•Ultrasound Atlas of the Infant Hip preview

 

Hi

I am looking for sonogram prints of interesant cases ,exceptions etc. of the baby hip;

specially where good mature hip Type I is worsening to decentering hip Type D/III/IV

 (with good quality  of  documentation ; I will pay to 150 eu for each)

I have read about it in paper,but I have never seen ( I have examined personally about 200 000 infant's hip)

 

 

Utrasound Atlas of the Infant Hip

 

Typical normal us sonogram and the comon mistakes:

 

 Type IIa+(GN coming to maturity) 6 weeks (below)

the bony roof satisfactory modeling

the bony rim angular  but bony roof is only satisfactory ,the first part of bony roof is very good,but  the second tail (deeper) is only satisfactory.

the cartilage roof cover the head;

the arrows show labrum (red)  ;

            the bony rim   (yellow);

              the lower iliac margin (blue) ,

 

the bony roof line (blue) is extends tangential to the lower iliac margin and tangent to the bony rim

the cartilage roof line(green) is drown tangential to the bony rim and through the middle point of the labrum echo;

  asymmetry in the loose joint  capsule; family DDH(  when it occurs ask always about it)

 the baseline (yellow) is drown parallel to ilium echo through the point of the junction of the perichondrium,the periosseum and ilium.

type I (abow) 6 weeks the bony roof is good

the bony rim blunt

the cartilage roof cover the head;

the arrows show labrum (red)  ;

            the bony rim   (yellow);

              the lower iliac margin (blue) ,

 

the bony roof line (blue) is extends tangential to the lower iliac margin and tangent to the bony rim

the cartilage roof line(green) is drown tangential to the bony rim and through the middle point of the labrum echo ;

 asymmetry in the loose joint  capsule ,family DDH(  when it occurs ask always about it)  the baseline (yellow) is drown parallel to ilium echo through the point of the junction of the perichondrium,the periosseum and ilium.

 

type IIa ( below )  4 weeks the bony roof  is  adequate

the bony rim rounded

the cartilage roof cover the head;

the arrows show labrum (red)  ;

            the bony rim   (yellow);

              the lower iliac margin (blue) ,

 

the bony roof line (green) is extends tangential to the lower iliac margin and tangent to the bony rim

the cartilage roof(blue) is drown tangential to the bony rim and through the middle point of the labrum

 the baseline (yellow) is drown parallel to ilium echo through the point of the junction of the perichondrium,the periosseum and ilium.

 

type D(up)  4 weeks the bony roof  severely deficient ,

the bony rim flattened

the cartilage roof  dispalced;

the arrows show labrum (red)  ;

            the bony rim   (yellow);

              the lower iliac margin (blue) ,

 

the bony roof line (green) is extends tangential to the lower iliac margin and tangential to the bony rim

the cartilage roof line(blue) is drown tangential to the bony rim and through the middle point of the labrum

 the baseline (yellow) is drown parallel to ilium echo through the point of the junction of the perichondrium,the periosseum and ilium.

 

 

type IIc (up) 6 weeks the bony roof  severely deficient ,

the bony rim flattened

the cartilage roof still covers ;

the arrows show labrum (red) ;

the bony rim   (yellow);

the lower iliac margin (blue) ,

 

the bone roof line (red)

the cartilage roof line(pink)

the baseline (yellow)

typd

 

 

 

 

type D(up)  1 weeks the bony roof  severely deficient ,

the bony rim flattened

the cartilage roof  dispalced;

the arrows show labrum (red)  ;

            the bony rim   (yellow);

              the lower iliac margin (blue) ,

 

the bony roof line (green)

the cartilage roof line(blue)

 the baseline (yellow)

 

 type I   (below) 6 weeks

  asymmetry in the loose joint  capsule;family DDH (  when it occurs ask always about it)

the bony roof is good

the bony rim blunt

the cartilage roof cover the head;

the arrows show labrum (red)  ;

            the bony rim   (yellow);

              the lower iliac margin (blue) ,

 

the bony roof line (blue) is extends tangential to the lower iliac margin and tangent to the bony rim

the cartilage roof line(green) is drown tangential to the bony rim and through the middle point of the labrum echo ;

 asymmetry in the loose joint  capsule ,family DDH(  when it occurs ask always about it)  the baseline (yellow) is drown parallel to ilium echo through the point of the junction of the perichondrium,the periosseum and ilium.

 type   Type GN (coming to maturity) (Physiologically immature, border type between I and II) (up ) 6 weeks

  asymmetry in the loose joint  capsule;family DDH (  when it occurs ask always about it)

the bony roof is adequate

the bony rim blunt

the cartilage roof cover the head;

the arrows show labrum (red)  ;

            the bony rim   (yellow);

              the lower iliac margin (blue) ,

 

the bony roof line (blue) is extends tangential to the lower iliac margin and tangent to the bony rim

the cartilage roof line(green) is drown tangential to the bony rim and through the middle point of the labrum echo ;

 asymmetry in the loose joint  capsule ,family DDH(  when it occurs ask always about it)  the baseline (yellow) is drown parallel to ilium echo through the point of the junction of the perichondrium,the periosseum and ilium.

