hip clinical conditions part 2

Question 1

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)

Answer 1

Congenital Hip Dysplasia

Question 2

most common disorder of the hip in children

Answer 2

Congenital Hip Dysplasia

Question 3

80% of affected children for Congenital Hip Dysplasia

Answer 3

female

Question 4

Exact cause of Congenital Dysplasia

Answer 4

unknown but is thought to be multifactorial (genetic, hormonal, and mechanical)

Question 5

Hip more commonly involved in Cogenital Dysplasia

Answer 5

left hip is more commonly involved

Question 6

Risk factors of Congenital Hip Dysplasia

Answer 6

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

Question 7

instability of the hip is the key clinical finding

hip clicks are nonspecific physical findings

Answer 7

neonates

Question 8

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

Answer 8

infants > 6 months

Question 8

restricted motion, limb-length inequalities, limp and waddling gait

Answer 8

toddlers

Question 9

all the above findings plus fatigue and pain in the hip, thigh, or knee

Answer 9

adolescents

Question 10

hips are flexed to 90°; positive if one knee (the involved side) is lower than the other – for unilateral cases only

Answer 10

Galeazzi (Allis) test

Question 11

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.

Answer 11

Barlow test

Question 12

abduction and lifting of the proximal femur anteriorly; positive if the dislocated hip is reduced

To relocate the hip

Answer 12

Ortolani test

Question 13

ROM will be normal in children < 6 months because

Answer 13

contractures have not yet developed

Question 14

decrease in abduction (most sensitive test)

Answer 14

ROM

Question 15

outline of what the hip would look like

Answer 15

Plain Radiographs

Question 16

line drawn horizontally through each triradiate cartilage of the pelvis

Answer 16

Hilgenreiner line

Question 17

drawn perpendicular to the Hilgenreiner line at the lateral edge of the acetabulum

Answer 17

Perkin line

Question 17

continuous arch drawn along the medial border of the femoral neck and superior border of the obturator foramen

Answer 17

Shenton line

Question 17

Radiographic Findings of Congenital Hip Dysplasia

Answer 17

Ultrasonography and Plain Radiographs

Question 18

angle formed by an oblique line (through the outer edge of the acetabulum and triradiate cartilage) and the Hilgenreiner line

Answer 18

Acetabular index

Question 19

Normal value of Congenital Hip Dysplasia in NEWBORNS

Answer 19

normal value averages 27.5°

Question 20

the acetabular index decreases to 21°

Answer 20

By 24 months of age

Question 20

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

Answer 20

Center-edge angle of Wiberg

Question 20

Developmental Dysplasia Treatment

0-6 mos; dysplatic

Answer 20

Pavlik harness

Question 20

Developmental Dysplasia Treatment

6-18 mos; dislocated

Answer 20

Closed or open reduction

Question 21

Developmental Dysplasia Treatment

> 18 mos; dislocated

Answer 21

open reduction, femoral shortening

pelvic osteonomy

Question 22

femoral shortening osteonomy

Answer 22

indicated in high-riding dislocations

typically in children >= 2 yrs old

Question 23

Pelvic osteonomy

Answer 23

indicated for significant dusplasia

often in children >= 18-24 mos old

Question 24

Cause of Hip Dislocation

Answer 24

Trauma

Question 25

Classifications of Hip Dislocation

Answer 25

Anterior Dislocation, Posterior Dislocation, Central Dislocation

Question 26

Hip is flexed, abducted and externally rotated at the moment of injury

Answer 26

Anterior Dislocation

Question 27

Hip is flexed, adducted and internally rotated Most common type

Answer 27

Posterior dislocation

Question 28

Direct impact on the lateral aspect of the greater trochanter forcing head into the acetabulum

Associated with acetabular fracture

Answer 28

Central dislocation

Question 29

Sciatic nerve palsy (common in posterior dislocation)
Fracture
Myositis ossificans
Avascular necrosis of femoral head
Post traumatic arthritis

Answer 29

Complications of Hip Dislocation

Question 30

Diagnosis of Hip Dislocation

Answer 30

X-ray, CT Scan

Question 31

Non operative treatment of Hip Dislocation

Answer 31

close reduction

Question 32

Operative treatment of Hip dislocation

Answer 32

consisting of open reduction for failure of closed reduction; concomitant fractures are also fixed

Question 33

Direct trauma to the iliac crest

Answer 33

Hip Pointer

Question 34

Signs and symptoms of Hip Pointer

Answer 34

Tenderness on the iliac crest, may have pain over iliac crest and during ambulation and active abduction

Question 35

Diagnosis for Hip pointer

Answer 35

X-ray if fracture is supected

Question 36

Treatment for Hip Pointer

Answer 36

Rest, ice, NASIDs, local steroid

Anesthetic for severe pain; gradual return to activities with progression

Question 37

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

Answer 37

Iliotibial band syndrome

Question 38

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.

Answer 38

+ Ober’s test

Question 39

If patient cannot do it, there is tightness of strain to the iliotibial band =

Answer 39

+ ober’s test

Question 40

Treatment of Iliotibial band syndrome

Answer 40

Modification of activity
Footwear (maybe patient is flatfooted)
Stretching program
Ice
NSAID

Question 41

Coxa sultans

Patients feel snap when walking

Answer 41

Snapping hip

Question 42

Iliotibial band over the prominent trochanter (most common)

Iliopsoas over the iliopectineal eminence

Answer 42

Extra-articular

Question 43

Labral tear

Answer 43

Intra-articular

Question 44

Diagnosis of Snapping Hip

Answer 44

Ultrasound

if in the labrum, MRI is better

Question 45

Treatment for Snapping Hip

Answer 45

Stretching the tight structures, NSAID, steroid injections

Surgery for failure of conservative management

Question 46

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

Answer 46

Sign and Symptom of Snapping Hip in Iliotibial Band

Question 47

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

Answer 47

Sign and Symptom of Snapping Hip in Iliopsoas