Pediatric Hips

Question 1

The acetabulum is composed of what kind of cartilage?

Answer 1

Triradiate cartilage AKA growth plate

Question 2

When does the femoral head begin to ossify?

Answer 2

3-8 months old from the center outwards

Question 3

Fluid aspiration if cases of hip effusion can determine between what two abnormalities?

Answer 3

Transient synovitis vs septic arthritis

Question 4

Symptoms of hip effusion?

Answer 4

Pain
Refuse to weight bear
Irritability

Question 5

What is a common cause of hip pain between the ages of 3-8 months?

Answer 5

Transient synovitis - mild condition

Question 6

With transient synovitis, the patient has likely had a history of?

Answer 6

Upper respiratory tract infection

Question 7

What type of infection is septic arthritis?

Answer 7

Bacterial - medical emergency

Question 8

In patients with septic arthritis, they will present with elevated levels of what lab values? (3)

Answer 8

1. Erythrocyte sedimentation rate
2. C-reactive protein
3. WBC count

Question 9

How is septic arthritis treated?

Answer 9

1. Antibiotics
2. Surgery (if serious)

Question 10

An abnormal appearance that indicates hip effusion consists of what parameters?

Answer 10

1. Capsular thickness >5mm
2. 2 mm difference between both hips

Question 11

What does DDH stand for?

Answer 11

Developmental dysplasia of the hip

Question 12

What 3 abnormalities does DDH consist of?

Answer 12

1. Instability
2. Subluxation - partial dislocation but not complete
3. Frank Dislocation - not in the socket at all

Question 13

Causes of DDH?

Answer 13

Mechanical
Physiologic

Question 14

What maneuver attempts to push the femoral head posteriorly out of the socket?

Answer 14

Barlow - a palpable SENSATION of movement

Question 15

What maneuver attempts to reduce a recently dislocated hip?

Answer 15

Ortolani - a palpable PHYSICAL movement

Question 16

What is known as the “ noted relative shortness of the femur with the hips and knees flexed where one knee will appear lower than the other”?

Answer 16

Positive Allis or Galeazzi sign

Question 17

When is ultrasound of the hip BEST performed?

Answer 17

Up to 6 months

Question 18

In the coronal scan plane, what angle is usually measured to assess DDH?

Answer 18

Alph angle

Question 19

What are the 3 “lines” used for obtaining a hip measurement on ultrasound?

Answer 19

Base - straight along ilium though femoral head
Roof - along acetabular roof intersecting baseline
Inclination - Across top of femoral head, through labrum

Question 20

An alpha angle of what is considered abnormal?

Answer 20

Greater than or equal to 60 degrees

Question 21

What are we looking for in the TRV scan plane of the hip? (90 degrees of the coronal plane with hips flexed)

Answer 21

1. U or V shape that is formed by the ischium and femoral shaft around femoral head

Question 22

What is the gold standard treatment for DDH?

Answer 22

Pavlik harness