Podcast
Questions and Answers
What anatomical structure is MOST affected in acetabular dysplasia?
What anatomical structure is MOST affected in acetabular dysplasia?
- Femoral neck
- Femoral head
- Acetabulum (correct)
- Greater trochanter
Up to what age should you examine a baby to catch late hip dislocations?
Up to what age should you examine a baby to catch late hip dislocations?
- 6 months
- 15-24 months (correct)
- 5 years
- 3 years
What is the MOST common hip disorder in children?
What is the MOST common hip disorder in children?
- Transient synovitis
- Legg-Calvé-Perth disease
- Slipped capital femoral epiphysis
- Hip dysplasia/dislocation (correct)
Which term is now preferred over "congenital hip dysplasia"?
Which term is now preferred over "congenital hip dysplasia"?
Which of the following BEST describes a subluxatable hip?
Which of the following BEST describes a subluxatable hip?
In the context of hip dysplasia, what does a 'reducible' hip refer to?
In the context of hip dysplasia, what does a 'reducible' hip refer to?
In hip dysplasia, what does 'irreducible' refer to?
In hip dysplasia, what does 'irreducible' refer to?
What is the approximate incidence of hip dysplasia at birth?
What is the approximate incidence of hip dysplasia at birth?
Which of the following is TRUE regarding the etiology of hip dysplasia?
Which of the following is TRUE regarding the etiology of hip dysplasia?
Which of the following is a known risk factor for developmental dysplasia of the hip (DDH)?
Which of the following is a known risk factor for developmental dysplasia of the hip (DDH)?
What percentage of deliveries are breech?
What percentage of deliveries are breech?
How do the quadriceps muscles contribute to hip dysplasia?
How do the quadriceps muscles contribute to hip dysplasia?
What is the typical ratio of occurrence of hip dysplasia in girls compared to boys?
What is the typical ratio of occurrence of hip dysplasia in girls compared to boys?
Following the description of muscle action leading to hip dysplasia, which direction is the hip MOST likely to slip?
Following the description of muscle action leading to hip dysplasia, which direction is the hip MOST likely to slip?
True or False: It is important to get X-rays to diagnose hip dysplasia.
True or False: It is important to get X-rays to diagnose hip dysplasia.
What is the MOST reliable method for diagnosing hip dysplasia?
What is the MOST reliable method for diagnosing hip dysplasia?
Which sign is associated with dislocation?
Which sign is associated with dislocation?
What indicates dislocation based on symmetry of skin folds?
What indicates dislocation based on symmetry of skin folds?
What does a positive Ortolani test indicate?
What does a positive Ortolani test indicate?
What combination of findings are expected in a normal neonate?
What combination of findings are expected in a normal neonate?
What is the correct order of maneuvers when examining a neonate for hip dysplasia?
What is the correct order of maneuvers when examining a neonate for hip dysplasia?
When does the abduction test become more reliable?
When does the abduction test become more reliable?
If one or both hips become dislocated at or around birth, a predictable series of changes occur. What is the first change?
If one or both hips become dislocated at or around birth, a predictable series of changes occur. What is the first change?
What is the term for the finding of a shortened femur in hip dislocation?
What is the term for the finding of a shortened femur in hip dislocation?
What does the Hilgenreiner line measure?
What does the Hilgenreiner line measure?
What is the MOST commonly used treatment modality in the US for hip dysplasia in the neonatal period?
What is the MOST commonly used treatment modality in the US for hip dysplasia in the neonatal period?
What does the Pavlik Harness do?
What does the Pavlik Harness do?
Why does extreme abduction increase risk for avascular necrosis in DDH?
Why does extreme abduction increase risk for avascular necrosis in DDH?
In the von Rosen view, how are the hips positioned during radiography?
In the von Rosen view, how are the hips positioned during radiography?
Which of the following statements accurately describes Shenton's line in the context of hip radiography?
Which of the following statements accurately describes Shenton's line in the context of hip radiography?
Which condition requires fixing the proximal femur?
Which condition requires fixing the proximal femur?
What does the Y-Line measure?
What does the Y-Line measure?
A newborn displays a positive Barlow test. What is the MOST appropriate next step in management?
A newborn displays a positive Barlow test. What is the MOST appropriate next step in management?
In the context of DDH, what is the significance of the iliopsoas tendon?
In the context of DDH, what is the significance of the iliopsoas tendon?
A 6-month-old infant presents with limited hip abduction on the left side. Ortolani and Barlow tests are negative. Which of the following is the MOST appropriate next step?
A 6-month-old infant presents with limited hip abduction on the left side. Ortolani and Barlow tests are negative. Which of the following is the MOST appropriate next step?
