This document describes the anatomy of the hip joint, including the ball-and-socket configuration of the femoral head articulating with the acetabulum. It further discusses hip dysplasia, noting that it results from an abnormal developmental relationship between the femur and acetabulum. Risk factors for hip dysplasia include genetic and intrauterine environmental factors. Ultrasound is useful for evaluating the hip joint before ossification occurs, using static and dynamic techniques to assess morphology and stability.
Ultrasound of Developmental dysplasia of hip Joint ..Dr.Mohamed SolimanMohamed Soliman
This document provides an overview of developmental hip dysplasia (DDH), including its definition, risk factors, clinical exam techniques, ultrasound techniques and measurements, and case examples. Key points include:
- DDH is underdevelopment of the acetabular component of the hip joint, ranging from a shallow acetabulum to complete dislocation.
- Ultrasound is useful for evaluation up to 6 months of age, using coronal, transverse, and stress views to assess coverage, subluxation, and stability.
- Measurements like the alpha and beta angles and bony coverage index indicate dysplasia if outside normal ranges.
- Early diagnosis and treatment with techniques like the Pavlik harness can
1) The patellofemoral joint is complex with requirements for normal function dependent on the congruent relationship between the patella and trochlear groove. Developmental or acquired alterations to the joint surface geometry are associated with patellar instability, chondromalacia patella, and anterior knee pain.
2) Trochlear dysplasia, patella alta (high riding patella), and excessive lateralization of the tibial tuberosity are the most important factors predisposing to patellar instability. Trochlear dysplasia can be classified into types A through D based on the shape of the trochlear groove.
3) Measurements of the patella, tro
Presentation1, radiological imaging of developmental dysplasia of the hip joint.Abdellah Nazeer
Developmental dysplasia of the hip (DDH) is an abnormal development of the hip joint where the femoral head does not properly fit into the acetabulum. It is more common in females and with certain risk factors like breech presentation. Ultrasound is used to evaluate the hip in infants under 6 months by measuring angles like the alpha angle. Once the femoral epiphysis ossifies around 6 months, plain x-rays are used which analyze features like the acetabular angle and Shenton's line to diagnose DDH. DDH can lead to late complications like osteoarthritis if not treated properly.
This document provides an overview of ankle radiography including:
- The Ottawa Ankle Rules for determining when radiographs are needed
- Common radiographic projections of the ankle including AP, mortise, and lateral views
- Measurements taken from the different views to assess for fractures and ligament injuries
- Stress tests that can be performed under fluoroscopy to evaluate ligament integrity
- Classification systems for common ankle fractures like the Danis-Weber and Pott's classifications
Here are the key points about rotator interval tears:
- The rotator interval is the space between the supraspinatus and subscapularis tendons through which the long head of the biceps tendon passes.
- Rotator interval tears refer to tears in the capsule in this space between the two tendons.
- They are often associated with instability or repetitive microtrauma and overuse.
- On MRI, they appear as abnormal high signal within the rotator interval capsule on fluid sensitive sequences like T2 or STIR. The torn edges may also enhance with contrast.
- Ultrasound can also identify fluid within the torn interval capsule but MRI is usually better for full
Post-graduate Certifcate Musculoskeletal Ultrasound - The ShoulderDr. Peter Resteghini
Lecture from The Post-graduate Certificate Musculoskeletal Ultrasound: Dr. Peter Resteghini
Course Director Post-graduate Certificate Musculoskeletal Ultrasound - http://www.uel.ac.uk/study/courses/Musculoskeletal.htm
Developmental dysplasia of the hip (DDH) is a condition where the femoral head has an abnormal relationship with the acetabulum. The document discusses the normal development of the hip joint, pathoanatomy and clinical presentation of DDH, as well as methods of diagnosis including imaging and treatment options depending on the age of presentation. Treatment in infants less than 6 months involves the Pavlik harness to obtain and maintain reduction of the hip to allow for normal development.
This document provides an overview of developmental dysplasia of the hip (DDH), including its normal development, etiology, epidemiology, diagnosis, treatment, and complications. Key points include: DDH can range from mild dysplasia to frank dislocation and is more common in females. Clinical diagnosis involves the Ortolani and Barlow maneuvers while imaging includes x-rays and ultrasound. Treatment depends on the grade of DDH and may involve closed or open reduction along with bracing or splinting. Complications can include avascular necrosis and osteoarthritis if left untreated.
Ultrasound of Developmental dysplasia of hip Joint ..Dr.Mohamed SolimanMohamed Soliman
This document provides an overview of developmental hip dysplasia (DDH), including its definition, risk factors, clinical exam techniques, ultrasound techniques and measurements, and case examples. Key points include:
- DDH is underdevelopment of the acetabular component of the hip joint, ranging from a shallow acetabulum to complete dislocation.
- Ultrasound is useful for evaluation up to 6 months of age, using coronal, transverse, and stress views to assess coverage, subluxation, and stability.
- Measurements like the alpha and beta angles and bony coverage index indicate dysplasia if outside normal ranges.
- Early diagnosis and treatment with techniques like the Pavlik harness can
1) The patellofemoral joint is complex with requirements for normal function dependent on the congruent relationship between the patella and trochlear groove. Developmental or acquired alterations to the joint surface geometry are associated with patellar instability, chondromalacia patella, and anterior knee pain.
2) Trochlear dysplasia, patella alta (high riding patella), and excessive lateralization of the tibial tuberosity are the most important factors predisposing to patellar instability. Trochlear dysplasia can be classified into types A through D based on the shape of the trochlear groove.
3) Measurements of the patella, tro
Presentation1, radiological imaging of developmental dysplasia of the hip joint.Abdellah Nazeer
Developmental dysplasia of the hip (DDH) is an abnormal development of the hip joint where the femoral head does not properly fit into the acetabulum. It is more common in females and with certain risk factors like breech presentation. Ultrasound is used to evaluate the hip in infants under 6 months by measuring angles like the alpha angle. Once the femoral epiphysis ossifies around 6 months, plain x-rays are used which analyze features like the acetabular angle and Shenton's line to diagnose DDH. DDH can lead to late complications like osteoarthritis if not treated properly.
This document provides an overview of ankle radiography including:
- The Ottawa Ankle Rules for determining when radiographs are needed
- Common radiographic projections of the ankle including AP, mortise, and lateral views
- Measurements taken from the different views to assess for fractures and ligament injuries
- Stress tests that can be performed under fluoroscopy to evaluate ligament integrity
- Classification systems for common ankle fractures like the Danis-Weber and Pott's classifications
Here are the key points about rotator interval tears:
- The rotator interval is the space between the supraspinatus and subscapularis tendons through which the long head of the biceps tendon passes.
- Rotator interval tears refer to tears in the capsule in this space between the two tendons.
- They are often associated with instability or repetitive microtrauma and overuse.
- On MRI, they appear as abnormal high signal within the rotator interval capsule on fluid sensitive sequences like T2 or STIR. The torn edges may also enhance with contrast.
