Lecture 6/7

Question 1

medial femoral or internal femoral torsion-abnormal increase in femoral anteversion beyond the normal values of 10-50° internal which occur during childhood development

Answer 1

Antetorsion:

Question 2

lateral femoral or external femoral torsion-abnormal increase in external femoral rotation beyond 10° internal

Answer 2

Retrotorsion

Question 3

External hip rotators (Notre Dame theme song: “Go Out And Get Some Quality Players”)

Answer 3

gluteus maximus
		obdurators
		adductors
		gemelli
		sartorius
		quadratus femoris
		piriformis

Question 4

Normal hip external and internal rotation values

Infants

Answer 4

60-90° external; 0-30° internal (3:1)

Question 5

Normal hip external and internal rotation values

1 year

Answer 5

50-60° external; 30° internal (2:1)

Question 6

Normal hip external and internal rotation values

Adult

Answer 6

45° external; 45° internal (1:1)

Question 7

3 activities occur to mold the epiphysis of the femoral head to reduce anteversion

Answer 7

Upper end of femur yields under pressure to tight anterior capsule so that excessive anteversion slowly molded away

contraction of internal rotator muscles and external rotators

Pelvic movement of inward rotation

Note: Therefore, walking is the decisive factor for reducing anteversion

Question 8

The most common cause of intoeing after the age of 2 or 3 is

Answer 8

internal femoral torsion (antetorsion) or tight internal hip rotators and/or tight iliofemoral, pubofemoral or ligamentum teres ligaments

Question 9

The most common cause of outoeing at any age is

Answer 9

external femoral torsion (retrotorsion) or tightness of the external hip rotators and/or ischiofemoral ligament

Question 10

generally the result of abnormal development of the soft tissues surrounding the hip joint and eventually, if not corrected, changes in the shape of the acetabulum, itself

Answer 10

DHD
Developmental Hip Dysplasia

over 90% of the time, the head of the femur is positioned upward, lateralward, and POSTERIORLY from its usual position in the acetabulum

Question 11

broken anchor sign”

Answer 11

Assymetry of gluteal folds

Question 12

Limited abduction of affected hip

Answer 12

DHD

Question 13

sign-with child supine and hip flexed and knee flexed, there is a lower level of the knee on the affected side

Answer 13

Galleazzi’s or Allis’

Question 14

sign-more evident if hip is truly dislocated; presence of palpable click in and out as the hip is reduced by abduction and dislocated by adduction

Answer 14

Ortaloni’s sign

Question 15

sign-when extremity is pushed in piston type fashion with hip flexed and extended, abnormal mobility or telescoping is felt

Answer 15

Telescoping sign

Question 16

4 most common criteria predictive of DDH*

Answer 16

Ortolani/Barlow test
Limited hip abduction
Leg length discrepancy
First degree family history of DDH

Question 17

horizontal line connecting the two most medial and inferior points of acetabular cavities

Answer 17

Hilgenreiner’s Line (HL):

Question 18

vertical line from most ossified lateral margin of rim of acetabulum-crosses HL perpendicularly, forming quadrants

Answer 18

Perkin’s Line

Question 19

angle formed by HL and a line connecting it from the most prominent medial and lateral points at rim of acetabulum

Answer 19

Acetabular index

Normal: 30°
DHD: >30°

Question 20

arc drawn along medial border of femoral neck and superior portion of obturator foramen

Answer 20

Shenton’s or Menard’s Line

Normal: uninterrupted arc
DHD: arc is broken