Society for Pediatric Radiology 2015 Hands on Session. DDH: Pitfalls and Practical Tips
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1 Society for Pediatric Radiology 2015 Hands on Session DDH: Pitfalls and Practical Tips
2 Michael A. DiPietro, M.D. John F. Holt Collegiate Professor of Radiology Professor of Pediatrics and Communicable Diseases Pediatric Radiology - C.S. Mott Children s Hospital University of Michigan Ann Arbor, MI
3 Missed DDH
4 Good judgment comes from experience. Experience... well that comes from poor judgment
5
6 Hips DDH
7 DDH Orientation to anatomy Static and dynamic aspects
8 Pediatric Musculoskeletal Ultrasound DDH Clicks / Clunks Lax hips Breech Torticollis Clubfoot / Metatarsus adductus Family History
9 Pediatric Musculoskeletal Ultrasound DDH Developmental dysplasia of the hip dislocated hip dislocatable hip subluxed/subluxable hip hip laxity (physiologic) acetabular dysplasia Static and dynamic aspects
10 Static (morphology) and Dynamic (stability/laxity) aspects
11 TWO VIEW MINIMUM EXAM PROPOSED 1993 Combines the Harcke and Graf techniques Accepted as STANDARD by ACR (1998)
12 DDH Pediatric Musculoskeletal Ultrasound Orientation Orientation Orientation Orientation Technique Technique Technique Technique
13 AE Schlesinger Coronal scanning
14 Coronal view Analogous to AP X-ray of left hip Ball in a socket
15 Coronal US orientation compared with AP radiograph US shows cartilage
16 Ball in a socket Is the ball in the socket? (located) Does the ball stay in the socket? (laxity) Is the socket well formed? (acetabulum mature)
17 Ball in a socket Is the ball in the socket? (located) Does the ball stay in the socket? (laxity) Is the socket well formed? (acetabulum mature)
18 Coronal US orientation compared with AP radiograph as appears on US screen Key concept
19 Normal
20 Slightly subluxed coronal
21 Subluxing right hip Case A. coronal
22 Case B. coronal Dislocated right hip
23 Coronal dislocated hip Femoral head Greater trochanter
24 Coronal acetabulum immature
25 Coronal posterior cartilaginous acetabulum
26 Newborn - Bilateral dislocated teratologic hips
27 Coronal dislocated note ilium
28 Coronal dislocated note ilium
29 Coronal dislocated note posterior acetabular cartilage
30 Transverse - dislocated Ant Post
31 HTHarcke
32 Transverse US compared with axial CT Key concept
33 Axial CT
34 Axial CT anterior posterior
35 Transverse US orientation compared with axial CT as appears on US screen Key concept
36
37 Subluxing left hip lateral posterior transverse
38 Subluxed hip transverse view
39 Coronal posterior acetabular cartilage
40 Transverse posterior acetabular cartilage
41 Transverse posterior acetabular cartilage
42 Transverse posterior acetabular cartilage
43 Trans Normal - cine
44 Trans Normal abd/add - cine
45 Testing for laxity - Barlow maneuver
46 Testing for laxity - Barlow maneuver
47 Dynamic case studies
48 Coronal Normal - cine
49 CINE 1. Right CORONAL slight laxity 1 DO
50 CINE 3. Left CORONAL 1 mo old Does not reduce fully
51 CINE 2. Left TRANSVERSE 7 do abduction adduction NORMAL
52 CINE 3. Left TRANSVERSE 1 mo old Lax and does not reduce fully
53 Another View Anterior Approach
54 Testing for laxity Barlow maneuver
55 Lt. (lat) Trans. view cine
56 Lt. Anterior view cine
57 Lt. Ant view cine
58 Ortolani maneuver dislocates reduces clunk
59 Anterior View - Ancillary Not as substitute for standard Confirmation Illustrative Education
60 Anterior View - Ancillary Save for the end of the study Babies cry Don t get pee d on
61 DDH ULTRASOUND Not Too Early Not Too Often Not Too Badly HTHarcke, M.D.
62 Some Pitfalls
63 Transducer misalignment
64 Coronal false abnormal - true normal - cine
65 Older patient
66
67 Coronal
68 14 mo Normal Coronal - cine
69 Impressions 1. Normal findings, see above discussion. 2. No evidence of DDH at this time. Acetabula appear mature. At this age, acetabular maturity is better assessed by radiography. 3. No gross laxity is apparent, but dynamic evaluation is limited as described above. 4. I doubt that this patient s out toeing has anything to do with DDH. 5.The parents were present throughout the study and were told the findings.
70 Hip flexion contracture or bowing
71 Right hip - in or out?? bowed femur - healing fracture 2 month old
72 Error Right hip thought to be out (greater trochanter * mistaken for femoral head) * coronal sonogram
73 Arthrogram right hip - in *
74 DDH Interpretative pitfall due to hip contracture or proximal femoral deformity e.g. Arthrogryposis PFFD Bowing (coxa vara) (be aware of plain radiograph)
75
76 Illustration of infant wearing a Pavlik harness The information on this Web page is provided for educational purposes. You understand and agree that this information is not intended to be, and should not be used as, a substitute for medical treatment by a health care professional. You agree that Lucile Salter Packard Children's Hospital
77 Newborn
78 13 days old
79 11 days old - Coronal
80 11 days old - Trans
81 6 wk old Doppler - Tran - Adducted
82 Doppler - Tran - Abducted
83 Cine loop Tran Abduction - Adduction
84 Doppler Coronal - Adducted
85 Doppler Coronal - Abducted
86 Cine loop Coronal Abduction - Adduction
87 Questions???? Questions??? Questions?????? Questions Questions???? answers Questions???? answers
88
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