- Ultrasound can also identify fluid within the torn interval capsule but MRI is usually better for full
Post-graduate Certifcate Musculoskeletal Ultrasound - The ShoulderDr. Peter Resteghini
Lecture from The Post-graduate Certificate Musculoskeletal Ultrasound: Dr. Peter Resteghini
Course Director Post-graduate Certificate Musculoskeletal Ultrasound - http://www.uel.ac.uk/study/courses/Musculoskeletal.htm
Developmental dysplasia of the hip (DDH) is a condition where the femoral head has an abnormal relationship with the acetabulum. The document discusses the normal development of the hip joint, pathoanatomy and clinical presentation of DDH, as well as methods of diagnosis including imaging and treatment options depending on the age of presentation. Treatment in infants less than 6 months involves the Pavlik harness to obtain and maintain reduction of the hip to allow for normal development.
This document provides an overview of developmental dysplasia of the hip (DDH), including its normal development, etiology, epidemiology, diagnosis, treatment, and complications. Key points include: DDH can range from mild dysplasia to frank dislocation and is more common in females. Clinical diagnosis involves the Ortolani and Barlow maneuvers while imaging includes x-rays and ultrasound. Treatment depends on the grade of DDH and may involve closed or open reduction along with bracing or splinting. Complications can include avascular necrosis and osteoarthritis if left untreated.
The document outlined ultrasound techniques for evaluating various structures of the knee, including tendons, ligaments, menisci, and neurovascular structures. It described optimal probe positioning and leg positioning for visualizing each target structure in longitudinal and transverse views. Comparisons were made to equivalent MRI planes to aid ultrasound interpretation. A variety of pathologies were also demonstrated through ultrasound images.
The document summarizes the radiological anatomy of the knee joint. It describes the various ligaments, tendons, bones and cartilage that make up the knee, including the medial and lateral menisci, anterior and posterior cruciate ligaments, patellar tendon, and surrounding muscles. It provides imaging protocols for MRI of the knee, covering positioning, slice thickness, pulse sequences and imaging planes used to visualize the different knee structures. Common anatomical variations and pitfalls in interpretation are also discussed.
This document provides a summary of MRI findings related to the ankle and foot. It describes MRI sequences and images of various ankle structures including tendons, ligaments, bones and bursae. Specific pathologies are discussed such as tendinopathies, ligament tears, tenosynovitis, plantar fasciitis, sinus tarsi syndrome and tarsal tunnel syndrome. Images demonstrate normal anatomy as well as examples of injuries and conditions affecting the ankle and foot.
1) The document describes the MRI anatomy of the shoulder, highlighting key supporting structures like the rotator cuff muscles and tendons.
2) It examines the shoulder in different planes including axial, coronal, and sagittal views, and provides a checklist of structures and pathologies to evaluate in each view.
3) Special attention is given to evaluating common shoulder injuries like labral tears and rotator cuff tears using specialized views like the ABER position.
This document discusses femoro-acetabular impingement (FAI), which occurs when there is reduced range of motion of the hip due to uneven surfaces of the femoral head or acetabulum. It can be caused by congenital or acquired factors. FAI is classified into cam, pincer, and mixed types. Cam FAI involves a bump on the femoral head-neck junction, while pincer FAI is due to overcoverage of the acetabulum. Clinical features include groin pain exacerbated by activity. Imaging can identify bone abnormalities, and treatments range from activity modification to surgical procedures like arthroscopy or osteotomy.
MRI imaging of knee joint -- from radiological anatomy to pathology. inspired from my dear professor Mamdouh Mahfouz, professor of radio diagnosis - Cairo university.
Developmental dysplasia of the hip (DDH) is a spectrum of hip disorders involving abnormal development of the femoral head and acetabulum. It ranges from instability where the femoral head can subluxate to full dislocation. Risk factors include ligamentous laxity and breech positioning. Ultrasound and x-rays are used to diagnose and monitor treatment, which may involve closed or open reduction depending on age, along with bracing or casting. The goal is early concentric reduction to prevent future hip degeneration.
Developmental Dysplasia of the Hip and Ultrasoundhungnguyenthien
Developmental dysplasia of the hip (DDH) refers to a spectrum of hip abnormalities ranging from mild dysplasia to frank dislocation. Risk factors include breech presentation and family history. Diagnosis involves a thorough physical exam including Ortolani's and Barlow's maneuvers in infants, with ultrasound used for further evaluation. Treatment depends on severity but may involve bracing or surgical reduction and stabilization of the hip.
SLIPPED CAPITAL FEMORAL EPIPHYSIS - By Dr. Lokesh SharoffLokesh Sharoff
This document provides information on slipped capital femoral epiphysis (SCFE), including:
- Incidence is highest in obese boys aged 13-15 and girls aged 11-13.
- Presentation includes hip or knee pain that increases with activity, limping, and limited range of motion.
- Treatment aims to prevent further slipping, reduce the degree of slippage, and provide salvage options.
- Methods include hip spica casting, pinning or screwing, closed manipulation, and osteotomies depending on stability and severity.
- Complications include osteonecrosis from reduced blood flow and chondrolysis from joint damage.
This document provides an overview of MRI techniques for evaluating the shoulder joint and common shoulder pathologies. It begins with normal shoulder anatomy as seen on MRI and descriptions of impingement syndrome, rotator cuff tears, labral tears, instability, biceps tendon injuries, and other conditions. For each pathology, the document describes MRI appearance and features that should be included in reports. In summary, the document is a guide for radiologists to understand MRI of the shoulder and identify and characterize various shoulder injuries and diseases.
This document provides an overview of MRI imaging protocols and findings related to the hip joint. It discusses common pathologies seen in the hip such as avascular necrosis, transient osteoporosis, Legg-Calve-Perthes disease, slipped capital femoral epiphysis, and femoro-acetabular impingement. Imaging findings for each condition are described along with associated anatomy, epidemiology, classification systems and differential diagnoses. Evaluation of muscle, labral injuries, bursitis and loose bodies are also covered.
This document discusses MR imaging of the knee. It describes common knee pathologies like meniscal tears, ligament injuries, and cartilage lesions. It provides details on MR imaging techniques and protocols for the knee. Specific meniscal anatomy and grading of meniscal signal are reviewed. Various types of meniscal tears, ligament injuries like ACL and PCL tears are demonstrated with images. Other findings like cartilage lesions, bony lesions, tendon injuries are also described. Potential pitfalls in interpreting MR images of the knee like pseudo meniscal tears are discussed to improve diagnostic accuracy.
Role of medical imaging in developemental dysplasia of Hip Dr muhammad Bin Zu...Dr. Muhammad Bin Zulfiqar
In this presentation we will discuss the role of medical imaging---plain Radiography, Ultrasound,Arthrography, CT and MRI in the evaluation of Developemental dysplasia of hip. Our main focuss will be on Sonographic evaluation.
The document discusses developmental dysplasia of the hip (DDH), previously known as congenital hip dislocation. It covers normal hip development, causes of DDH, diagnosis, treatment including the Pavlik harness, and prognosis. DDH can be detected in newborns through clinical exams and worsens over time without treatment. Early reduction and stabilization of the hip is important for recovery and prevention of long-term issues.