A 3-month-old infant is being treated with a Pavlik harness for DDH. At a follow-up appointment, the physician notes persistent hip subluxation on examination and imaging. What is the MOST appropriate next step?
A 3-month-old infant is being treated with a Pavlik harness for DDH. At a follow-up appointment, the physician notes persistent hip subluxation on examination and imaging. What is the MOST appropriate next step?
A 1-year-old child presents with a painless limp. Radiographs reveal unilateral hip dislocation with a shallow acetabulum and femoral head ossification delay. What is the MOST appropriate management strategy?
A 1-year-old child presents with a painless limp. Radiographs reveal unilateral hip dislocation with a shallow acetabulum and femoral head ossification delay. What is the MOST appropriate management strategy?
Which of the following accurately reflects the impact of age on treatment outcomes of developmental dysplasia of the hip (DDH)?
Which of the following accurately reflects the impact of age on treatment outcomes of developmental dysplasia of the hip (DDH)?
Hip dysplasia and dislocation are uncommon in children.
Hip dysplasia and dislocation are uncommon in children.
What term is used to describe hips that are unstable and manually dislocatable?
What term is used to describe hips that are unstable and manually dislocatable?
A femoral head that is out and NOT able to be reduced is considered ______.
A femoral head that is out and NOT able to be reduced is considered ______.
Match the following hip conditions with their descriptions:
Match the following hip conditions with their descriptions:
Which of the following is NOT a risk factor for developmental dysplasia of the hip (DDH)?
Which of the following is NOT a risk factor for developmental dysplasia of the hip (DDH)?
Breech presentation increases the risk of hip dysplasia due to the in utero position.
Breech presentation increases the risk of hip dysplasia due to the in utero position.
In breech presentations, what position are the knees and hips typically in, predisposing the infant to hip dysplasia?
In breech presentations, what position are the knees and hips typically in, predisposing the infant to hip dysplasia?
The typical in-utero position of knees and hips is ______, with feet crossed and around the buttocks.
The typical in-utero position of knees and hips is ______, with feet crossed and around the buttocks.
Which muscle group contributes to upward, outward, and lateral slipping of the hip due to contracture in hip flexion?
Which muscle group contributes to upward, outward, and lateral slipping of the hip due to contracture in hip flexion?
In the context of hip dysplasia, relying solely on X-rays is preferable to clinical examination due to its higher accuracy.
In the context of hip dysplasia, relying solely on X-rays is preferable to clinical examination due to its higher accuracy.
Which clinical finding is MOST reliable for indicating hip dislocation in infants?
Which clinical finding is MOST reliable for indicating hip dislocation in infants?
What is the name of the sign used to describe the ability to displace a mobile proximal femur in a dislocated hip?
What is the name of the sign used to describe the ability to displace a mobile proximal femur in a dislocated hip?
A positive Ortolani's test indicates a dislocated hip that is ______.
A positive Ortolani's test indicates a dislocated hip that is ______.
A normal neonate should have positive Ortolani's, Barlow's, and Palmen's tests.
A normal neonate should have positive Ortolani's, Barlow's, and Palmen's tests.
After 8 weeks of age, which test becomes more reliable than provocative tests like Ortolani and Barlow for assessing hip stability?
After 8 weeks of age, which test becomes more reliable than provocative tests like Ortolani and Barlow for assessing hip stability?
What is the fatty plug that impedes the relocation of the femoral head within the acetabulum called?
What is the fatty plug that impedes the relocation of the femoral head within the acetabulum called?
What is the name of the line used as reference for Perkin's line and measurement of the acetabular angle?
What is the name of the line used as reference for Perkin's line and measurement of the acetabular angle?
In the context of a von Rosen view X-ray, the AP of the pelvis is taken while the examiner internally rotates the hips ______ degrees.
In the context of a von Rosen view X-ray, the AP of the pelvis is taken while the examiner internally rotates the hips ______ degrees.
Flashcards
Early Hip Dysplasia Treatment
Early Hip Dysplasia Treatment
Early treatment of hip dysplasia is typically successful.
Unstable pediatric hip
Unstable pediatric hip
Problems in the acetabulum; continuum where mild=undetectable to severe=dislocated.
Subluxatable Hip
Subluxatable Hip
The femoral head can be manually pushed into partial dislocation but returns to its original position when pressure is released.
