Neonatal Hips

Question 0

What is the Galeazzi sign?

Answer 0

when legs are bent the knees aren’t the same height

Question 1

What are some reasons you would scan a neonatal hip?

Answer 1

family history of DDH (developmental dysplasia of the hip)

breech presentation at birth (girls), oligohydramnios

abn findings on clinical exam

eval of infant with postural deformity

uneven gluteal crease

Question 2

Hips wont abduct/adduct with _______

Answer 2

hip dislocation

Question 3

At least ______of the femoral head should be covered

Answer 3

50%

slide13

Question 4

what is the cartilage that looks like the ice cream cone on slide 13?

Answer 4

triradiate cartilage

Question 5

in what directions does the hip dislocate?

Answer 5

superior and lateral

Question 6

What maneuvers do the doctors do in order to determine DDH?

Answer 6

barlow

Ortolani

Question 7

DDH ultrasounds can be done up to _______months of age

Answer 7

3

Question 8

What angles do you need to use in order to measure the hip?

Answer 8

alpha angle

beta angle

Question 9

What is the alpha angle?

Answer 9

between the baseline and acetabular roof

represents acetabular formation

normal is >60 degrees

see slide 20 for picture (line that goes through word labrum)

Question 10

what is the beta angle

Answer 10

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

evaluates formation of cartilaginous acetabulum

normal 55 degrees

Question 11

What is the Barlow Maneuver?

Answer 11

adduction (pushing inward) and gentle pushing against the knee with hip flexed (knees bent)

Question 12

What is the Ortolani Maneuver?

Answer 12

Hip flexed and thigh abducted (pushed outward and down)

“clunk” is felt as femoral head returns to acetabulum

Question 13

What are the anatomical parts of the hip?

Answer 13

ishium

ilium

femoral head

acetabular labrum

Question 13

What is the neutral position?

Answer 13

leg extended

Question 14

How many of Graf’s classification are there?

Answer 14

4

type 1 - normal alpha angle > 60*

type 2 - alpha angle 43-60*

type 3 - alpha angle 77*

type 4 - alpha angle <43* beta angle immeasurable

Question 15

What is Graf’s type I?

Answer 15

normal

cannot be displaced out of acetabulum

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

Question 16

What is subluxable

Answer 16

femoral head displaced in relation to acetabulum

soft tissue echoes between femoral head and acetabulum

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

Question 17

What does it mean for a hip to be dislocatABLE?

Answer 17

Can be displaced out of acetabulum but can be reduced

Question 18

What does it mean for a hip to be dislocatED?

Answer 18

femoral head is displaced out of acetabulum and CANNOT be reduced

Question 19

What are the secondary signs of DDH?

Answer 19

acetabular roof is irregular and angled

labrum echogenic and thickened

echogenic soft tissue between femoral head and bony acetabulum

acetabulum flattened

femoral head calcifies early

Question 20

What is the treatment for DDH?

Answer 20

double diapering

spica cast

pavlik harness

Question 21

What is a bachelor cast?

Answer 21

worn after spica cast removed

covers only the legs

child more flexible

can learn to walk while in cast