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Questions and Answers
What anatomical structure connects the ligamentum teres to the head of the femur?
Which factor has been proposed to increase the risk of congenital dysplasia of the hip joint?
What is the meaning of 'luxation' in the context of congenital dysplasia of the hip joint?
In which demographic group is congenital dysplasia of the hip joint more commonly observed?
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What is a characteristic feature of light dysplasia form in congenital hip dysplasia?
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What developmental issue occurs when the femur head is positioned at the edge of the acetabulum?
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What is Julius Wolf's Law primarily concerned with?
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What is formed in the hip joint due to luxation and results in changes in muscle size?
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Which ligament is NOT mentioned as part of the joint capsule surrounding the hip joint?
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What characterizes Peter-Bade Symptom in diagnosing hip issues?
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Which test is performed to identify an ‘unstable subluxating joint’ in a newborn?
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Which type of luxation is described as 'Luxatio coxae iliaca'?
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Which test involves assessing the hip's flexion and observing a 'dislocation click'?
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What happens to the head of the femur on the ipsilateral side due to muscular compensatory changes?
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Which factor contributes to pelvic joint contractures in hip luxations?
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What is the purpose of Thomas’ Test in diagnosing luxation?
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What does the Nelaton Method primarily assess in children with potential hip issues?
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Which symptom indicates abnormal flexibility of the hip when pushed?
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What is a sign of delayed walking development in children with hip issues?
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What does the Putti's X-ray trinity include as a sign of hip joint dysplasia?
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What is meant by externally provoked dysplasia?
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What clinical assessment is positive in typical congenital luxation during early diagnosis?
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Which factor contributes to retarded dysplasia of the pelvic joint after treatment?
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How does the Gurdon's symptom manifest in children with dysplasia?
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What characterizes the Barlow test in relation to hip joint instability?
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What is a common feature of luxation noted during clinical examination?
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Study Notes
Hip Joint Anatomy
- Ball and socket joint with the head of the femur (ball) fitting into the acetabulum (socket)
- The acetabulum is formed by the fusion of three pelvic bones: the ischium, ileum, and pubis.
- The acetabulum has a fossa that houses the ligamentum teres, which connects to the fovea capitis of the femur head.
- The acetabulum also has a rim of cartilage called the acetabular labrum.
- The transverse ligament fills in a notch in the acetabulum.
- The joint capsule is made up of three main ligaments: the ileofemoral, pubofemoral, and ischiofemoral ligaments.
- During congenital dysplasia of the hip (CDH), the femur does not sit properly in the acetabulum, leading to hypertrophy of the ligamentum teres, acetabular labrum, and transverse ligament.
- The acetabulum becomes shallow due to this hypertrophy, further impairing the fit of the femur head, leading to subluxation or complete dislocation.
Etiopathogenesis
- Mechanical Theory: Increased force on the fetal thigh due to reduced amniotic fluid or a sciatic fetal position can contribute to luxation (dislocation).
- Harmful Factors: Ionizing radiation, toxic substances, medications, vitamin deficiencies, endocrine disorders, metabolic and feeding disorders, infections, and premature birth can increase the risk of CDH.
- Paralytic Theory: A stronger adductor muscle tone compared to abductor muscle tone can contribute to CDH.
- Genetic Theory: Parents with CDH have a 10 times higher risk of having children with the same condition.
- Lax (Loose) Joints: More common in girls due to hormonal factors and can be inherited.
Pathoanatomy
- Julius Wolff's Law: States that bone adapts to the stresses placed upon it.
- Light Dysplasia: Shallow acetabulum, mild hypoplasia (underdevelopment) of the hip bone, and an outward angle (valgus) of the femur neck.
- Subluxation: The head of the femur is partially out of the acetabulum.
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Luxation: The head of the femur is completely dislocated from the acetabulum, resting against the iliac bone.
- The joint capsule becomes hourglass shaped, leading to two cavities.
- The femur head on the affected side is smaller, resulting in muscular compensations.
- A "neocotil" formation may occur due to the dislocated head pressing on the iliac bone, forming a new acetabulum-like structure.
- Types of Luxations:
- Luxatio coxae iliaca
- Luxatio coxae supracotyloidea
- Luxatio coxae cotyloidea
- Pelvic Joint Contractures: The pelvic joint may develop contractures due to CDH.
Diagnosis
- Peter-Bade Symptom: Asymmetrical skin folds around the hips, either unilateral or bilateral.
- Barlow's Test: Flex the hips and knees and then abduct the legs. A click indicates displacement of the femur head.
- Ortolani Symptom: Place the newborn supine with hips at 90 degrees and legs at 90-100 degrees. Gentle abduction may produce a "fitting click" when the femur head is reduced to the acetabulum, or a "dislocation click" when the head pops out of the acetabulum.
- Palmen's Test: Used to assess unstable subluxation in infants around 10 days old. It involves adduction, extension, and pressure along the longitudinal axis of the hip. A telescopic springing and sliding sensation without a click indicates an unstable joint.
- Thomas' Test: Used to diagnose luxation in infants up to 2-3 months old. It involves passive flexion of the hip, looking for restricted movement due to a contracture of the iliopsoas muscle.
- Restricted Abduction: Unable to fully abduct the flexed hip, indicating a tight adductor muscle.
- Nelaton-Ombredane's Measure: Shows shortening of the affected leg.
- Savaruids Measure: Checks for leg length differences when moving from a lying to a sitting position with straight knees.
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Loose Joints: Demonstrated by increased internal rotation of the dislocated joint.
- Gurdon's symptom - increased crossing-over of the leg
- Nove-Josserand's symptom - abnormal flexibility of the hip
- Duputren's symptom - telescoping sensation when pushing the hip
- Putti's Symptom: Asymmetrical interlabial sulci (indentations between the vulva and anus) in girls, pointing towards the affected hip.
- Delayed Walking: Child may start walking later than expected (14-15 months).
X-Ray
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Putti's X-Ray Trinity: Three findings on X-ray diagnostic of CDH
- Abnormal or slanting arch of the acetabulum.
- Delayed formation of the epiphyseal nucleus of the femur head.
- Ectopia or displacement of the femur head.
Additional Notes
- Barlow's test identifies unstable joints where the femur head can be easily luxated and reduced.
- Palmen's test identifies unstable joints where the femur head can be partially luxated (subluxated).
- CDH can be diagnosed with ultrasound directly after birth.
- Externally provoked dysplasia can be diagnosed via ultrasound at 3 months old and is often due to improper care or untreated unstable joints.
- Retarded CDH can occur after treatment of congenital or provoked subluxation/luxation, due to early trauma to the acetabulum.
- Congenital luxation develops during embryogenesis.
- Externally provoked subluxation can be caused by improper swaddling.
- Retarded subluxation can occur after congenital or provoked subluxation due to insufficient healing of the acetabulum and femoral anteversion (forward tilt of the femur neck).
- Typical congenital luxation develops before or at birth and demonstrates positive Ortolani and Barlow tests with no muscle contractures.
- Provoked luxation may occur in children with physiologically hyperlax connective tissue, with negative Ortolani, Barlow, and Palmen tests.
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Description
Explore the intricate anatomy of the hip joint, focusing on the ball and socket structure formed by the femur and acetabulum. Learn about the pelvic bones involved, the ligaments that support the joint, and how conditions like congenital dysplasia affect its function. This quiz covers both the anatomical details and the mechanistic theories related to hip joint disorders.
