neonatal hip Flashcards
Where do the bones, connective tissues and muscles originate from?
mesoderm
Femoral head is cartilaginous at birth. When does it ossify?
2-8mo
Why is it easier for a neonatal hip to sublaxate or dislocate?
maternal hormones make the ligaments lax, which makes a vulnerable atmosphere
When does DDH most frequently occur?
birth – can be mechanical (positions in utero or after birth) or physiological (maternal hormones)
What are the risk factors of DDH? (6)
oligohydramnios
breech position
family hx
cultures that swaddle infants in extension + hip adduction
metatarsus adductus + torticollis
first born, female, white, high birth weight, native american
In a clinical assessment of DDH, the Barlow + Ortolani tests are done. What are they?
Barlow- determines if the hip can be dislocated. The femoral head is pushed posteriorly out of socket, and then a gentle adduction + push on the knee
Ortolani- attempt to reduce/relocate a dislocated hip. Gentle up and out movement.
If positive, both tests should make a clunk
What’s the positive Allis or Galeazzi sign?
relative shortness of the femur with the hip and knees flexed
asymmetry of gluteal and thigh folds
*used for unilateral DDH only
What transducers do we use for sonographic evaluation of the hip?
linear
older infants- 5MHz
birth-3mo- 7.5-12MHz
When is the best time to image the hip?
up to 6mo–any later US is not as reliable due to the increasing ossification of the bone
What planes do we use to evaluate the hip?
trv w/o stress
cor w/ + w/o stress
The femoral head can be seen in the _________. The iliac line can be identified __________, and the femoral neck ____________.
acetabulum
superiorly, inferiorly
The alpha and beta angle are obtained in what plane?
coronal–
prolly review what these angles mean
if the α- angle is >60 it’s normal. If the β angle is <55 it’s normal
“big beta bad”
use GRAFF CLASSIFICATION (this was in caps on his slides so I also put it in caps)
What is Type I Graff classification of DDH?
normal, α angle >60
What is Type II Graff classification of DDH?
normal if newborn, up to 3mo of age; indicates slowed development. α angle 44-60
What is Type III Graff classification of DDH?
dislocated hip, α angle <43 degrees