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
What makes up the hip bone?
- 2 innominate bones
Where does the femur articulate with the pelvis
What type of joint is the hip?
ball and socket
What is the most important ligament reinforcing the hip joint?
What is the importance of the iliofemoral ligament?
How long can an ultrasound exam be done on the hip joint
size shape and position of the femur can be assessed before the bones are ossified
How much of the femoral head is covered by the acetabulum?
What is assessed?
position of the femoral head at rest, in motion and under stress
How long should an infant have physiologic laxity of the hips?
What are the required images in a neonatal hip exam?
What is assessed with the coronal neutral image?
- femur head
- shape of acetabulum
- femur covered 2/3
- angle greater than 60* normal
femur can be displaced but can be reduced
femur is displaced and can NOT be reduced
What is assessed with the coronal flexion image?
hip moves in 90* angle of flexion
incomplete or partial dislocation
purpose of the Barlow maneuver
used to distinguish between
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
What is assessed in the transverse neutral image?
the sonolucent femur head is positioned against the bony acetabulum over the triradiate cartilage
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
What is the incidence of developmental displacement of the hips?
10 in 1000 after the removal of subluxation
Who does developmental displacement of the hips affect?
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
What is the presentation of developmental displacement of the hips?
asymatry of skin folds
limitation of abduction
What is the Galeazzi sign?
one knee higher than the other
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
How is developmental displacement of the hips treated
resolve on own
Pavlik Harness - holds hips in acetabulum
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
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
What happens if developmental displacement of the hips is left untreated?
premature onset of arthritis and hip pain