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    Pediatric Hip Dysplasia Case Study

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    This document describes a case of developmental dysplasia of the hips in a 5 month old female. An ultrasound found a dislocation of the right femoral head and subluxation of the left femoral head. The patient had previously been placed in a Pavlik harness for 6 weeks with no improvement. Follow up ultrasound showed the condition was unchanged. The patient will continue treatment with the Pavlik harness for 6 more weeks.

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    Pediatric Hip Dysplasia Case Study

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    api-349474075
    255 views13 pages
    This document describes a case of developmental dysplasia of the hips in a 5 month old female. An ultrasound found a dislocation of the right femoral head and subluxation of the left femoral head. The patient had previously been placed in a Pavlik harness for 6 weeks with no improvement. Follow up ultrasound showed the condition was unchanged. The patient will continue treatment with the Pavlik harness for 6 more weeks.

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    This document describes a case of developmental dysplasia of the hips in a 5 month old female. An ultrasound found a dislocation of the right femoral head and subluxation of the left femoral head. The patient had previously been placed in a Pavlik harness for 6 weeks with no improvement. Follow up ultrasound showed the condition was unchanged. The patient will continue treatment with the Pavlik harness for 6 more weeks.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    255 views13 pages

    Pediatric Hip Dysplasia Case Study

    Uploaded by

    api-349474075
    This document describes a case of developmental dysplasia of the hips in a 5 month old female. An ultrasound found a dislocation of the right femoral head and subluxation of the left femoral head. The patient had previously been placed in a Pavlik harness for 6 weeks with no improvement. Follow up ultrasound showed the condition was unchanged. The patient will continue treatment with the Pavlik harness for 6 more weeks.

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    DEVELOPMENTAL

    DYSPLASIA OF THE HIPS


    Shelby Rhoda
    DMS 497
    Fall 2016
    CASE HISTORY
    5 mo Caucasian female
    Pediatric hip ultrasound ordered to follow up diagnosis of
    developmental dysplasia of the hips after being placed in
    Pavlik harness for 6 weeks
    Born at 38w 3d by spontaneous vaginal delivery weighing
    6lb 3oz
    Symptoms: persistent hip clicks
    Labs: none available
    Elevated circulating maternal estrogen creates ligamentous laxity
    CASE HISTORY

    Previous ultrasound 6 weeks prior for hip clicks


    Superolateral dislocation of the right femoral
    head with no contact with the acetabulum
    Lateral subluxation of the left femoral head with
    partial coverage by the acetabulum
    Patient placed in Pavlik harness for 6 weeks
    SCANNING TECHNIQUES
    Dynamic Technique:
    the Barlow maneuver with the patient laying supine and
    using a linear transducer to have a lateral view of the hip
    Coronal and transverse images are taken in flexion and
    extension positions
    should show sonographically a femoral head remaining in
    the acetabulum with the flexion and extension movements

    Acetabulum is composed of both bone and


    cartilage
    Ossification centers of the ilium, ischium, and
    SONOGRAPHIC FINDINGS

    Figure 1: Labelled anatomy on a normal ultrasound of the Figure 2: Animation of normal hip anatomy.
    Pediatric femur fixed within the acetabulum
    SONOGRAPHIC FINDINGS
    LAT

    SUP INF

    MED
    igure 3: Coronal image of the right hip showing
    ateral and superior displacement of the femur. Figure 4: Transverse image of the laterally displaced
    he red star indicates the correct location of the femoral
    femoral head.
    head.
    SONOGRAPHIC FINDINGS

    Figure 5: Coronal image of the left hip showingFigure 6: Coronal image of the left hip showing lateral
    lateral displacement of the femoral head. Subluxation of the femoral head.
    DIAGNOSIS

    Superolateral dislocation of the right femoral


    head
    Lateral subluxation of the left femoral head
    Unchanged from previous ultrasound
    Dislocation: femoral head is displaced laterally,
    posteriorly, and superiorly to the acetabulum
    with no contact or coverage by the acetabulum
    Subluxation: the femoral head is positioned
    DIAGNOSIS

    Incidence: occurs in 1.5 for every 1000


    infants
    More common in females with 4:1 ratio
    After ossification is complete MRI is used
    to diagnose DDH
    DIFFERENTIAL DIAGNOSIS
    Differential:
    Hip Effusion: build-up of fluid around the joint
    capsule, the anterior recess of the joint becomes
    distended with at least 2mm of increased
    thickness of the abnormal joint
    Sonographically: bulging joint capsule is seen
    with debris between the femoral epiphysis and
    the acetabular cup
    Rare finding before the first year of life because
    the femoral neck has not developed and the
    capsule is small
    Treatment: Arthrocentesis
    FOLLOW-UP

    Patient placed in Pavlik harness for 6 weeks


    a restraint device that maintains the hip in flexion and
    abduction
    US used to document progress every 6 weeks
    Placement in the harness continues until ligaments are
    stable
    CONCLUSION
    5 mo presents for follow-up of Pavlik harness placement
    Presents with hip clicks
    Subluxation of the left hip and dislocation of the right hip

    Treatment with Pavlik harness will continue for 6


    more weeks
    Pitfall: not having knowledge on the subject
    Take away message:
    Seek help with doctor or radiologist when not confident with
    an exam
    REFERENCES
    Harcke, Theodore. Grissom, Leslie. Performing Dynamic
    Sonogrpahy of the Infant Hip. Wilmington, DE: Department of
    Medical Imaging; 1990.
    Chung, Ellen. Coley, Brian. Pediatric Sonography. First edition.
    Retrieved from: http://ovidsp.tx.ovid.com/sp-3.22.1b/ovidweb.cgi?
    &S=AIGHFPGOPDDDGNHNNCHKMEJCFJIFAA00&Link+Set=S
    .sh.6267_1479088521_48%7c2%7csl_10
    Carol Rumack, Stephanie Wilson, J. Charboneau, Deborah Levine.
    Diagnostic Ultrasound. Fourth edition. Philadelphia, PA: Mosby,
    Inc.; 2011.

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