Presentation1, radiological imaging of slipped femoral capital epiphysis.Abdellah Nazeer
Slipped capital femoral epiphysis (SCFE) is a common hip condition in adolescents where the femoral head slides out of position from the femoral neck. It typically presents with hip or knee pain and can cause leg length discrepancies. Radiographs are used to diagnose SCFE by looking for signs of physis widening and femoral head displacement. More advanced imaging like CT, MRI, and ultrasound can provide additional details but radiographs remain the primary imaging method used. Left untreated, SCFE can lead to long term deformities and osteoarthritis.
The document discusses developmental dysplasia of the hip (DDH), including: definitions; clinical detection from birth to 6 months using tests like Ortolani's and Barlow's; treatment from birth to 6 months using a Pavlik harness or closed reduction and hip spica casting; and treatment from 6 to 18 months also using closed reduction and hip spica casting, with the goal of obtaining and maintaining reduction without damaging the femoral head. Obstacles to reduction like hypertrophic soft tissues are also mentioned.
The document discusses various hip disorders that can be imaged radiographically. It describes the anatomy of the hip joint and movements. Various developmental hip disorders are covered like developmental dysplasia of the hip, proximal focal femoral deficiency, and slipped capital femoral epiphysis. Other conditions discussed include Legg-Calve-Perthes disease, transient synovitis, septic arthritis, acetabular fractures, femoral head fractures, and hip dislocations. Imaging features of avascular necrosis, femoroacetabular impingement, and herniation pits of the femoral neck are also summarized.
Classification & management of legg calve perthes diseaseSitanshu Barik
This document discusses Legg-Perthes disease (LPD), a childhood condition causing temporary osteonecrosis of the femoral head. It provides details on:
1. Diagnostic imaging techniques used including X-rays, MRI, bone scans, and arthrography. X-rays can classify LPD into stages and assess head shape.
2. Classification systems for LPD staging and outcome prediction including Waldenstrom, Catterall, Herring, and Stulberg systems. These consider factors like head shape, containment, and congruency.
3. Non-surgical and surgical treatment options from observation to hip bracing to osteotomies. The goal is containment of the femoral
Developmental dysplasia of the hip is a spectrum of disorders affecting the development of the hip joint that can present from birth to 18 months of age. It has genetic, hormonal, and positioning factors that can affect proper formation of the acetabulum and coverage of the femoral head. Clinical signs include limited abduction, a positive Galeazzi sign, and the femoral head being displaced in the Klisic test for older children. Treatment may involve harnessing or closed reduction depending on the stability and reducibility of the hip.
Hip dysplasia in adults, types, radiographs and management!
Useful for Orthopaedic residents and Surgeons.
Include most of the basics from reliable sources, pardon for any mistakes. Contact at singh_prabhjeet@yahoo.com for any corrections.
The document outlined ultrasound techniques for evaluating various structures of the knee, including tendons, ligaments, menisci, and neurovascular structures. It described optimal probe positioning and leg positioning for visualizing each target structure in longitudinal and transverse views. Comparisons were made to equivalent MRI planes to aid ultrasound interpretation. A variety of pathologies were also demonstrated through ultrasound images.
The document summarizes the radiological anatomy of the knee joint. It describes the various ligaments, tendons, bones and cartilage that make up the knee, including the medial and lateral menisci, anterior and posterior cruciate ligaments, patellar tendon, and surrounding muscles. It provides imaging protocols for MRI of the knee, covering positioning, slice thickness, pulse sequences and imaging planes used to visualize the different knee structures. Common anatomical variations and pitfalls in interpretation are also discussed.
This document provides a summary of MRI findings related to the ankle and foot. It describes MRI sequences and images of various ankle structures including tendons, ligaments, bones and bursae. Specific pathologies are discussed such as tendinopathies, ligament tears, tenosynovitis, plantar fasciitis, sinus tarsi syndrome and tarsal tunnel syndrome. Images demonstrate normal anatomy as well as examples of injuries and conditions affecting the ankle and foot.
1) The document describes the MRI anatomy of the shoulder, highlighting key supporting structures like the rotator cuff muscles and tendons.
2) It examines the shoulder in different planes including axial, coronal, and sagittal views, and provides a checklist of structures and pathologies to evaluate in each view.
3) Special attention is given to evaluating common shoulder injuries like labral tears and rotator cuff tears using specialized views like the ABER position.
This document discusses femoro-acetabular impingement (FAI), which occurs when there is reduced range of motion of the hip due to uneven surfaces of the femoral head or acetabulum. It can be caused by congenital or acquired factors. FAI is classified into cam, pincer, and mixed types. Cam FAI involves a bump on the femoral head-neck junction, while pincer FAI is due to overcoverage of the acetabulum. Clinical features include groin pain exacerbated by activity. Imaging can identify bone abnormalities, and treatments range from activity modification to surgical procedures like arthroscopy or osteotomy.
MRI imaging of knee joint -- from radiological anatomy to pathology. inspired from my dear professor Mamdouh Mahfouz, professor of radio diagnosis - Cairo university.
Developmental dysplasia of the hip (DDH) is a spectrum of hip disorders involving abnormal development of the femoral head and acetabulum. It ranges from instability where the femoral head can subluxate to full dislocation. Risk factors include ligamentous laxity and breech positioning. Ultrasound and x-rays are used to diagnose and monitor treatment, which may involve closed or open reduction depending on age, along with bracing or casting. The goal is early concentric reduction to prevent future hip degeneration.
Developmental Dysplasia of the Hip and Ultrasoundhungnguyenthien
Developmental dysplasia of the hip (DDH) refers to a spectrum of hip abnormalities ranging from mild dysplasia to frank dislocation. Risk factors include breech presentation and family history. Diagnosis involves a thorough physical exam including Ortolani's and Barlow's maneuvers in infants, with ultrasound used for further evaluation. Treatment depends on severity but may involve bracing or surgical reduction and stabilization of the hip.
SLIPPED CAPITAL FEMORAL EPIPHYSIS - By Dr. Lokesh SharoffLokesh Sharoff
This document provides information on slipped capital femoral epiphysis (SCFE), including:
- Incidence is highest in obese boys aged 13-15 and girls aged 11-13.
- Presentation includes hip or knee pain that increases with activity, limping, and limited range of motion.
- Treatment aims to prevent further slipping, reduce the degree of slippage, and provide salvage options.
- Methods include hip spica casting, pinning or screwing, closed manipulation, and osteotomies depending on stability and severity.
- Complications include osteonecrosis from reduced blood flow and chondrolysis from joint damage.
This document provides an overview of MRI techniques for evaluating the shoulder joint and common shoulder pathologies. It begins with normal shoulder anatomy as seen on MRI and descriptions of impingement syndrome, rotator cuff tears, labral tears, instability, biceps tendon injuries, and other conditions. For each pathology, the document describes MRI appearance and features that should be included in reports. In summary, the document is a guide for radiologists to understand MRI of the shoulder and identify and characterize various shoulder injuries and diseases.
