4.6 of 150 Ratings
Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC.
A 4-year-old patient presents for follow-up of left hip dysplasia previously treated with closed reduction and spica cast application The patient does not have any symptoms at this time. Figure A is an AP radiograph of the pelvis during the visit. What is the most appropriate treatment option?
Continued observation with routine follow-up
Left varus derotational osteotomy with shortening, continued observation of right hip
Open reduction with spica casting
Left pelvic osteotomy
Repeat closed reduction with spica casting
Select Answer to see Preferred Response
A 4-month-old boy is brought to clinic by his parents for routine evaluation. On physical examination, there is evidence of hip clicking but negative Barlow and Ortalani testing. Radiographs are obtained and reveal a left and right hip acetabular index of 35° and 40°, respectively. Both hips are well located but there is evidence of hip dysplasia. What is the most appropriate next step in treatment?
Triple diaper regimen
Open reduction of the left hip
Closed reduction of right and left hips
An 8-week-old infant comes back to your office following 4 weeks of treatment for a developmental hip dislocation in a Pavlik harness. Figure A is the current ultrasound of her left hip. What is next best step?
Discontinue Pavlik harness
Readjust Pavlik harness, weekly ultrasounds for 4 more weeks
Apply rigid hip abduction orthosis, weekly ultrasounds for 4 more weeks
Closed, possible open reduction and hip spica casting
Pelvic osteotomy to obtain coverage
A 7-month-old female with a left developmental hip dislocation underwent closed reduction and spica casting. Which of the following is the safest and most accurate imaging modalities to evaluate the reduction after casting?
AP and lateral radiographs of the hip
Magnetic resonance imaging
You are asked to evaluate a 2 week old child referred from her pediatrician for an abnormal hip exam. You find her knees to be at different levels with the hips flexed to 90 degrees and adducted. The left hip makes a palpable clunk when moved from adduction to wide abduction. There are no other physical exam abnormalities. You order an ultrasound which confirms your diagnosis and you decide to place the child in a Pavlik harness. What is the next step?
Ultrasound in Pavlik immediately
Full-time Pavlik followed by ultrasound in Pavlik in 7-10 days
Night-time Pavlik followed by ultrasound in Pavlik in 7-10 days
Full-time Pavlik followed by ultrasound out of Pavlik in 7-10 days
Night-time Pavlik followed by ultrasound out of Pavlik in 7-10 days
A 4-week-old infant male is treated in a Pavlik harness for developmental dysplasia of the hip. Hip flexion is set to 125 degrees at the initial visit. At his 1-week follow-up appointment, ultrasound shows an alpha angle of 54 degrees and beta angle of 60 degrees. On physical exam, the patient is unable to kick his right leg and holds his knee in a flexed position. Which of the following is the most likely responsible for these findings?
Excessive hip abduction in Pavlik harness
Irreducible hip dislocation
Sciatic nerve palsy present before application of harness
Excessive hip flexion in Pavlik harness
A 15-year-old soccer player complains of bilateral hip pain. The pain is worse with activity and she notices that she has fatigue and pain that extends to the thighs and knees following a soccer match. She is nontender at the pubis symphysis and has no pain with resisted abdominal crunches. She has no pain with adduction of the hip. Hip flexion and rotation is normal. A radiograph of the right hip is shown in Figure A. Which of the following surgical interventions is best indicated?
Single innominate osteotomy (Salter)
Double innominate osteotomy
Peri-acetabular osteotomy (Ganz)
Triple innominate osteotomy (Steele)
A 6-week-old female infant is referred to your practice for concerns of developmental dysplasia of the hip. On physical exam, you note a positive Ortolani test on the left side. Pavlik harness treatment is initiated. Which of the following imaging modalities should be utilized at the two week follow-up visit?
Magnetic Resonance Imaging (MRI)
Computed Tomography (CT)
Arthrogram and Dynamic Fluroscopy
Which of the following best describes the radiographic measurement labeled #1 on Figure A.
Which of the following is true regarding the structure outlined in Figure A?
