infant hip joint Flashcards

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1
Q

bones, connective tissues and muscles originate from

A

mesoderm

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2
Q

hip bone composed of 3

A

ilium, ischium and pubis

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3
Q

acetabulum has the

A

triradiate cartilage
located at lateral aspects
articulation point for femoral head

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4
Q

At the rim of the acetabulum sits a lip of cartilage called

A

acetabular labrum

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5
Q

femoral head is ______ at birth

A

cartilaginous

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6
Q

femoral head begins to ossify at

A

2 to 8 months from the centre outwards

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7
Q

_____ contribute to the laxity of the fetal ligaments

A

maternal hormones

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8
Q

laxity of fetal ligaments may cause

A

create vulnerable atmosphere for the hip to become subluxable or dislocatable

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9
Q

developmental dysplasia of the hip occurs most freq when

A

at birth

sometimes happen during infancy

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10
Q

the cause of DDH may be mechanical as a result of

A

positional influences in utero and after birth

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11
Q

The cause of DDH may be physiological as a result of

A

resulting from a response to maternal hormones in utero

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12
Q

risk factors of DDH

A

Born in breech position
Positive family Hx
Living in cultures that swaddle infants in extension and hip adduction
Oligohydramnios
Metatarsus adductus (img) and torticollis associated with DDH
Firstborn, female, white, high birth weight, native North American

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13
Q

3 things done during clinical assessment of both hips

A

barlow maneuver
Ortolani maneuver
Visual assessment

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14
Q

do instabilities of hip need treatment

A

some but most become normal without treatment

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15
Q

significant dysplasia leads to

A

to disability / hip replacement surgeries in adulthood

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16
Q

explain barlow test

A

Provocative test, determines if hip can be dislocated
The examiner attempts to push the femoral head posteriorly out of socket
Gentle adduction and push on the knee

17
Q

describe ortolani test

A

The examiner attempts to reduce/relocate a recently dislocated hip
Gentle out** and up*** movement

If positive both tests produce a sensation of clunk**

18
Q

what is positive allis or galeazzi sign

A

Relative shorteness of the femur with the hip and knees flexed
Discrepancy in leg lengths
Asymmetry of gluteal and thigh folds

19
Q

allis or galeazzi sign are only useful when

A

for unilateral DDH

20
Q

transducer freq for birth to 3 mo and older infants

A

12-7.5 MHz for birth to 3 mo

5.0 MHz for older infants

21
Q

Sonography of the hip is best performed up to

A

6 months

22
Q

what planes are used in hip scan

A

Coronal plane without stress

Transverse plane with and without stress maneuvers

23
Q

what is seen coronal scan plane

A

The femoral head can be identified sitting in the acetabulum

Iliac line will be identified superiorly, and the bony shaft of the femoral neck will be identified inferiorly

Iliac line should appear as a straight line - important in making an accurate assessment

24
Q

how to obtain the alpha and beta angles in the coronal plane

A

The first line is aligned with the ilium and extends through the head of the femur
The second line is drawn along the bony acetabulum
The third line extends from end of ilium line along the cartilaginous acetabulum (labrum)
The α-angle is formed between the 1st and 2nd line
The β-angle is formed between the 1st and 3rd line

25
Q

what is a normal alpha angle

A

more than or equal to 60 degrees

26
Q

normal beta angle

A

less than 55

big beta bad

27
Q

what are these angles compared to for diagnosis

A

graft classification

28
Q

4 classifications on GRAFF

A

type 1: normal alpha more than 60
type 2: normal up to 3 mo, angle 44-60
type 3: dislocated hip, angle less than 43
type 4: gross dislocation, angle not measurable

29
Q

what is femoral head coverage and what plane is it obtained in

A

Shows how well femoral head is contained in the acetabulum and whether or not the femoral head is in contact with the acetabular floor
coronal plane

30
Q

normal femoral head coverage

A

60%

31
Q

Hip instability (subluxation) will present with a FHC of approx

A

36-37%

32
Q

whats more reproducible FCH or alpha angle

A

alpha angle

33
Q

what is the classic normal appearance sign of the hip

A

ball on spoon
ball: femoral head
iliac line: handle
scoop: acetabulum