This document provides an overview of MRI imaging protocols and findings related to the hip joint. It discusses common pathologies seen in the hip such as avascular necrosis, transient osteoporosis, Legg-Calve-Perthes disease, slipped capital femoral epiphysis, and femoro-acetabular impingement. Imaging findings for each condition are described along with associated anatomy, epidemiology, classification systems and differential diagnoses. Evaluation of muscle, labral injuries, bursitis and loose bodies are also covered.
This document discusses MR imaging of the knee. It describes common knee pathologies like meniscal tears, ligament injuries, and cartilage lesions. It provides details on MR imaging techniques and protocols for the knee. Specific meniscal anatomy and grading of meniscal signal are reviewed. Various types of meniscal tears, ligament injuries like ACL and PCL tears are demonstrated with images. Other findings like cartilage lesions, bony lesions, tendon injuries are also described. Potential pitfalls in interpreting MR images of the knee like pseudo meniscal tears are discussed to improve diagnostic accuracy.
Role of medical imaging in developemental dysplasia of Hip Dr muhammad Bin Zu...Dr. Muhammad Bin Zulfiqar
In this presentation we will discuss the role of medical imaging---plain Radiography, Ultrasound,Arthrography, CT and MRI in the evaluation of Developemental dysplasia of hip. Our main focuss will be on Sonographic evaluation.
The document discusses developmental dysplasia of the hip (DDH), previously known as congenital hip dislocation. It covers normal hip development, causes of DDH, diagnosis, treatment including the Pavlik harness, and prognosis. DDH can be detected in newborns through clinical exams and worsens over time without treatment. Early reduction and stabilization of the hip is important for recovery and prevention of long-term issues.
Presentation1, radiological imaging of slipped femoral capital epiphysis.Abdellah Nazeer
Slipped capital femoral epiphysis (SCFE) is a common hip condition in adolescents where the femoral head slides out of position from the femoral neck. It typically presents with hip or knee pain and can cause leg length discrepancies. Radiographs are used to diagnose SCFE by looking for signs of physis widening and femoral head displacement. More advanced imaging like CT, MRI, and ultrasound can provide additional details but radiographs remain the primary imaging method used. Left untreated, SCFE can lead to long term deformities and osteoarthritis.
The document discusses developmental dysplasia of the hip (DDH), including: definitions; clinical detection from birth to 6 months using tests like Ortolani's and Barlow's; treatment from birth to 6 months using a Pavlik harness or closed reduction and hip spica casting; and treatment from 6 to 18 months also using closed reduction and hip spica casting, with the goal of obtaining and maintaining reduction without damaging the femoral head. Obstacles to reduction like hypertrophic soft tissues are also mentioned.
The document discusses various hip disorders that can be imaged radiographically. It describes the anatomy of the hip joint and movements. Various developmental hip disorders are covered like developmental dysplasia of the hip, proximal focal femoral deficiency, and slipped capital femoral epiphysis. Other conditions discussed include Legg-Calve-Perthes disease, transient synovitis, septic arthritis, acetabular fractures, femoral head fractures, and hip dislocations. Imaging features of avascular necrosis, femoroacetabular impingement, and herniation pits of the femoral neck are also summarized.
Classification & management of legg calve perthes diseaseSitanshu Barik
This document discusses Legg-Perthes disease (LPD), a childhood condition causing temporary osteonecrosis of the femoral head. It provides details on:
1. Diagnostic imaging techniques used including X-rays, MRI, bone scans, and arthrography. X-rays can classify LPD into stages and assess head shape.
2. Classification systems for LPD staging and outcome prediction including Waldenstrom, Catterall, Herring, and Stulberg systems. These consider factors like head shape, containment, and congruency.
3. Non-surgical and surgical treatment options from observation to hip bracing to osteotomies. The goal is containment of the femoral
Developmental dysplasia of the hip is a spectrum of disorders affecting the development of the hip joint that can present from birth to 18 months of age. It has genetic, hormonal, and positioning factors that can affect proper formation of the acetabulum and coverage of the femoral head. Clinical signs include limited abduction, a positive Galeazzi sign, and the femoral head being displaced in the Klisic test for older children. Treatment may involve harnessing or closed reduction depending on the stability and reducibility of the hip.
Hip dysplasia in adults, types, radiographs and management!
Useful for Orthopaedic residents and Surgeons.
Include most of the basics from reliable sources, pardon for any mistakes. Contact at singh_prabhjeet@yahoo.com for any corrections.
This document provides information on developmental dysplasia of the hip (DDH). It discusses the definition, causes, incidence, clinical findings, pathology, diagnosis through imaging like ultrasound and X-rays, and treatment approaches for different age groups from newborns to older children. Key tests like Barlow, Ortolani and imaging classifications including Graf are outlined. The main treatment mentioned is use of Pavlik harness for young infants, while older infants may require traction and closed reduction or open reduction if closed fails.
This document discusses developmental dysplasia of the hip (DDH). It begins by defining DDH and providing epidemiological data on incidence. It then covers normal hip development, risk factors, clinical presentation, imaging findings, and management approaches. For newborns, treatment focuses on stabilizing unstable hips or reducing dislocated hips using a Pavlik harness, which places the hips in flexion and abduction. The success rate of the Pavlik harness in newborns is reported to be 85-95%.
This document discusses developmental dysplasia of the hip (DDH), also known as congenital hip dysplasia. DDH ranges from shallow acetabulum to complete hip dislocation. Risk factors include breech presentation and family history. Diagnosis involves clinical tests like Barlow and Ortolani in newborns and ultrasound or x-ray in older infants. Treatment depends on age and includes Pavlik harness in newborns, closed or open reduction and casting in infants, and osteotomies if needed in older children. Complications can include avascular necrosis. Proper screening and treatment can prevent long term issues from untreated DDH.
HIP JOINTS-1.pptx.........................IshaKanojiya1
The hip joint is a ball and socket joint that connects the femur to the pelvis. It has 3 degrees of freedom and its primary function is to support the weight of the head, arms, and trunk. The hip joint has an acetabulum socket in the pelvis and a femoral head ball. It is surrounded by strong ligaments and a capsule that provide stability, especially in extension. The hip joint positioning in extension, slight abduction and medial rotation places the joint in its closest packed and most stable position.
This document discusses developmental dysplasia of the hip (DDH), also known as congenital hip dysplasia. DDH ranges from shallow acetabulum to complete hip dislocation. It is more common in females and breech babies. Clinical signs include leg length discrepancy, limited hip abduction, and Trendelenberg gait. Ultrasound is the best initial imaging method, using the alpha and beta angles to assess acetabular depth and femoral head position. X-rays become more useful after age 4-7 months as ossification centers appear. Early diagnosis and treatment are important to prevent long-term complications of DDH like osteoarthritis.
This document discusses developmental dysplasia of the hip (DDH), formerly known as congenital dislocation of the hip. DDH is a spectrum of pathology in the development of the immature hip joint, ranging from mild dysplasia to frank dislocation. Risk factors include increased joint laxity, female sex, breech presentation, tight intrauterine space, and family history. Diagnosis involves physical examination maneuvers in infants and imaging like ultrasound and x-rays in older children. Treatment depends on age, with harnesses and casting for young infants and open reduction and casting for older children. Complications can include avascular necrosis, redislocation, and residual deformities.
