Hips

Question 1

Why do we screen

Answer 1

Early detection of dislocated or disclosatble hips
Indication of sonographic pathological hip dysplasia through selective USS
Minimise risk of long term complication

Question 2

Incidence

Answer 2

3-5 on 1000 live births may require pelvis harness
12 in 100- live births may require surgery

Question 3

Risk factors

Answer 3

Family history ( first degree) of hip problems in early life
Breech at presentation after 36 weeeks
Breech at time of birth between 28-40/40
Where a risk factors are present in multiple pregnancy all babies should hae hip USS
Oligohydrmnious

Question 4

Barlow manoeuvre

Answer 4

Hips and knees flexed to right angles
Position thumb on inner thighs
With middle finger on greater trochanter while flexed leg is he’d by other hand
Babys hips is abducted and gentle posterior pressure is placed on the hip

Question 5

Positive Barlow sign

Answer 5

When clunk felt as head of femur subluxes out of the soket

Question 6

Ortalani

Answer 6

Hips and knees flexed to right angles
Gentry abduct the tight nd put pressure over greater trochanter while flexed
Elevate trochanter upwards replacing disclosed head of the femur back into the acetabulum

Question 7

Positive oratlani sign

Answer 7

Clunk felt as head goes back

Question 8

Screen positive

Answer 8

Difference n leg length
Knee at different heights
Restricted unilateral
Limitation in hip abduction
Palpable clunk when undertaking manaouerves

Question 9

Screen positive more than 34/40

Answer 9

USS at 4-6 eeks of age
Discharge from hip screening pathway after normal USS
Or clinical assessment within 6 weeks of age

Question 10

Screen positive less than 34/40

Answer 10

USS at 38-40 weeks corrected age
Discharge from hip screening pathway when normal USS
Or clinical assesssmnth at 40 weeks corrected age

Question 11

Screen positive at nipe 6-8 weeks

Answer 11

Refer to passed surgeon as urgent second opinion
Seen by 10 weeks of age

Question 12

Palvik harness

Answer 12

Prevent adduction and extension but promotes flexion and abduction
Leads to stabilisation
Success 95% if maintained full time for 6 weeks

Question 13

What do you need to know before exam

Answer 13

Mum’s obstretric noes
Baby’s family history

Question 14

Observe

Answer 14

Symmetry of legs
Level of knees when hips and knees are flexed
Restricted abduction of hips when flexed