6761092
Description
Flashcards by Louise Weir, updated more than 1 year ago
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Created by Louise Weir
about 8 years ago
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| Question | Answer |
| Hip Anatomy Blood supply Capsular ligaments Type of joint Features of the HOF | anastamosis - supplies HOF ligaments are tight in IR + extn Type: Ball and Socket HOF - spherical in shape - pit = fovea - ligamentum teres -> transverse acetabular ligament |
| Hip Anatomy Features of the Acetabulum | Acetabulum - C Shaped - inferior = transverse acetabular ligament - articular cartilage - rim = acetabular labrum (deepens acetabulum/adds stability) |
| Hip Anatomy Muscles | abductors - greater trochanter psoas - lesser trochanter adductors - medial/proximal femur |
| DDH Epidemiology | (L) hip = 65% of cases (in-utero - fetus against mother's sacrum => increased addn of the hip) bilateral dysplasia = 20% of cases (commonly identified late due to symmetry as both hips involved and no instability) |
| Capsular laxity | can occur during delivery or post natally subluxation = contact with the acetabulum dislocation = no contact with the acetabulum - reducable (can be put back in socket) - irreducable (cannot be put back in socket) |
| DDH Capsular changes | capsular stretch (hourglass shape) psoas stretched (across waist of hourglass) ligamentum teres is loose morphological change of shape - more ovoid acetabular shape change - lat lying HOF tight adductors |
| Acetabular Dysplasia | isolated incidence vs related to DDH change of shape => more shallow HOF not properly in socket may spontaneously improve may not dislocate some not dx until later in life sec. to OA changes |
| DDH Epidemiology | DDH affects 1:1000 live births instability in 1:100 live births if present at birth usu due to contracted mm cause = SB, Arthrogryposis - teratological |
| DDH - Presentation at 6/52 | assymetry of leg posture shortened leg uneven thigh and gluteal fold decreased abduction |
| DDH Reasons for late diagnosis | persistent and progressive laxity - true missed hip (always lax - not dx at ax) posturing - misshapen acetabulum sec to playing on one side only Plagiocephaly - addn of opposite hip (acetabular dysplasia) => "Developmental Dysplasia" |
| DDH Risk Factors | girls > boys family history of DDH breech position in utero intrauterine packaging problems |
| DDH Risk Factors Females | 80% of cases are female maternal hormones => increased laxity increased risk if 1st degree relative is affected |
| DDH Risk Factors Breech position in utero | causes capsular stretching sec to - increased flexn of hips - limitation of hip ROM => Acetabular Dysplasia (shallow, dish shaped aetabulum) |
| DDH Risk Factors Intrauterine Packaging Problems | decrease in space in utero can => DDH - first pregnancy - oligohydramnios (low level of amniotic fluid) - multi pregnancy i.e., twins, triplets etc hyper extension of knees |
| More Intrauterine Packaging Problems | foot deformities plagiocephaly (flattening of head) torticollis (turning of neck) post natal wrapping => DDH (if wrapped with legs extended) |
| Hip Examination | 1. keep the infant warm and speak calmly 2. keep the infant relaxed and fed 3. position feet towards mum 4. stand square to infant 5. infant should be undressed from waist down 6. order of Ax: - hip instability (Barlow/Ortolani Tests) - assymmetry - general features |
| Hip Examination Hip Instability / Dislocation Barlow Test (Features) | provocative test one hand stabilizes the pelvis other hand "cups" opposite knee and takes into flxn adduct flexed hip to 10-20 deg apply backward pressure +ve instability = gliding sensation felt repeat 2-3 times |
| Hip Examination Hip Instability / Dislocation Ortolani Test (Features) | aim - see if can reduce dislocated hip flex both hips and knees to 90deg fingers "cupping" HOF as hip is abducted "lift" HOF into acetabulum +ve test = hear a "clunk", hip dislocates and leg "shortens" NOTE: clicks are not clunks (-ve). They are gen from ligaments and are usu innocent |
| Hip Examination Asymmetry | due to: soft tissue contractures - previous tests not as reliable asymmetry presentation: - asymetrical creases (not a dx by itself) - shortening of limb - limitation of abduction |
| Hip Examination Shortening of Limb (features) | inreased gluteal fold "bunching up" of mm dislocation of subluxation +ve Galeazzi Test (see next slide) |
| Hip Examination Galeazzi Test | flex bilat hips to 90deg neutral abdn/addn measure level of knees +ve = asymmetry of gluteal fold pelvis MUST be level |
| Hip Examination Limitation of Abduction | most sensitive flex hips to 90deg + abduct measure ROM and resistance do slowly and gradually as can be uncomfortable |
| General Examination General pathologies linked with DDH 1 | Dysmorphism - Downs Syndrome - Arthogryposis - Larsen Syndrome |
| General Examination General pathologies linked with DDH 2 | Other conditions: - Plagiocephaly - Torticollis - Scoliosis - Spina Bifida - Knee hyperextension - Calcaneovalgus - Metatarsus Adductus - Congenital Talipes Equinovarus (CTEV) |
| Early Diagnosis vs Late Diagnosis (6/52 to Walking) | later dx => poorer outcome and diff Rx dx < 6/52 = obs, bracing, usu resolves dx > 3/12 = soft tissue changes and adaptations evident, diff to relocate hip, requires hip spica dx > walking stage = adaptive changes well established, open reduction and osteotomy usu req'd. Dec ability to create a "normal" hip |
| Early Diagnosis vs Late Diagnosis (Adolescence and Adulthood) | dx in adolescence + adulthood = dysplasia and disability usu universal > 4 yrs, altered mechanics sec. to changes in soft tissue and joint => - fatigue - pain - antalgic gait pattern - OA (=> THR) |
| Examination Timeline | 1st year of life screening until 3.5 years essential time points: - birth - 1/52 at home visit, then - 2, 4, 8 weeks, then - 4, 8, 12 months then as required |
| Investigations Ultrasound | U/S - < 6/52 - screening - monitoring - safe - requires specialist in paediatric ultrasound |
| Investigations Radiography | Radiograph - > 6/52 - monitoring - requires specialist in paediatric radiography |
| When to refer | evidence of risk factors abnormal examination (or +ve tests) send referral with a Victorian Perinatal Data Collection Notification Form with status as confirmed / unconfirmed |
| DDH - Safe Wrapping What is it? Risks? Methods? | What is it? way of wrapping to ensure safe, happy, comfortable baby Risks? too tight, wrapped with straight hips legs should move freely 1st 3/12 = increased risk of DDH Methods? - diamond - square - pouch |
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