This document provides an overview of scoliosis, including:
- Definitions and classifications of scoliosis types like idiopathic, congenital, neuromuscular, etc.
- Descriptions of curve patterns, measurements, and radiographic assessments.
- Clinical features and evaluations like trunk examination, scoliometer use, and Adams forward bend test.
- Etiology, progression risks, and long-term effects of different scoliosis types.
- Common curve classifications including King's type and Cobb angle measurement method.
It serves as a reference for the clinical presentation, evaluation, and management considerations for different scoliosis conditions.
1) The hip joint is a ball and socket joint that connects the femur to the pelvis and allows for flexion, extension, abduction, adduction, and rotation. It is stabilized by strong ligaments and powered by surrounding muscles.
2) Biomechanics examines the forces acting on the hip joint during various activities like walking, running, and standing. The forces are counterbalanced to allow for stability and mobility.
3) Hip disorders are managed by reducing joint reaction forces through decreasing body weight moments, improving abductor function, and redistributing forces through aids like canes or limping.
- The document provides an overview of pelvic, hip, and sacroiliac joint anatomy as seen on radiographs. It describes the bones that make up the pelvis and joints, ossification of the hip bone and femur, and key radiographic lines and projections used to evaluate the pelvis and hips. These include AP pelvis, frog leg lateral, Judet views, and SI joint views. The document is a useful radiographic anatomy reference for interpreting hip and pelvis x-rays.
BIOMECHANICS OF HIP JOINT BY Dr. VIKRAMVicky Vikram
The hip joint is a ball-and-socket joint that allows flexion, extension, abduction, adduction, and rotation. It is formed by the acetabulum of the pelvis articulating with the femoral head. The primary function is to support the weight of the upper body. Key biomechanical aspects include the angles of inclination and torsion of the femur, congruence of the joint surfaces, and forces transmitted during weight bearing that are balanced by the joint capsule and trabecular bone structure. Motion occurs through tilting and rotation of the pelvis on a fixed femur. Surrounding muscles provide dynamic stability and control movement.
1) The biomechanics of the hip joint were discussed, including the structure of the hip joint, angles of the femur, and motions of the pelvis on the femur.
2) Key structural aspects like the acetabulum, femoral head, labrum, and angles of inclination and torsion were defined. Motions at the hip include flexion, extension, abduction, adduction, and rotation.
3) In standing, the body weight and ground reaction forces create a force couple across the femoral neck. The trabecular bone structure and hip muscles work together to support the weight of the body.
BIOMECHANICS OF HIP JOINT BY Dr. VIKRAMVicky Vikram
1) The hip joint is a ball-and-socket joint that allows flexion, extension, abduction, adduction, and rotation. It supports the weight of the head, arms, and trunk.
2) The hip joint is made up of the femoral head articulating with the acetabulum. Several ligaments and the acetabular labrum provide stability to the joint. The angle of the femoral neck and torsion of the femur also affect biomechanics.
3) During standing and walking, forces from the body weight and ground reaction force act on the hip joint and femoral neck. A system of trabeculae in the femoral neck adapt to these forces. Muscles around the
BIOMECHANICS OF HIP JOINT BY Dr. VIKRAMVicky Vikram
The hip joint is a ball-and-socket joint that allows flexion, extension, abduction, adduction, and rotation. It is formed by the acetabulum of the pelvis articulating with the femoral head. The primary function is to support the weight of the upper body. Key biomechanical aspects include the angles of inclination and torsion of the femur, congruence of the joint surfaces, and forces transmitted during weight bearing that are balanced by the joint capsule and trabecular bone structure. Motion occurs through tilting and rotation of the pelvis on a fixed femur. Surrounding muscles provide dynamic stability and control movement.
This document discusses developmental dysplasia of the hip (DDH). It begins with an introduction to DDH, covering the etiology, normal hip development, pathoanatomy, clinical presentation, investigations, treatment, and complications. Key points include that DDH has multifactorial causes, involves abnormalities in the femoral head's relationship to the acetabulum, and is diagnosed through physical exams and imaging tests like ultrasound and x-rays. Left untreated, DDH can lead to secondary pathological changes in hip structure and function.
Developmental dysplasia of the hip (DDH) is a spectrum of abnormalities in hip development ranging from mild acetabular dysplasia to dislocated hips. Girls are affected six times more often than boys, and in one third of cases both hips are affected. Abnormalities may not be noticed until the child begins to walk and presents with a limp or waddling gait. Diagnosis involves clinical examination and ultrasound or X-ray imaging to assess hip stability and anatomy. Treatment depends on age and severity, ranging from splinting in flexion and abduction for mild cases to closed or open reduction and hip immobilization in a spica cast for more severe or persistent dislocations.
The document describes the ligaments of the wrist. It discusses the intrinsic ligaments which connect individual carpal bones and the extrinsic ligaments which link the carpal bones to the radius, ulna, and metacarpal bones. Specific intrinsic ligaments include the scapholunate, lunotriquetral, and scaphocapitate ligaments. Extrinsic ligaments include the volar and dorsal radioulnar ligaments. The triangular fibrocartilage complex is described along with its ligaments and meniscal homologue. Ligaments of the thumb are also outlined. Classification systems for triangular fibrocartilage complex injuries are provided.
Elastography is a noninvasive imaging technique that uses ultrasound to image the elasticity or stiffness of tissues. It works by applying slight pressure and tracking how tissues deform. Stiffer tissues will deform less than softer tissues. There are different elastography techniques that vary by how tissue excitation is achieved and measured. Elastography provides objective quantification of tissue stiffness and has applications in imaging the breast, thyroid, prostate, liver and lymph nodes to help distinguish between benign and malignant lesions. It provides quantitative measurements of tissue elasticity in kilopascals and qualitative color maps of relative stiffness.
This document contains images and text describing the anatomy and pathologies of the heart and great vessels. It discusses aortic regurgitation and stenosis, providing details on:
- Etiology, presentation, associated abnormalities
- Radiographic, CT, and MRI findings for each condition
- Differential diagnosis
It uses diagrams and images from CT, MRI, and radiography to illustrate the key features of aortic regurgitation and stenosis.
This document provides information on primary pulmonary neoplasms (lung cancer). It discusses the epidemiology and causes of lung cancer, including the major risk factor of cigarette smoking. It then covers the histologic classification of lung cancers, distinguishing between non-small cell lung carcinoma (NSCLC) and small cell lung carcinoma. Within NSCLC, it describes the characteristics and radiologic manifestations of the main subtypes: squamous cell carcinoma, adenocarcinoma, and other rare types. Key precursor lesions like atypical adenomatous hyperplasia and diffuse idiopathic pulmonary neuroendocrine cell hyperplasia are also summarized.
This document provides positioning and technical guidelines for taking lateral, PA, submento-vertex, and occipitomental radiographs of the skull. It describes the ideal patient positioning, anatomical structures visualized, common errors to avoid, and clinical indications for each view. Key details include positioning the infraorbital meatal line parallel or perpendicular to the cassette depending on the view, using tube angulation of 15-35 degrees, and instructing breath-hold to minimize motion artifacts.
