Neonatal Hips

Question 0

what is the sign for hip dysplasia with uneven knees when bent

Answer 0

galeazzi sign

Question 1

indications for hips US

Answer 1

family history of hip dysplasia
breech birth - girls > boys - oligohydramnios
abn findings on exam (click, instability, limited range of motion)
eval of an infant with postural deformity (torticollis, foot deformity)
uneven gluteal crease
limited hip abduction

Question 2

what transducer will be used to scan hips

Answer 2

7-10 mhz linear - 12 mhz if its a really tiny baby

Question 3

what are scanning procedures for hips

Answer 3

coronal and transverse in neutral/extension and flexion/bent

Question 4

what is the anatomy of the hips

Answer 4

ishium
ilium
femoral head
acetabular labrum

Question 5

what is a standard that should be seen when dealing with the femoral head

Answer 5

50% of the femoral head should be covered or below a certain level

Question 6

how will the femoral head dislocate

Answer 6

anteriorly, superiorly, and laterally the femoral head will dislocate

hips dislocate laterally so right hip dislocates left and vice versa

Question 7

what do you look for when scanning the acetabulum

Answer 7

is it rounded or flat shaped

Question 8

what does DDH stand for

Answer 8

developmental displacement of the hip

Question 9

know anatomy and lay out of the hip structures

Answer 9

slides 13-17

Question 10

what are the maneuvers used by the doctors to identify hip dysplasia

Answer 10

Barlow or Ortolani

Question 11

US is done up to what age to identify hip dysplasia

Answer 11

up to 3 mos

after 3 mos, CT is used

Question 12

what are the names of the 2 angles used to measure the hips

Answer 12

alpha and beta angles

Question 13

describe the alpha angle

Answer 13

angle between baseline and acetabular roof

represents acetabular formation

normal > 60 degrees

ilium must be straight when imaging for appropiate angling

Question 14

describe beta angle

Answer 14

angle between the baseline and the inclination line (along labrum)

evaluates formation of cartilaginous acetabulum

normal < 55 degrees

Question 15

along with measuring alpha and beta angles, what else is measured

Answer 15

depth of the femoral head

must be more than 50% covers when ilium is straight

Question 16

describe the barlow maneuver

Answer 16

adduction and gentle pushing against the knee with hip flexed

up and in pressure

Question 17

what is the ortolani maneuver

Answer 17

hip flexed and thigh abducted

“clunk” is felt as femoral head returns to acetabulum

down and out pressure

Question 18

how many graf’s classifications are there

Answer 18

4

Question 19

graf’s classification type I

Answer 19

normal

alpha angle > 60 degrees

Question 20

graf’s classication type II

Answer 20

alpha angle 43-60 degrees

Question 21

graf’s classification type III

Answer 21

alpha angle < 43 degrees

beta angle > 77 degrees

Question 22

graf’s classification type IV

Answer 22

alpha angle < 43 degrees

beta angle immeasurable

Question 23

describe normal hips

Answer 23

type I

cannot be displaced out of acetabulum

can hav up to 6 mm of motion on left and 4 mm on right

Question 24

describe subluxable hips

Answer 24

femoral head displaced in relation to acetabulum

soft tissue echoes between femoral head and acetabulum

moves more than 6 mm on left and 4 mm on right

Question 25

describe dislocatable hips

Answer 25

can be displaced out of acetabulum but can be reduced

Question 26

describe dislocated hips

Answer 26

femoral head is displaced out of acetabulum and cannot be reduced

Question 27

what are secondary signs of DDH

important

Answer 27

acetabular roof is irregular and angled

labrum echogenic and thickened

echogenic soft tissue between femoral head and bony acetabulum

acetabulum flattened

femoral head calcified

Question 28

treatment for hip dysplasia

Answer 28

double diapering

spica cast

pavlik harness

Question 29

what is a bachelor cast

Answer 29

worn after spica cast removed

covers only the legs

child more flexible

can learn to walk while in cast