type D(up) decentirc hip  3 days newborn with normal  arterial supply at the  cartilage femoral head in power doppler

the arrows show the arterial main supplay from a.circumflexa medialis (red)   ;

         Parallel projection  to artery  (yellow);

         Traverse projection to artery(green)               arterial supplay from a.lig.teres (blue)  

 

the bony roof  severely deficient ,

the bony rim flattened

the cartilage roof  dispalced;

 

 

normal   position                                                                          obduction 60 degree

 

 

 

type IV (up) eccentric hip  4weeks   the apex of the femoral  head is upper to  highest point  of cartilaginous roof

bony roof  poor ,

 superior bony rim flattened

 cartilage roof  dispalced pressed downwards;

 arrows show labrum (red)  ;

               bony rim   (yellow);

              lower iliac margin (blue) ,

           displaced   joint capsule (green)

 

 

type IV (up) eccentric hip 6 days   the apex of the femoral  head is upper to  highest point  of cartilaginous roof

bony roof  poor ,

 superior bony rim flattened

 cartilage roof  dispalced pressed downwards;

 arrows show  feamoral head (red)  ; and   displaced   joint capsule

 

type IIIb 8 weeks . the bony roof  poor ,

the bony rim flattened

the cartilage roof  dispalced; pressed upwards with structural alteration (echogenic) orange arrows

the arrows show labrum (red)  ;

            the bony rim   (yellow);

              the lower iliac margin (blue) ,

 

Type IIa(GN) 6 weeks (up)

the bony roof satisfactory modeling

the bony rim angular  but bony roof is only satisfactory ,the first part of bony roof is very good,but  the second tail (deeper) is only satisfactory.

the cartilage roof cover the head;

the arrows show labrum (red)  ;

            the bony rim   (yellow);

              the lower iliac margin (blue) ,

 

the bony roof line (pink) is extends tangential to the lower iliac margin and tangent to the bony rim

 

 the baseline (magneta) is drown parallel to ilium echo through the point of the junction of the perichondrium,the periosseum and ilium.

 

type III a (up)1 week . the bony roof  poor ,

the bony rim flattened

the cartilage roof  dispalced; pressed upwards without structural alteration(devoid of echo)

the arrows show labrum (red)  ;

            the bony rim   (yellow);

              the lower iliac margin (blue) ,

 

Type II / IV 6 weeks

the bony roof  is deficient(adequate to type II) but

the cartilage roof dispalced pressed downwards(adeguate to type IV);

 

 

Type I   abdominal silhouette of the os ilium      Type IIB (4.5 months.old)  the femoral head is pressed to external border of the acetabullum with contracture of the muscles

(ultrasound head  turn to the right)

 

silhouette of the echo of os ilium (turn to the left)     silhouette of the echo of os ilium (turn to the right)

( ultrasound head  turn to the right) abdominal                           ( ultaosound head  turn to the left) dorsall

 

 

Pavlik harness treatment 2 weeks

Type IIa- 4 weeks (below) before treatment            Type IIc 6 weeks after trreatment

The bony rim flattened (red arrow ) becouse in this age os is lighter then muscls and ligaments

 

 

Type GN (above) second left hip slighty worsennig to type IIa too

 

type I  red points shows   labrum left  ;

            the bony rim   medium;               the lower iliac margin right

 

 

Type IIc  red points shows   labrum left  ;

            the bony rim   medium;( two points)

              the lower iliac margin right

 

        

Typical mistake

( Ortholani sign  after  born  ortopaedic control for 3 weeks .)

 during ortopaedic control  3 weeks old baby  Type IIa  @ 56  B 53 ( typical error)    automatical measuring the alpha i beta angles ;

Type  D @46 B 87( correct angles valuae)

Type IV next control after 8weeks

 

 

the same problem with second hip  Type I  @ 62  B 47 ( typical error)    automatical measuring the alpha i beta angles

 Type  IIa @57 B 76( correct angles valuae)

type IIIa below 8 weeks   sonograms of the same hip but difrent us devices

 

 

 

 

 

 

 

 

 

Type IIa 7 weeks old  muscles contracture  and displaced of femoral head to the outer end of acetabulum  with pseudo  Barlow sign

 

 

family DDH Type II a 5 weeks  (  up)asymmetry in the loose joint  capsule

 

 

 

type D(up)

the bony roof  severely deficient ,

the bony rim flattened

the cartilage roof  dispalced;

                                

 

type D(below)  5 weeks angle @ 48st angle B 85;

the bony roof  severely deficient ,

the bony rim flattened

the cartilage roof  dispalced;

the arrows show labrum (red)  ;

            the bony rim   (yellow);

              the lower iliac margin (blue) ,

 

the bony roof line (green)

the cartilage roof line(blue)

 the baseline (yellow)

type II/D up typical error  of measurement  as type I ( ange @ 62st ange B 55) be careful  during diagnosis   ,when  view and desciption of the hip are difrent to the alpha angle value .

 

type IV (up) eccentric hip 4 weeks   the apex of the femoral  head is upper to  highest point  of cartilaginous roof

bony roof  poor ,

 superior bony rim flattened

 cartilage roof  dispalced pressed downwards;

 arrows show  femoral head (red)  ; and   displaced   joint capsule

 

 

 

rtg secondary acetabulum

 Michał Kulej

 

 

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