neonatal hip Flashcards

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1
Q

Where do the bones, connective tissues and muscles originate from?

A

mesoderm

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2
Q

Femoral head is cartilaginous at birth. When does it ossify?

A

2-8mo

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3
Q

Why is it easier for a neonatal hip to sublaxate or dislocate?

A

maternal hormones make the ligaments lax, which makes a vulnerable atmosphere

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4
Q

When does DDH most frequently occur?

A

birth – can be mechanical (positions in utero or after birth) or physiological (maternal hormones)

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5
Q

What are the risk factors of DDH? (6)

A

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

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6
Q

In a clinical assessment of DDH, the Barlow + Ortolani tests are done. What are they?

A

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

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7
Q

What’s the positive Allis or Galeazzi sign?

A

relative shortness of the femur with the hip and knees flexed
asymmetry of gluteal and thigh folds
*used for unilateral DDH only

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8
Q

What transducers do we use for sonographic evaluation of the hip?

A

linear
older infants- 5MHz
birth-3mo- 7.5-12MHz

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9
Q

When is the best time to image the hip?

A

up to 6mo–any later US is not as reliable due to the increasing ossification of the bone

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10
Q

What planes do we use to evaluate the hip?

A

trv w/o stress

cor w/ + w/o stress

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11
Q

The femoral head can be seen in the _________. The iliac line can be identified __________, and the femoral neck ____________.

A

acetabulum

superiorly, inferiorly

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12
Q

The alpha and beta angle are obtained in what plane?

A

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)

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13
Q

What is Type I Graff classification of DDH?

A

normal, α angle >60

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14
Q

What is Type II Graff classification of DDH?

A

normal if newborn, up to 3mo of age; indicates slowed development. α angle 44-60

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15
Q

What is Type III Graff classification of DDH?

A

dislocated hip, α angle <43 degrees

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16
Q

What is Type IV Graff classification of DDH?

A

gross dislocation, α angle not measurable

17
Q

Hip instability will present with a FMC (femoral head coverage) of approx?

A

36-37% sublaxation

normal mean- 54% in females. 56% in males

18
Q

What is the normal hip appearance on a coronal/flexion image?

A

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

if it’s sublaxable: superior or lateral displacement of fem head will be identified
if it’s dislocated: fem head will appear out of acetabulum

19
Q

What are the clinical presentations of a hip effusion? (4)

A

localized pain
limping/refusal to bear weight
limited movement
fever

20
Q

What is transient synovitis?

A

common causes of hip pain
self-limiting dx–can be treated with anti-inflammatory meds and rest
no fever or long term effects

21
Q

What is septic arthritis?

A

serious bacterial infection
more severe clincial symptoms than transient synovitis
may be difficult to differentiate, but these children may have a fever
inc ESR (not sure what this means)
inc WBC count

22
Q

Is septic arthritis a medical emergency?

A

yes. Can cause long-term effects: avascular necrosis of fem head, osteomyelitis, systemic sepsis and osteoarthritis of hip joint

23
Q

What is the treatment for septic arthritis?

A

Us guided arthrocentesis. If sepsis is confirmed, hospitalized w/ IV a/b

24
Q

What’s the normal hip capsule thickness?

A

2-5mm

abnormal if >5mm or a 2mm difference b/w sides

25
Q

What are treatments for DDH?

A
US follow up 
Pavlik harness
bracing the lower extremities
casting 
surgical reduction
26
Q

Erythrocyte sedimentation rate:

A

rate at which they settle down

lab test that is non specific indicator for inflammation

27
Q

Torticollis:

A

neck is turned sideways because one of the SCM becomes contracted
a/w hip dysplasia