The document provides an overview of shoulder anatomy including:
1) It describes the bones, joints, ligaments, muscles and bursae of the shoulder complex. Key joints include the glenohumeral joint (ball and socket) and acromioclavicular joint.
2) Rotator cuff muscles of particular focus are the supraspinatus, infraspinatus, teres minor and subscapularis.
3) Imaging techniques for evaluating the shoulder are discussed including radiography, ultrasound, CT, and MRI. MRI is highlighted as the most accurate for assessing rotator cuff pathology and other soft tissue injuries.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Hiranandani Hospital in Powai, Mumbai, is a premier healthcare institution that has been serving the community with exceptional medical care since its establishment. As a part of the renowned Hiranandani Group, the hospital is committed to delivering world-class healthcare services across a wide range of specialties, including kidney transplantation. With its state-of-the-art facilities, advanced medical technology, and a team of highly skilled healthcare professionals, Hiranandani Hospital has earned a reputation as a trusted name in the healthcare industry. The hospital's patient-centric approach, coupled with its focus on innovation and excellence, ensures that patients receive the highest standard of care in a compassionate and supportive environment.
4. • A multiaxial synovial joint of ball-and-socket type
• Femoral head articulates with the
cupshaped acetabulum
• Acetabular fossa forms the
central floor-rough and non
articular
• Femoral head is covered by
articular cartilage, except for a
rough pit for the ligamentum
teres
5. • Approximately hemispherical cavity central on the lateral
aspect of the innominate bone
• Faces antero-inferiorly
• Deficient inferiorly at the
acetabular notch
• Starts to ossify at 12 yrs
• Fuses at 18 -25 years
Os acetabuli : unfused 2
ossification centres of
the acetabulum
6. • Acetabular depth is increased by the acetabular labrum which
deepens the cup
• Transverse acetabular ligament bridges the acetabular notch
8. • Aka ligament of Bigelow
• Very strong and shaped like an inverted y, lying anteriorly and
intimately blended with the capsule
• Apex is attached between the anterior inferior iliac spine &
acetabular rim and base to the intertrochanteric line
9. • Triangular, its base attaching to the iliopubic eminence,
superior pubic ramus, obturator crest and obturator
membrane.
• It blends distally with the capsule and deep surface of the
medial iliofemoral ligament..
10. • Thickens the back of the capsule and consists of three distinct
parts:- 1) Central 2) Medial 3) Lateral
11. • Triangular, flattened band
• APEX: attached anterosuperiorly in the fovea on femoral head
• BASE: attached on both sides of the acetabular notch
between which it blends with the transverse ligament
• Ensheathed by synovial membrane
12.
13. • Hip dysplasia is a result of abnormal development of the hip
when the relationship between femur, and acetabulum is
disrupted
• Formerly known as congenital dislocation of the hip joint
–term changed since DDH is a developmental process and is
not always detectable at birth.
14. • Multifactorial – genetic + intrauterine environmental factors
• Usually unilateral (80% of the time), occurs more frequently
in the left hip – since the left hip of the fetus usually lies
posteriorly against the mother’s L-spine, limiting abduction
15. • Native-Americans
• Family history (more in first degree relatives)
• Females (4 to 8 times more common)
• Breech delivery (extreme flexion at hip stretching of
capsule & ligaments Dysplasia)
• Oligohydramnios
• First born
• Persistent hip asymmetry
16. After last menstrual period in fetal development:
• 12 weeks – lower limb rotates medially after hip joint arises
at 7-11 wks – dysplasias are teratologic
• 18 weeks – hip muscle development – dysplasias d/t
neuromuscular disorders
• B/w perinatal period and 1st few weeks of birth – femoral
head grows faster than acetabulum, minimal coverage of
head – dysplasias d/t mechanical factors - oligohydramnios,
breech position
• Postnatal period – labral growth more rapid (more coverage
of femoral head) – dysplasias tend to be due to functional
factors instead – increased estrogens causing ligamentous
laxity, swaddling
17. • Loss of tight fit between acetabulum and femoral head in
the hip may result in dysplasia or dislocation
• Findings – shallow acetabulum with femoral anteversion
femoral neck version : angle of the femoral neck relative to the pelvic
horizontal (interischial line), with a normal range of 5-25 degrees of
anteversion
femoral neck torsion : angle between the femoral neck and posterior
condylar axis of the distal femur, with a normal range of 10-20 degrees
of antetorsion
25. • Ortolani’s (reduction) and
Barlow’s (dislocation) maneuver
• Shortened leg (6-8 wks of age)
• Asymmetry of thigh folds (rare)
26. • Ortolani’s (reduction) and
Barlow’s (dislocation) maneuver
• Shortened leg (6-8 wks of age)
• Asymmetry of thigh folds (rare)
• Galeazzi’s/Allis sign (6-8 wks) -
affected knee is lower with
knees bent in supine position –
seen in unilateral DDH
27. MODALITY AGE OR INDICATION
ADVANTAGES &
DISADVANTAGES
ULTRASOUND Up to 4-5 months
Unossified femoral, head,
bony and non-bony
landmaks well evaluated
RADIOGRAPHY After 5-6 months
Once femoral head ossifies,
bony landmarks evaluated
CT
Problem solving, mostly
post-operative evaluation
Unnecessary radiation
MRI
Treatment planning and
monitoring, including
post-operative evaluation
No radiation
28.