Dislocatable Hip
Dislocatable Hip
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Irreducible Dislocation
Irreducible Dislocation
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Etiology of Hip Dysplasia
Etiology of Hip Dysplasia
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Breech Presentation Risk
Breech Presentation Risk
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Effect of Hip Flexion Muscles
Effect of Hip Flexion Muscles
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Gender and Laterality
Gender and Laterality
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Associated Conditions
Associated Conditions
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Family History Risk
Family History Risk
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Teratologic Form DDH
Teratologic Form DDH
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Typical or Idiopathic DDH
Typical or Idiopathic DDH
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Symmetry in Skin Folds
Symmetry in Skin Folds
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Femoral Head Position
Femoral Head Position
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Telescoping Sign
Telescoping Sign
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Ortolani's Test
Ortolani's Test
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Barlow's Test
Barlow's Test
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Normal Neonate Tests
Normal Neonate Tests
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Barlow's Precedence
Barlow's Precedence
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Abduction Test
Abduction Test
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Changes After Dislocation
Changes After Dislocation
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Iliopsoas position
Iliopsoas position
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Galeazzi's Sign
Galeazzi's Sign
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Trendelenburg Sign
Trendelenburg Sign
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Pseudoacetabulum on XR
Pseudoacetabulum on XR
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Von Rosen View
Von Rosen View
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Hilgenreiner line (Y line)
Hilgenreiner line (Y line)
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Acetabular Index
Acetabular Index
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Perkin's Line
Perkin's Line
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Shenton's Line
Shenton's Line
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Size of Femoral Ossific Nucleus
Size of Femoral Ossific Nucleus
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Syndromic Association with Hip Dysplasia
Syndromic Association with Hip Dysplasia
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Vertical Talus
Vertical Talus
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Spasticity
Spasticity
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Complications of Surgical tx
Complications of Surgical tx
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Neonatal period
Neonatal period
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Pavlik Harness position
Pavlik Harness position
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Avascular necrosis
Avascular necrosis
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Structures Preventing Reduction
Structures Preventing Reduction
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Hip Dysplasia/Dislocation Prevalence
Hip Dysplasia/Dislocation Prevalence
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Developmental Hip Dysplasia
Developmental Hip Dysplasia
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Incidence of Dysplasia
Incidence of Dysplasia
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Symmetry in Motion
Symmetry in Motion
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Order of Exam Maneuvers
Order of Exam Maneuvers
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Provocative Test Limitations
Provocative Test Limitations
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Iliac Angle
Iliac Angle
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Hilgenreiner Line
Hilgenreiner Line
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Study Notes
New Information: Case Studies
- Overview of specific patient cases related to hip dysplasia and dislocation.
Patient #1
- A 4-year-old female.
- X-ray shows the femoral head is out of place.
- A false acetabulum developed because the femoral head was out of place for an extended period.
- The problem involves fixing the proximal femur to reduce the high inclination angle and performing an osteotomy of the pelvis.
- A significant problem is with the osteotomy of the pelvis; dropping the acetabulum down can lead to good superior coverage but poor posterior coverage, resulting in a risk of falling out..
- It was necessary to shorten the femur to get the femoral head into the acetabulum.
Patient #2
- The chief complaint is flat feet.
- X-ray shows the right femoral head is out of place.
- Dislocation occurred a long time ago, either congenitally or around age 1.
- Pelvic osteotomy is required to reduce the acetabular index.
- Examination reveals possible Trendelenburg sign due to weakness, a negative Gower sign, and full symmetrical abduction
Patient #3
- A boy with Down syndrome.
- Collagen is poor, resulting in very lax/loose joints.
- Palmen, telescoping, and Barlows tests are positive (+).
- The left hip is dysplastic.
- Down syndrome often involves a small angle of inclination, resulting in limited posterior coverage, increasing the risk of posterior dislocation.
- He requires an osteotomy.
Patient #4
- A 9-year-old female.
- Cavus foot with left hip pain.
- Family history of Charcot-Marie-Tooth disease.
- Hip dysplasia/dislocation occurs in about 20% of the population with CMT.
- All CMT patients get a screening hip x-ray for hip dysplasia and dislocation.
- Lateral instability is present.
- She has genu valgum, which shows no correlation with coxa varum.
- She has a subluxed left hip and a possible right hip subluxation.
Patient #5
- Older girl
- Subluxed R hip
- Acetabulum is dysplastic on L and subluxed on R
Patient #6
- If false acetabulum, it means the hip has been out a long time
- Hips are out, acetabulum is low, and the femoral head is high→ false acetabulum is very deep-been out a long time therefore teratological dislocation (something is wrong w/ the muscle)
- L hip dislocated
Patient #7
- 9 mo old female
- Asymmetry of the ossific nucleus.
- The hip is out, dislocated, and has been so for a long time.
- Abduction x-ray shows:
- Left side dislocation
- Decreased abduction
- Shallow acetabulum
- Pseudoacetabulum
- A line from the metaphysis does not enter the triradiate cartilage
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