital Hip Dysplasia
female
Exact cause of Congenital Dysplasia
unknown but is thought to be multifactorial (genetic, hormonal, and mechanical)
Hip more commonly involved in Cogenital Dysplasia
left hip is more commonly involved
Risk factors of Congenital Hip Dysplasia
females and firstborns, and with breech presentation (30% to 50%)
commonly associated with intrauterine “packaging” problems (prematurity, oligohydramnios, congenital dislocation of the knee, congenital muscular torticollis and metatarsus adductus)
family history is a strong risk factor
instability of the hip is the key clinical finding
hip clicks are nonspecific physical findings
neonates
limitation of motion and apparent limb shortening
Usual signs, leg length difference, you can “open” one leg but the not the other, and the skin lines = shorter leg
infants > 6 months
restricted motion, limb-length inequalities, limp and waddling gait
toddlers
all the above findings plus fatigue and pain in the hip, thigh, or knee
adolescents
hips are flexed to 90°; positive if one knee (the involved side) is lower than the other – for unilateral cases only
Galeazzi (Allis) test
posterolateral force to the extremity with the hip in a flexed and adducted position; positive if the hip subluxates or dislocates
Posterolateral force to the hip, and you feel a click= dislocated hip.
Barlow test
abduction and lifting of the proximal femur anteriorly; positive if the dislocated hip is reduced
To relocate the hip
Ortolani test
ROM will be normal in children < 6 months because
contractures have not yet developed
decrease in abduction (most sensitive test)
ROM
outline of what the hip would look like
Plain Radiographs
line drawn horizontally through each triradiate cartilage of the pelvis
Hilgenreiner line
drawn perpendicular to the Hilgenreiner line at the lateral edge of the acetabulum
Perkin line
continuous arch drawn along the medial border of the femoral neck and superior border of the obturator foramen
Shenton line
Radiographic Findings of Congenital Hip Dysplasia
Ultrasonography and Plain Radiographs
angle formed by an oblique line (through the outer edge of the acetabulum and triradiate cartilage) and the Hilgenreiner line
Acetabular index
Normal value of Congenital Hip Dysplasia in NEWBORNS
normal value averages 27.5°
the acetabular index decreases to 21°
By 24 months of age
angle formed by a vertical line through the center of the femoral head and perpendicular to the Hilgenreiner line and an oblique line through the outer edge of the acetabulum and center of the femoral head
reliable only in patients older than 5 years
<20° is considered abnormal
Center-edge angle of Wiberg
Developmental Dysplasia Treatment
0-6 mos; dysplatic
Pavlik harness
Developmental Dysplasia Treatment
6-18 mos; dislocated
Closed or open reduction
Developmental Dysplasia Treatment
> 18 mos; dislocated
open reduction, femoral shortening
pelvic osteonomy
femoral shortening osteonomy
indicated in high-riding dislocations
typically in children >= 2 yrs old
Pelvic osteonomy
indicated for significant dusplasia
often in children >= 18-24 mos old
Cause of Hip Dislocation
Trauma
Classifications of Hip Dislocation
Anterior Dislocation, Posterior Dislocation, Central Dislocation
Hip is flexed, abducted and externally rotated at the moment of injury
Anterior Dislocation
Hip is flexed, adducted and internally rotated Most common type
Posterior dislocation
Direct impact on the lateral aspect of the greater trochanter forcing head into the acetabulum
Associated with acetabular fracture
Central dislocation
Sciatic nerve palsy (common in posterior dislocation)
Fracture
Myositis ossificans
Avascular necrosis of femoral head
Post traumatic arthritis
Complications of Hip Dislocation
Diagnosis of Hip Dislocation
X-ray, CT Scan
Non operative treatment of Hip Dislocation
close reduction
Operative treatment of Hip dislocation
consisting of open reduction for failure of closed reduction; concomitant fractures are also fixed
Direct trauma to the iliac crest
Hip Pointer
Signs and symptoms of Hip Pointer
Tenderness on the iliac crest, may have pain over iliac crest and during ambulation and active abduction
Diagnosis for Hip pointer
X-ray if fracture is supected
Treatment for Hip Pointer
Rest, ice, NASIDs, local steroid
Anesthetic for severe pain; gradual return to activities with progression
Can have pain on lateral side of knee when stretched
History of lateral hip, thigh or knee pain, snapping as iliotibial band passes over the greater trochanter
Iliotibial band syndrome
Patient will lie down on his side. Lying on left, right thigh over left. Try to put the right thigh behind, making the knee touch the bed or table.
+ Ober’s test
If patient cannot do it, there is tightness of strain to the iliotibial band =
+ ober’s test
Treatment of Iliotibial band syndrome
Modification of activity
Footwear (maybe patient is flatfooted)
Stretching program
Ice
NSAID
Coxa sultans
Patients feel snap when walking
Snapping hip
Iliotibial band over the prominent trochanter (most common)
Iliopsoas over the iliopectineal eminence
Extra-articular
Labral tear
Intra-articular
Diagnosis of Snapping Hip
Ultrasound
if in the labrum, MRI is better
Treatment for Snapping Hip
Stretching the tight structures, NSAID, steroid injections
Surgery for failure of conservative management
Snap noted over the prominence of the greater trochanter during hip flexion and extension or rotation
When patient adducts the hip and rotate the hip from external to internal rotation, snap is produced
Sign and Symptom of Snapping Hip in Iliotibial Band
Snap felt at groin during extension of hip
Snap is produced with patient in supine and hip is moved from flexion to extension in an abducted and externally rotated position
Feels the snap anteriorly
Sign and Symptom of Snapping Hip in Iliopsoas
