Chapter 28: Infant and Pediatric Hip

The hip bones are the fusion of three separate bones. Which one of the following bones does not belong in this group?

a. Ilium

b. Femur

c. Ischium

d. Pubis

b. Femur

The hip bones are the fusion of the ilium, ischium, and pubis

The femur is surrounded by all of the following structures except:

a. bursa.

b. muscles.

c. ligaments.

d. tendons.

a. bursa.

The femur is surrounded by muscles, ligaments, and tendons.

Which movement does the psoas major, iliacus, and rectus femoris provide?

a. stabilization

b. rotation

c. adduction

d. flexion

d. flexion

The primary flexors of the hip are the psoas major, iliacus, and rectus femoris. Extension is limited to 20 degrees and is brought about by the hamstrings and gluteus maximus.

Bending the hip backward is called:

a. adduction.

b. flexion.

c. extension.

d. abduction.

c. extension.

Flexion is the bending forward, and extension is the bending backward. Adduction is a sideways movement, and abduction is the combination of a sideways and outward movement.

The articulation of the head of the femur with the acetabulum of the hip bone forms the _______________.

a. hip joint

b. femoral triangle

c. iliofemoral ligament

d. ligament teres

a. hip joint

The hip joint is formed by the articulation of the head of the femur with the acetabulum of the hip bone.

The ligament in the shape of an inverted y or V passing from the anteroinferior iliac spine to each end of the intertrochanteric line is the _______________ ligament.

a. iliofemoral

b. obturator

c. femoral

d. gluteal

a. iliofemoral

The most important ligament of the hip joint is the iliofemoral ligament, which is in the shape of an inverted y or V.

When a person crosses his or her legs in a sitting position, which one of the following muscle groups is used?

a. Adductor

b. Abductor

c. Flexion

d. Extension

a. Adductor

The adductor muscle group is used when crossing the legs (moving inward).

In the coronal neutral view, the sonographic finding of a frankly dislocated hip is which one of the following?

a. The femoral head rests against the bony acetabulum.

b. The femoral head migrates laterally and superiorly with decreased coverage of the femoral head.

c. The acetabular roof is irregular and angled.

d. The labrum may be deformed.

d. The labrum may be deformed.

In the coronal neutral view, the labrum may be deformed when visualizing a frankly dislocated hip.

In the "push-pull" maneuver, which one of the following findings is seen in the normal hip in the coronal neutral view?

a. The femoral head is never seen over the posterior lip of the acetabulum.

b. The femoral head remains in place in the acetabulum.

c. The femoral head appears over the posterior lip of the triradiate cartilage as the femur is pushed.

d. The femoral head migrates laterally and posteriorly.

a. The femoral head is never seen over the posterior lip of the acetabulum.

In the normal hip, the femoral head is never seen over the posterior lip of the acetabulum.

Indications for sonography of the neonatal hip include all of the following except:

a. to rule out hip dysplasia.

b. sacral dimple.

c. breech birth.

d. abnormal hip examination.

b. sacral dimple.

A sacral dimple is an indication for a sonographic evaluation of the neonatal spine. Breech birth, especially female infants, should be routinely screened for hip dysplasia.

The hip of a normal infant has a Graf alpha angle of ____________ degrees.

a. less than 43

b. less than 60

c. between 43 and 60

d. less than 77

b. less than 60

Classified as a type I hip, a normal hip has a Graf alpha angle of less than 60 degrees.

The coronal neutral view of the subluxed infant hip demonstrates which one of the following?

a. Irregular and angled acetabular roof

b. Deformed labrum

c. Femoral head gradually migrating superiorly and laterally with decreased coverage of the femoral head

d. Femoral head resting against the bony acetabulum

c. Femoral head gradually migrating superiorly and laterally with decreased coverage of the femoral head

The coronal neutral view of the subluxed infant hip demonstrates the femoral head gradually migrating superiorly and laterally with decreased coverage of the femoral head.

