Download Pediatric Hip

Pediatric Hip
Protocol
 Patient Position

Supine or lateral decubitus, hip flexed 90 degrees
 Sonographer Position
 One hand on knee at right angle to thigh, holds thigh neutral
position for image
 Movement of the femoral head during stress test is abnormal
Organ/Order
Scan Plane
Label
Coronal
HIP
CORONAL
NEUTRAL
POSITON
Landmarks Identified
Lower limb of the bony ilium, in the depth
of the acetabular fossa, middle of the
acetabular roof and acetabular labrum
seen
Rotate the superior edge of the transducer
until the iliac forms a straight line
Femoral head should be centered in the
joint space, with half or more of the
femoral head medial to the baseline in the
coronal plane
Same landmarks above
Hip
Measure Alpha Angle and Beta Angle
Indicated on
the labeling
if it is the
right or left
hip
HIP CORONAL
NEUTRAL
WITH
MEASUREMENT
Transverse
TX W/O STRESS
Knee in a neutral position
TX W/O STRESS
ABDUCTION
TX WITH STRESS
ABDUCTION
Knee rotated away from the midline
TX W/O STRESS
ADDUCTION
Knee rotated toward the midline
TX WITH STRESS
ADDUCTION
With knee rotated toward the midline
push knee toward the hip joint- Barlow
Test
With knee rotated outward push the knee
toward the hip joint -Ortolani Test
Anatomical/Image Correlation
 Femoral Head-round hypoechoic
 Acetabulum -echogenic, cup-shaped, articulates with femoral head
 Triradiate Cartilage- hypoechoic and posterior and inferior to femoral head
 Ilium, Ischium, Pubis- echogenic linear structures with posterior shadowing
 Acetabular Labrum- echogenic ring that surrounds acetabulum
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Pediatric Hip
Normal Measurement Ranges
Structure
Alpha
Angles
Area of Interest
Plane



Acetabular Roof
Line
Denotes the slope
of the bony
acetabulum
Measurement
Coronal
Angle Greater
than 60 degrees is
normal

Inclination Line
Beta
Angle
Tips







Denotes the slope
of the
cartilaginous
acetabulum

Coronal
Angle less than 55
degrees is normal


Comments
Angle less than 55 degrees is abnormal
Smaller the angle the greater the dysplasia
Line is drawn parallel to the ossified lateral
wall of the ilium
A second line drawn from the inferior edge
of the bony acetabulum, at the triradiate
cartilage, to the distal part of the ilium,
tangential to the slope of the bony
acetabulum (roof line)
Angle lies between the proximal end of the
femur, the medial trochanter and the edge
of the acetabulum
Line is drawn parallel to the ossified lateral
wall of the ilium
A second line is drawn along the roof of the
cartilaginous acetabulum (from the lateral
bony edge of the acetabulum to the
labrum)
Used for detection of Developmental Dysplasia of the Hip (DDH)
Congenital hip dysplasia describes a range of hip dysplasia including—instability, subluxation and frank
dislocation
Usually found in first year of life, sonography less reliable after 6 months, not used after 1 year
Most common form of dislocation is superolaterally
Do not perform stress maneuvers on infants in harness or splint devices
Associations
 Caucasians
 Females
 Breech presentations at birth (Frank Breech—rump first with legs above head)
 Oligohydramnios while in utero
 Family history
 Skin folds in gluteal or thigh region
 Left hip more than right
Clinical Indications
 Instability in the joint
 Hip “clicks”
 Limited range of motion of the affected limb
 Positive Galeazzi (Alli’s) test
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**Only for infants 3 months or older.
If one knee is lower than the other,
there may be a dislocated hip on the
lower side