Neonatal hips

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created 5 years ago by Annabelle
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1

What is the indication for a neonatal hip exam?

rule out developmental displacement of the hips

septic arthritis and joint effusion

proximal focal femoral deficiency

2

What makes up the hip bone?

  • 2 innominate bones
    • ileum
    • ischium
    • pubis
3

Where does the femur articulate with the pelvis

acetabulum

4

What type of joint is the hip?

ball and socket

5

What is the most important ligament reinforcing the hip joint?

iliofemoral ligament

6

What is the importance of the iliofemoral ligament?

maintaining balance

standing

7

flexion

bending forward

8

extension

bending backwards

9

abductions

moving lateral

10

adduction

moving medial

11

How long can an ultrasound exam be done on the hip joint

1 year

size shape and position of the femur can be assessed before the bones are ossified

12

How much of the femoral head is covered by the acetabulum?

3/4

13

What is assessed?

position of the femoral head at rest, in motion and under stress

14

How long should an infant have physiologic laxity of the hips?

4 weeks

15

What are the required images in a neonatal hip exam?

coronal neutral

coronal flexion

transverse neutral

transverse flexion

16

What is assessed with the coronal neutral image?

  • femur head
    • position
    • motion
    • shape
  • shape of acetabulum
  • femur covered 2/3
  • angle greater than 60* normal
17

dislocatable hip

femur can be displaced but can be reduced

18

dislocated

femur is displaced and can NOT be reduced

19

What is assessed with the coronal flexion image?

hip moves in 90* angle of flexion

subluxation

dislocation

20

Subluxation

incomplete or partial dislocation

21

purpose of the Barlow maneuver

used to distinguish between

subluxatable

dislocatable

dislocated

22

Explain the Barlow maneuver

Patient in supine

hip flexed 90* and adducted downward and outward pressure applied

if hip can be dislocated examiner will feel femoral head move out of the acetabulum with finger

push - displacement of head over posterior acetabulum

pull - head no long positioned over triadiate cartilage

23

What is assessed in the transverse neutral image?

the sonolucent femur head is positioned against the bony acetabulum over the triradiate cartilage

24

What is assessed in the transverse flexion image?

echoes from the bony acetabulum appear posteriorly to the femoral head

in normal hip a U configuration is produced with maximum abduction

the U is absent when there is dislocation

in adduction the V appearance is seen

25

What is the incidence of developmental displacement of the hips?

10 in 1000 after the removal of subluxation

26

Who does developmental displacement of the hips affect?

first born

females

left hip

caucasians

breech

27

What is the cause of developmental displacement of the hips?

Gradual migration of the femoral head from the acetabulum because of the loose elastic joint capsule

28

What is the presentation of developmental displacement of the hips?

asymatry of skin folds

Galeazzi sign

limitation of abduction

29

What is the Galeazzi sign?

one knee higher than the other

30

Explain the Ortolani Maneuver

examiner hand is placed around the hips to be examined with fingers over femoral head

middle fingers over greater trochanter, thumb over lesser trochanter

hip is flexed 90* and the thigh abducted

movement should be smooth. In DDH a clink is noted as femoral head returns to acetabulum

31

How is developmental displacement of the hips treated

resolve on own

Pavlik Harness - holds hips in acetabulum

32

What is the most important factor influencing of treatment of developmental displacement of the hips?

the age at diagnosis

treatment should begin bfore patient walks

33

When is an hip exam ordered?

only when physical exam is abnormal

but sonography is much more sensitive than a physical exam in detection of developmental displacement of the hips

34

What happens if developmental displacement of the hips is left untreated?

short leg

pronounced limp

hip pain

premature onset of arthritis and hip pain