Hips Flashcards
(25 cards)
Embryology of hip development:
-acetabulum and femoral head formed from save primitive mesenchymal cells
-cleft form in 7/40 and define both structures
-hip joint formed 11/40
Why does the acetabulum start of shallow and then gets deeper?
-gets deeper due to increase fetal movements resulting in increased blood flow
-ligamentum teres holds the femoral head in the acetabulum
Types of his dysplasia:
-DDH
-Dysplasia
-Subluxation
-Dislocation
DDH:
Those born with instability/dislocation of hip joints
Dysplasia
Progressive process
Subluxation:
-hip ligaments are lax and it’s possible to move femoral head without full dislocation
Dislocation:
Femoral head out of acetabulum
Incidence of DDH:
3-5:1000 requires a pavlik harness
1-2:1000 require surgery
Why is it important DDH is picked up:
-impairs mobility
-osteoarthritis of hips and back
-sooner DDH is picked up, reduced need for surgery
-DDH can develop over time so may not be picked up at 1st SPEN
Risk factors for DDH:
-first degree relatives with hip problems in early life
-breech after 36/40, regardless of delivery presentation
-breech at birth
-ALL BABIES WITH RISK FACTORS MUST HAVE HIP USS
Hips observations:
-symmetry in leg length
-free movement. Behaviour
-allis sign
What does the barlow manoeuvre tests for?
Is the hip dislocatable?
How to stabilise the pelvis?
Place thumb on symphysis pubis and 4 fingers over sacrum
How to perform Barlow manoeuvre?
-hips and knees flexed to right angles
-thumb on inner thigh and fingers over greater trochanter
-hip is adducted into the hard surface below
What does Barlow do to the femoral head?
-should push head out of the acetabulum if +
-clunk could be heard
What does the ortolani manoeuvre test for?
If hip is dislocated
How to perform ortolanis
-after Barlow, abduct hip and knee outwards to a right angle
-simultaneously place upwards pressure on greater trochanter
-femoral head will relocate back into acetabulum
Positive ortolanis?
Clunk felt as acetabulum repositions
Clicky hips
-clicky hips are referred to USS in local trust
What are DDH positive results
-difference in leg length
-limited movement of hip abduction and adduction
-clunk when manoeuvring
When should a USS be done?
USS between 4-6 weeks
Should babies with risk factors but NAD SPEN be referred?
USS by 6 weeks of age
What does a pavlik harness do?
Prevents extension and adduction but allows flexion and abduction
How successful is the pavlik harness:
-95% success if maintained full time for 6 weeks
- after 6 months, success is less than 50% due to active, unwilling child
