neonatal hip

Question 1

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

Answer 1

mesoderm

Question 2

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

Answer 2

2-8mo

Question 3

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

Answer 3

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

Question 4

When does DDH most frequently occur?

Answer 4

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

Question 5

What are the risk factors of DDH? (6)

Answer 5

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

Question 6

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

Answer 6

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

Question 7

What’s the positive Allis or Galeazzi sign?

Answer 7

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

Question 8

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

Answer 8

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

Question 9

When is the best time to image the hip?

Answer 9

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

Question 10

What planes do we use to evaluate the hip?

Answer 10

trv w/o stress

cor w/ + w/o stress

Question 11

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

Answer 11

acetabulum

superiorly, inferiorly

Question 12

The alpha and beta angle are obtained in what plane?

Answer 12

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)

Question 13

What is Type I Graff classification of DDH?

Answer 13

normal, α angle >60

Question 14

What is Type II Graff classification of DDH?

Answer 14

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

Question 15

What is Type III Graff classification of DDH?

Answer 15

dislocated hip, α angle <43 degrees

Question 16

What is Type IV Graff classification of DDH?

Answer 16

gross dislocation, α angle not measurable

Question 17

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

Answer 17

36-37% sublaxation

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

Question 18

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

Answer 18

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

Question 19

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

Answer 19

localized pain
limping/refusal to bear weight
limited movement
fever

Question 20

What is transient synovitis?

Answer 20

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

Question 21

What is septic arthritis?

Answer 21

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

Question 22

Is septic arthritis a medical emergency?

Answer 22

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

Question 23

What is the treatment for septic arthritis?

Answer 23

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

Question 24

What’s the normal hip capsule thickness?

Answer 24

2-5mm

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

Question 25

What are treatments for DDH?

Answer 25

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

Question 26

Erythrocyte sedimentation rate:

Answer 26

rate at which they settle down

lab test that is non specific indicator for inflammation

Question 27

Torticollis:

Answer 27

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