HIP ULTRASOUND

 The protocol and techniques  of performing the ultrasound of the hip

HIP ANATOMY

 Bony landmarks of the pelvis you have the ilium you also have the

acetabulum, where the femoral head goes into the ischium and then the pubis and right here in the middle, is a pubic symphysis typically.


When you're scanning your scan you're seeing the ilium and the acetabulum in a horizontal plane, I've rotated the image and put it here against the iliac wing so you can see the relation

from the ultras, the relation of the ultrasound image to the sonographic image here's another view of the hip in cross-section here we have the femoral head at the end of the femur in the socket in the acetabulum this type of joint is known as a ball and socket joint obviously you can see the circular formation of the femoral head it allows for a large degree of rotation for walking this joint is meant to support a lot of weight so naturally any underdevelopment or hyperplasia of the acetabulum will lead to walking difficulties in the future ok so here's a coronal or longitudinal view of the hip right here this equal genic line is the ilium dips down to become the acetabulum the bony acetabulum here is the femoral head you can see all the little interfaces showing the spongy bone this is the labrum here and then this is the ischium here is a transverse view and you can see the femoral head or the ball of the femur again and acetabulum just posterior to it you can see the ischium and here you can see a

beginning of the femoral shaft and this patient.

 Cartilaginous scanning indications for hip sonography are abnormal physical exams a family

history of hip dysplasia breech presentation all ago Hydra meals and also if there is known hip dysplasia.

For this exam you will need a linear transducer for bigger babies you can use a nine if the babies are really small you can use a fifteen the exemption should typically be done after one month it's better if the baby is at least one month to discount the possibility of getting physiologically immature hips which are normal those by three months typically go back to normal you will want the patient to be in a lateral depute to Cuba disposition this allows for better angling of your transducer and for manipulation as well you may perform.

Abduction of the patient's legs these movements are called the Barlow and Ortolani maneuvers and these are done during a physical examination by the pediatrician to rule out dislocation of the hips this dynamic technique is invaluable as you can see subluxation in real-time.


While scanning we also take a pair of measurements called alpha and beta angles of the acetabulum developed by graph we draw a line across the ilium horizontally and then two other lines that dissect this line through the acetabulum and labral areas here you get the Alpha angle and here you get the beta angle a normal angle is 60 degrees or above and a normal beta angle is considered 55 degrees or below the typical protocol consists of a series of coronal and transverse images.

 In the coronal plane you want to scan your baby whether they're in supine or letter decubitus which is preferable you want to scan the leg in a neutral position that's just the body naturally you may need to measure in this plane depending on your institution a lot of institutions vary in their protocol some will have you measure in neutral others in adduction some places


In immature  it looks pretty

 normal the corner thereof where the ileum meets the acetabulum is a little rounded off to see is considered a mild dysplasia anywhere from 43 to 50 degrees alpha angle and then indeed you can see some significant acetabular dysplasia you can see just by looking at that that it's abnormal the as a team is very shallow and in real-time you may be able to see the femoral head moving side to side on this side by side image you can see the right is normal the acetabulum is well-formed and on the left  acetabulum

is shallow and also the femoral head appears to be smaller when compared to the right so it's a little bit less thick as well in this image, you can see the femoral head is completely outside of the acetabular cavity acetabular rim is flattened this is a graph type for hip the angle can be either unmeasurable 

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