29. • Advantages - visualizes the nonossified cartilage of the
femoral epiphyses and the cartilaginous labrum
- permits dynamic assessment of stability
• Disadvantage - cannot be used > 12 months d/t acoustic
shadowing from developing ossification center of epiphysis
• Sonographic features to be noted include :
a. Femoral head - Position, coverage & change in position with stress
b. Assessment of acetabular dysplasia
c. Acetabular roof - horizontal or inclined
d. Acetabular edge - sharp, rounded or flattened
e. Labrum - everted or inverted
f. Acetabular fossa - +/- interposed soft tissues such as excessive fat or
hypertrophied ligamentum teres
30. Two methods –
Static (Graf method) assessment with hip at rest
• emphasizes morphology and classifies the status of the hip
on the basis of angular measurements of the acetabulum
Dynamic (Harcke method) assessment with hip under stress
• consists of a multipositional evaluation that resembles the
physical examination
31. • Done in Coronal view
• Infant lies supine or in the
lateral decubitus position
with feet toward the
sonographer
• When examining the left hip
the sonographer grasps the
infant’s left leg with left
hand and transducer is held
in the right hand & vice versa
• To get coronal view – the transducer is placed in coronal
orientation over the lateral aspect of the hip
32. • Transducer is positioned over greater trochanter and held
parallel to the table showing maximum depth of acetabulum
• Cardinal landmarks - 1) inferior edge of the ilium
2) lateral margin of ilium projected as horizontal line 3) acetabular labrum
[“ball on spoon” appearance, with the femoral head representing the ball, the
acetabulum, the bowl of the spoon and the ilium the handle of the spoon]
• False positive - when transducer is rotated anteriorly
• False negative - when transducer is rotated posteriorly
• Proper coronal view –
(a) echoes from bony ilium should be in a straight line parallel to transducer
(b) transition between ilium & triradiate cartilage should be seen definitively
(c) echogenic tip of the labrum should be in the same plane as the other two
34. Alpha (α) and Beta (β) angles
• Baseline : drawn along the straight lateral margin of the ilium
• Inclination line : connects osseous convexity to labrum
• Roof line : connects lower edge of acetabular roof medially to
osseous convexity
35. Alpha (α) angle
• Angle between Base line & Roof line
• denotes inclination of acetabulum
• Small alpha indicates a shallow bony acetabulum
; Normally > 60
36. Beta (β) angle
• Angle between Baseline & Inclination line
• Normally < 55
• Large β angle indicates lateral migration of femoral head
37. TYPE DESCRIPTION α β COMMENTS T/T
I Normal hip > 60 < 55 Good bony modelling None
II Concentric position Sufficient roofing of femoral head
a
Physiologic immaturity
(age < 3 months)
50 – 60 55 – 77
*Deficient bony modelling
*Cartilaginous acetabular roof is still
broad and covers femoral head
Observe until
mature
b
Delayed ossification
(age > 3 months)
Pavlik harness
c Concentric position 43 – 49 55 – 77
*Highly deficient bony modelling
*Cartilaginous acetabular roof is still
broad and covers femoral head
Pavlik harness
d Subluxation 43 – 49 > 77 *Labrum is everted
Pavlik harness
/ Reduction
III Low dislocation Bony roof deficient, labrum everted
a
No structural change
of Cartilaginous roof
< 43 > 77 Cartilage normal echogenicity,
Cartilaginous roof pushed upwards
Reduction
b
Structural change of
Cartilaginous roof
< 43 > 77 Cartilage increased echogenicity,
Progression of upward pushing
Reduction
IV High dislocation Can’t be
measured
Can’t be
measured
Flat bony acetabulum, interposed
labrum
Reduction
40. Pulvinar (P) = fibrofatty tissue b/w acetabulum and femoral head, more
evident in DDH d/t femoral head not pressing against it in the acetabulum
41. • This technique incorporates motion and stress maneuvers
that are based on accepted clinical examination techniques
• The multiview dynamic assessment emphasizes hip position
and stability, but it also includes an assessment of
acetabular development.
• With the dynamic method, an attempt is made to visualize
the Barlow and Ortolani maneuvers on the ultrasonography
screen.
• The technique is dependent on ligamentous or capsular
laxity, and, as with the physical examination, the study
quality depends on the operator performing the stress test
42. Normal Hip
• In the first few
week of life, the
femoral head is
reduced in the
acetabulum at
rest, but it may
show slight
displacement
under stress
• This should
resolve by the
time infant is
four weeks of age
Subluxation
• Displacement of
the head from the
acetabulum
• However, the
head is not
completely
dislocated
Dislocation
• The femoral head
is completely
dislocated
• Fibro-fatty tissue
with increased
echogenic
properties fills
the space
between the
head and the
acetabulum.
43. • The lateral approach for ultrasonography has been the most
widely accepted.
• Four basic lateral views are described –
– Coronal – neutral
– Coronal – flexion
– Transverse - neutral
– Transverse – flexion
• Neutral: The femoral shaft is in the position of rest, usually
15-20 degrees of hip flexion.
• Flexed: The femoral shaft is flexed 90 degrees at the hip
44. • The dynamic technique is performed with the infant in both
the lateral decubitus and the supine position, and imaging is
carried out in the coronal and transverse planes both with
and without stress
• At a minimum, the examination should consist of two
orthogonal views with one obtained during a stress
maneuver
45. TRANSVERSE FLEXION
• The hip and knee are flexed
90 and the ultrasound
transducer is placed
perpendicular to the lateral
aspect of the infants hip
• With the hip in this
position of flexion and
adduction, a posterior push
is analogous to the Barlow
test
46. : normally the femoral head (H)
remains in contact with the ischium (IS) during movement.
TRANSVERSE FLEXION
AC-acetabular cartilage; G-gluteus muscle; GT-greater trochanter; H-cartilaginous
femoral head; C-Capsule; FS-femoral shaft; IS-ischium; IL-ilium; L-labrum; LT/P-
Ligamentum teres / pulvinar complex; M-femoral metaphysis; Tr-triradiate cartilage
47. With instability and
displacement: the femoral
head moves laterally and
posteriorly. The laterally
displaced head (F, open
arrows) has no contact with
the ischium (solid arrows).
Fibrofatty tissue (T) with
increased echogenicity fills the
acetabulum.
TRANSVERSE FLEXION
54. • Avascular necrosis of femoral head is common complication
of DDH treatment devices
• Doppler ultrasound is used to assess the vascularity of
femoral head during treatment
• Normal hip show a radial pattern of flow from the center of
the unossified head
55. Normal radial pattern of flow from
the center of the unossified head
Power Doppler image obtained
during wide abduction shows
absent flow in femoral head
56.
57. • Line of Hilgenreiner
• Perkin's line
• Shenton's curved line
• Acetabular angle
• Andren Von Rosen line
58. Line of Hilgenreiner
• Line connecting supero-
lateral margins of triradiate
cartilage
H
59. Line of Hilgenreiner
• Line connecting supero-
lateral margins of triradiate
cartilage
Perkin's line
• Vertical line to
Hilgenreiner's line through
the lateral rim of
acetabulum
P
H
60. Femoral head position
• Normal ossified capital
femoral epiphysis lie in
lower inner quadrant (H-
and P- lines)
P
H
61. Shenton's curved line
• Arc formed by inferior
surface of superior pubic
ramus (top of obturator
foramen) and medial
surface of proximal femoral
metaphysis to level of
lesser trochanter
S
62. Acetabular angle
• Slope of acetabular roof
• Angle that lies between
Hilgenreiner's line and a
line drawn from most
superolateral ossified edge
of acetabulum to
superolateral margin of
triradiate cartilage
A
63. Acetabular angle
• The acetabular angle
using Hilgenreiner's line
should be less than 28
at birth.
• The angle should
become progressively
shallower with age, and
should measure less
than 22 at and beyond
1 year of age.
P
H
S
A
64. Head position : outer
lower quadrant
Broken Shenton’s line
Acetabular angle > 22
65. Andren Von Rosen line
• X-ray AP view is taken with
both hips Abducted,
Internally Rotated and
Extended
• Line is drawn along femoral
shaft, which intersect
acetabulum normally
66. Andren Von Rosen line
• X-ray AP view is taken with
both hips Abducted,
Internally Rotated and
Extended
• Line is drawn along femoral
shaft, which intersect
acetabulum normally
• In dislocated hip, it crosses
above the acetabulum
67.
68. • Acetabular angle
• Acetabular Index
• Center-edge (CE) angle of Wiberg
• Refined CE Angle of Ogata
• Vertical-center-anterior margin (VCA) angle
• Femoral Head-Neck-Shaft Angle
69. Acetabular angle
• In adult, triradiate cartilages
are fused and therefore
inapparent, thus inferior
margin of the pelvic tear
drop is used instead.