It is comprised of the iliopectineal eminence and quadrilateral surface
In normal hips, all children usually have this radiographic figure by 18 months of age
This figure is usually present in children with developmental dysplasia of the hip prior to reduction
The structure is a result of the radiographic superimposition of the ilioischial and Iliopectineal lines
It is comprised of the cotyloid fossa and iliopectineal eminence
Which of the following concepts regarding pediatric hips is true?
The proximal femoral physis and greater trochanteric apophysis develop from different cartilaginous physes
The proximal femoral physis grows at a rate of 9 mm per year
Normal infant femoral anteversion is between 10-20 degrees
The ossific nucleus of the proximal femur is visible on radiographs by 6 months of age in most children
Slipped capital femoral epiphysis (SCFE) typically occurs through the zone of proliferation
Failure to achieve reduction of a dislocated hip in an otherwise healthy 4 month old infant which did not reduce after 3 weeks in a Pavlik harness and 3 weeks in an abduction brace is best treated with which of the following?
Adjusting the harness to 75 degrees of abduction and maintaing 90 degrees of hip flexion
Adjusting the harness to 75 degrees of abduction and increasing hip flexion to 120 degrees
Closed reduction with hip arthrogram, adductor tenotomy if necessary, and hip spica casting
Open reduction and femoral shortening osteotomy
Open reduction, femoral shortening osteotomy, and pelvic acetabular osteotomy
In patients older than 12-months of age with developmental dysplasia of the hip, all of the following physical exam findings are likely present EXCEPT?
Limited hip abduction
Positive Ortolani maneuver
Abnormal leg lengths on Galeazzi testing
A 2-week-old infant girl is referred for a hip clunk noticed by the pediatrician. She has a history of a normal spontaneous vaginal delivery and is otherwise healthy. Examination demonstrates a right hip Ortolani sign. A coronal ultrasound is shown in figure A. What is the most appropriate next step in treatment?
Observation with repeat ultrasound in 1 month
Pavlik harness application
Closed reduction and spica casting
Open reduction and spica casting
Open reduction, acetabular osteotomy, femoral shortening, and spica casting
A newborn girl is referred for evaluation of suspected hip instability. What information from her history would place her in the highest risk category?
History of maternal diabetes mellitus
Frank breech presentation
Concomitant metatarsus adductus
What acetabular procedure for developmental dysplasia of the hip does not require a concentric reduction of the femoral head in the acetabulum?
Salter innominate osteotomy
Pemberton innominate osteotomy
Dega innominate osteotomy
Triple innominate osteotomy
Staheli shelf procedure
A newborn girl with an isolated unilateral dislocatable hip is placed in a Pavlik harness with the hips flexed 100 degrees and at resting abduction. Figure 23 shows an ultrasound obtained 2 weeks later. What is the next step in management?
Reposition the harness to hold the hips in 70 degrees of abduction
Closed reduction and arthrography under anesthesia
Open reduction and a spica cast
Continued harness treatment in the current position
A patient who underwent closed reduction of the hips as an infant now reports pain. An abduction internal rotation view shows an incongruous joint. Based on the findings shown in Figure 3, what is the most appropriate type of pelvic osteotomy for the right hip?
Ganz or Bernese periacetabular
Figures A-E show a series of radiographic lines used in the assessment of a paediatric hip joint. Which of the following figures shows Perkin's line?
A 3-month-old infant is brought in for a routine well-child evaluation. Physical exam uncovers moderately limited hip abduction bilaterally. The child is otherwise developmentally normal with sonographically normal hips. Which of the following is accurate regarding this clinical pathology?
Adductor tenotomy is recommended in place of observation to mitigate the risk of developmental hip dysplasia.
Developmentally normal infants without hip dysplasia rarely demonstrate limitations in hip abduction.
The majority of infants with hip dysplasia do not demonstrate limited hip abduction.
Unilateral limitation of hip abduction is a very specific clinical predictor DDH, while bilateral limitation in hip abduction is not.
Untreated limitation in hip abduction in sonographically normal infants increases risk of developing hip dysplasia.
Figure A depicts an ultrasound of a newborn infant's hip. Which of the following structures (1 through 5) represents the labrum?
A five-year-old boy with cerebral palsy presents to the clinic with a dislocated right hip, what quadrant of the acetabulum is most likely deficient?
Anterior-inferior and anterior-superior