Which one of the following hips gives the appearance of a "ball on a spoon" in the mid-acetabulum in the coronal flexion view?

a. Subluxed

b. Dislocated

c. Frankly dislocated

d. Normal

d. Normal

A normal hip demonstrates a "ball on a spoon" in the mid-acetabulum in the coronal flexion view.

Which one of the following describes the femoral head completely out of the acetabulum?

a. Normal hip with abduction

b. Dislocated hip

c. Hip fracture

d. Hip dysplasia

b. Dislocated hip

In Frank dislocation, the femoral head is completely out of the acetabulum.

Sonographic examination of the infant hip is performed with a(n) _______________ transducer.

a. linear array

b. curvilinear

c. endocavity

d. vector array

a. linear array

A 7.5 MHz linear transducer is used to sonographically examine the infant hip.

The sonographic protocol of the basic hip anatomy is imaged in _____ different views.

a. two

b. three

c. four

d. five

c. four

Protocol of the infant hip includes four different views: coronal neutral, coronal flexion, transverse neutral, and transverse flexion.

A type IV hip has an alpha angle of _______________ degrees and a beta angle of _______________ degrees.

a. less than 60; greater than 40

b. less than 43; greater than 77

c. less than 43; immeasurable

d. immeasurable; less than 60

c. less than 43; immeasurable

A type IV hip demonstrates an alpha angle of less than 43 degrees and a beta angle of immeasurable degrees.

The alpha angle is the angle between the ___________ and the ______________.

a. baseline; acetabulum roof line

b. baseline; inclination line

c. acetabulum roof line; inclination line

d. baseline; acetabular labrum

a. baseline; acetabulum roof line

The alpha angle is the angle between the baseline and the acetabulum roof line.

In the ____________ maneuver, down and outward pressure is applied with the patient lying in a supine position with the hip adducted and flexed 90 degrees.

a. Galeazzi

b. push-and-pull

c. Barlow

d. Ortolani

c. Barlow

In the Barlow maneuver, down and outward pressure is applied with the patient lying in a supine position with the hip adducted and flexed 90 degrees.

Select the maneuver that induces a "clunk" as the femoral head returns to the acetabulum.

a. Adduction

b. Barlow

c. Rotation

d. Ortolani

d. Ortolani

The Barlow (adduction) and Ortolani (abduction) maneuvers provide stress in opposite directions. In cases of developmental displacement of the hip (DDH), the return of the femoral head into the acetabulum results in a "clunk."

The gluteus maximus muscle is also known as a(n) ______________ muscle.

a. hamstring

b. extensor

c. abductor

d. adductor

b. extensor

The gluteus maximus is a powerful extensor of the hip and is the cover for the upper part of the hip joint. The gluteus medius and gluteus minimus pass from the outer surface of the hip bone to the greater trochanter. Together they act as abductors of the hip joint.

Choose the diagnostic criteria for subluxation.

a. Femoral head coverage between 54% and 56%

b. Femoral head coverage lower than 45%

c. Normal femoral head coverage

d. Femoral head coverage lower than 39%

d. Femoral head coverage lower than 39%

Normally, the mean femoral head coverage is between 54% and 56% (in females and males, respectively), with a lower limit of 45%. Fifty percent is considered the limit between normal and potentially abnormal. Subluxation is reached when femoral head coverage is lower than 39%, and dislocation less than 10%.

Which one of the following is moving sideways outward?

a. Flexion

b. Adduction

c. Abduction

d. Extension

c. Abduction

Abduction is moving sideways outward.

The physical signs of the development of a displacement of the hip include all of the following except:

a. prominence of trochanter.

b. extreme abduction.

c. shortening of the femur.

d. asymmetry of skinfolds.

b. extreme abduction.

Physical signs of the development of a displacement of the hip include limited abduction, prominence of trochanter, shortening of the femur, and asymmetry of skinfolds.

With treatment of hip displacement using the Pavlik harness, the hip should be positioned in flexion with adduction and ____________ rotation.

a. neutral

b. internal

c. external

d. either neutral or internal

c. external

With treatment of hip displacement using the Pavlik harness, the hip should be positioned in flexion with adduction and external rotation.