• Pelvic tear drop (aka U-
figure) results from the the
end-on projection of a bony
ridge running along the
floor of the acetabular fossa
70. Acetabular angle
• In adult, it is measured as
Angle formed between a
horizontal line and a line
from the teardrop to lateral
acetabulum.
• Normal - 33 to 38
• > 47 - dysplasia
• 39 to 46 - indeterminate
72. Acetabular Index
• Aka Tonnis angle
• Measures the weight bearing surface of the acetabulum or
sourcil.
• The sourcil represents an area of subchondral osseous
condensation in the acetabular roof, which is a response
by the articular portion of the ilium to the stress provoked
by the compressive forces acting on it
73. Acetabular Index
• This angle is formed
between a horizontal
line and a tangential
line extending from the
medial to lateral edges
of the sourcil
• Normal ≤ 13°
• Dysplastic > 13°
74. • Angle subtended by one
line drawn from the
acetabular edge to
center of femoral head+
second line
perpendicular to line
connecting centers of
femoral heads
Center-edge (CE) angle of Wiberg
75. P
H
S
A
Center-edge (CE) angle of Wiberg
• Angle subtended by one
line drawn from the
acetabular edge to
center of femoral head+
second line
perpendicular to line
connecting centers of
femoral heads
76. • Normal
– 6-13 > 19
– Above 13 > 25°
• Borderline dysplasia=20–25°
• Dysplasia < 20 P
H
S
A
Center-edge (CE) angle of Wiberg
78. • Used where lateral point
of osseous condensation
did not reach the lateral
rim of the acetabular roof
• Similar to CE angle of
Wiberg except the lateral
line is tangent to the
lateral point of bony
condensation
Refined (CE) angle of Ogata
79. Vertical-center-anterior margin (VCA) angle
• Aka anterior-center-edge angle
• Evaluates anterior coverage of
the femoral head by the
acetabulum
• Measured on a lateral or “false-
profile” view of the hip
• Obtained with patient in
standing position, affected hip
against the cassette and pelvis
rotated 65; The foot on affected
side should be parallel to the
cassette; beam is centered on
the femoral head
80. Vertical-center-anterior margin (VCA) angle
• Measured as the angle
formed between a vertical
line through the center of
the femoral head and a line
tangential to the anterior
margin of the acetabular roof
• Normal > 25°
• < 20° is diagnostic of hip
dysplasia.
• 20°-25° - borderline dysplasia
81. Femoral Head-Neck-Shaft Angle
• Aka caput collum
diaphysis (CCD) angle
• Measured at the
intersection of the
femoral neck axis
with the long axis of
the femoral shaft
• Normal 120° to 135°
82. Femoral Head-Neck-Shaft Angle
• Aka caput collum
diaphysis (CCD) angle
• Measured at the
intersection of the
femoral neck axis
with the long axis of
the femoral shaft
• Normal 120° to 135°
• > 135° - coxa valga
83. Femoral Head-Neck-Shaft Angle
• Aka caput collum
diaphysis (CCD) angle
• Measured at the
intersection of the
femoral neck axis
with the long axis of
the femoral shaft
• Normal 120° to 135°
• > 135° - coxa valga
• < 120° - coxa vara
84. Delta angle
• Used to quantify the position of the fovea capitis along
the femoral head
• The abnormal superior position of the fovea capitis, also
known as ‘Fovea alta’, is regarded as a potential
radiographic diagnostic marker of dysplastic hip
85. Delta angle
• The delta angle is formed
between the lines drawn
from the center of the
femoral head to the
medial edge of the sourcil
and to the superior edge
of the fovea capitis
• Normal > 10°
86. Delta angle
• The delta angle is formed
between the lines drawn
from the center of the
femoral head to the
medial edge of the sourcil
and to the superior edge
of the fovea capitis
• Normal > 10°
87. Delta angle
• The delta angle is formed
between the lines drawn
from the center of the
femoral head to the
medial edge of the sourcil
and to the superior edge
of the fovea capitis
• Normal > 10°
• Fovea alta ≤ 10°
88.
89. • In children, most commonly used to document reduction
if child is placed in spica cast
• Can be performed preoperatively in the older child in
severe cases to help the surgeon in planning treatment
procedures
• In adults, CT is useful for characterizing hip dysplasia to
anterior, posterior, or global deficiency
• In addition, can be used to measure and confirm
correlates of radiographic center-edge angle, vertical-
center-anterior margin, and acetabular index
90. Measurements of Developmental Dysplasia of the Hip
• Anterior acetabular sector angle (AASA)
• Posterior acetabular sector angle (PASA)
• Horizontal acetabular sector angle (HASA)
Values are measured on axial CT one cut above greater
trochanters
91. • Created by drawing lines through centers of femoral heads
and line tangential to anterior lip of acetabulum
• Normal > 50°
Anterior acetabular sector angle (AASA)
92. • Created by drawing lines through centers of femoral heads
and line tangential to posterior lip of acetabulum
• Normal > 90°
Posterior acetabular sector angle (PASA)
93. • Created by drawing lines from anterior lip of acetabulum
through center of femoral head and posterior lip of acetabulum
• Normal > 140°
Horizontal acetabular sector angle (HASA)
96. • Reserved for difficult cases
• Major advantage : can delineate soft-tissue structures as
well as osseous structures without ionizing radiation
• Many MRI studies are ordered in the postoperative
period, usually after reduction and spica cast placement
97.
98. Axial T1-weighted images show interval reduction of right hip with mild
persistent posterior subluxation. Acetabulum is shallow. Compared with
normal left side (solid arrow, B), right femoral head ossification is
delayed (long solid arrow, A). Anterior labrum is mildly inverted (short
solid arrow, A). Significant pulvinar hypertrophy (dotted arrow, A).
A B
99. 32-year-old woman with hip dysplasia and labral disease
Coronal proton density–weighted (A) & sagittal fat-saturated proton
density–weighted (B) MR images show redundant patulous labrum
with extensive intrasubstance signal abnormality (curved arrows)
A B
100. 32-year-old woman with hip dysplasia and labral disease
Sagittal fat-saturated proton density–weighted MR images show
anterior acetabular subchondral cysts (dashed arrow)
102. 28-year-old woman with left hip dysplasia and subchondral
impaction fracture
Coronal proton density–weighted (A) and coronal fat-saturated T2-
weighted (B) MR images show subchondral fracture line (arrow)
located in superior weightbearing aspect of femoral head
A B
Notes de l'éditeur
The triradiate cartilage is the 'Y'-shaped epiphyseal plate between the ilium, ischium and pubis to form the acetabulum of the os coxae
There are several variations and
modifications of this technique10,20,38,74,96. It is possible to
reduce the extent of the examination yet theoretically to
obtain the same information
It should be remembered that four to six millimeters of subluxation is normal during the first few days of life. Not all infants become normal so continued observation is required
ARROWHEAD IS TRIRADIATE CARTILAGE
Central collection of vessels is the precursor of the ossification center and is seen before the center is apparent on radiograph