Ch 11 Hips

Question 1

What are the 2 pathologies we cover regarding ped hips?

Answer 1

-Hip effusion (transient synovitis + septic arthritis)
-Developmental dysplasia

Question 2

The hip joint is composted of the ___ + the ___?

Answer 2

Pelvic girdle + femur

Question 3

The hip bone (aka pelvic girdle) is composed of what 3 structures?

Answer 3

Ilium, ischium + pubis

Question 4

___ is the socket of the hipbone into which the femur head fits?

Answer 4

Acetabulum

Question 5

___ is a lip of cartilage that sits at the rim of the acetabulum?

Answer 5

Acetabular labrum

Question 6

The femoral head is cartilaginous at birth + begins to ossify from the center outward at ___ months of age?

Answer 6

2-8

Question 7

Differentiate abduct + adduct?

Answer 7

Abduct: move AWAY from midline

Adduct: move TOWARD midline

Question 8

What 2 things create the acetabulum?

Answer 8

Triradiate cartilage (growth plate) + bone

Question 9

What is hip effusion?

Answer 9

Increased fluid within joint

Question 10

Can u/s differentiate b/w transient synovitis + septic arthritis?

Answer 10

No! Must aspirate the fluid to tell, as u/s can only assess for presence of fluid with hip effusion

Question 11

What are the 2 main S/S of hip effusion?

Answer 11

Pain + limping or refusal to bear weight

Question 12

___ is a common cause of hip pain b/w 3-8 years old?

Answer 12

Transient synovitis

Question 13

Which type of hip effusion is self limiting/treated with anti-inflammatory meds + rest?

Answer 13

Transient synovitis

Question 14

Both types of hip effuison have similar symptoms, which form m/c has milder symptoms + no long term effects?

Answer 14

Transient synovitis

Question 15

Which type of hip effusion m/c presents with a fever?

Answer 15

Septic arthritis

Question 16

Which type of hip effusion may have a recent history of a upper respiratory infection but are afebrile at presentation?

Answer 16

Transient synovitis

(afebrile = no fever)

Question 17

___ is a serious bacterial infection + is considered a medical emergency that requires rapid treatment?

Answer 17

Septic arthritis

Question 18

Which type of hip effusion may have elevated RBCs, C-reactive protein + WBCs?

Answer 18

Septic arthritis

Question 19

Which form of hip effusion may present with complications if not treated?

Answer 19

Septic arthritis

Question 20

Which form of hip effusion requires IV antibiotics + surgery if severe?

Answer 20

Septic arthritis

Question 21

How do we align our probe when checking for hip effusion?

Answer 21

Place probe on the anterior part of leg + parallel to long axis of femoral neck

Question 22

What measurements would indicate hip effusion on u/s?

Answer 22

Capsular thickness >5mm
OR
2mm difference b/w both hips (assuming unilateral)

Question 23

What is developmental dysplasia of the hip (DDH)?

Answer 23

Range of hip dysplasia includinng instability, subluxation + frank dislocation

Question 24

What is DDH also known as?

Answer 24

Congenital hip dysplasia (even tho most dislocations occur after birth)

Question 25

List 2 causes of DDH?

Answer 25

-Mechanical (position in utero or after birth) -Physiologic (maternal hormones in utero or physical makeup after birth)

Question 26

Differentiate subluxation + dislocation?

Answer 26

Subluxation: partial dislocation Dislocation: not in socket at all

Question 27

What 2 maneuvers are used to assess hip stability?

Answer 27

Barlow + ortolani

Question 28

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

Answer 28

Barlow (a clunk is felt as the femoral head exits the acetabulum posteriorly)

Question 29

The ___ maneuver attempts to reduce a recently dislocated hip?

Answer 29

Ortolani (a clunk is felt as the dislocated femoral head reduces into the acetabulum)

Question 30

List 3 visual signs of DDH?

Answer 30

-Asymmetry of thighs or gluteal folds -Discrepancy of leg lengths -Positive allis or galeazzi sign

Question 31

What is a positive allis or galeazzi sign?

Answer 31

Short femur when hips + knees are flexed (1 knee appears lower than other)

Question 32

U/s of the hip is best performed up to ___ months of age?

Answer 32

6 (due to bony ossification, radiography is more reliable after)

Question 33

During a hip u/s, do we only image the hip presenting with problems?

Answer 33

No, must image both to assess for asymmetry

Question 34

___ angle is the m/c measurement obtained?

Answer 34

Alpha

Question 35

The femoral head can be identified sitting in the ___?

Answer 35

Acetabulum

Question 36

The iliac line should appear as a straight line superiorly or posteriorly?

Answer 36

Superiorly

Question 37

The alpha + beta angles can be obtained by using the ___ scan plane?

Answer 37

Coronal

Question 38

Where is the baseline, roof line + inclination line?

Answer 38

Baseline: along ilium through femoral head Roof: along acetabular roof intersecting baseline Inclination: across top of femoral head through labrum + intersects baseline + roof line

Question 39

What is considered a normal alpha angle?

Answer 39

> 60 degrees

Question 40

What info can we obtain when scanning coronally?

Answer 40

-Can assess the femoral head + see if it is in contact with acetabulum (50% normally sit in it) -A dislocated hip will sit completely out of acetabulum

Question 41

What is considered an abnormal alpha angle?

Answer 41

<60 degrees

Question 42

90% of babies are born with which type of hip?

Answer 42

Type 2

Question 43

Which scan plane is 90 degrees from coronal + is posterior lateral?

Answer 43

TRV plane

Question 44

What shape is seen in TRV due to the ischium + femoral shaft wrapping around the femoral head?

Answer 44

U or V shape

Question 45

What is the only plane we obtain measurements from?

Answer 45

Coronal

Question 46

If a dislocation is seen in TRV, what should we do when scanning?

Answer 46

Apply stress (abduction) to observe reduction

Question 47

___ is the gold standard for treating DDH?

Answer 47

Pavlik harness

Question 48

Sonography of the hips should be done in what planes + what positions?

Answer 48

Scan both hips in coronal + TRV with neutral + flexed positions (supine or decub)

Question 49

What 4 things create the hip joint?

Answer 49

Pelvic girdle, acetabulum, triradiate cartilage + femoral head