9783540309574

Sonography of baby hips for the diagnosis of DDH and dysplasia has grown steadily in importance in recent years. A strict standardized technique for investigation of the baby and interpretation of the sonograms has made hip ultrasound reproducible, reliable and independent of examiner skill and experience.Graf's technique is now used worldwide, and selective or even general screening programmes for all babies are established in many European countries today.The first part of this book includes the fundamentals of hip sonography, static as well as dynamic techniques, anatomical identification of the echograms, typing, a measurement technique and usability check.The second part is an atlas including a summary of the essential data and demonstrating correct and incorrect sonograms in different variations. The book is indispensable for everyone dealing with DDH problems in diagnosis and therapy.

Technique

Equipment

2

(1)

Additional Equipment for Hip Ultrasound

2

(1)

Image Projection

2

(4)

Anatomy and Ultrasound of the Normal Infant Hip Joint

Explanation of Terminology Used in Describing the Ultrasound Anatomy

6

(1)

Ultrasound Characteristics of the Different Tissues in the Region of the Hip Joint

6

(1)

The Proximal Femur in Hip Ultrasound

6

(1)

Femoral Head

7

(7)

Femoral Head Ossification Centre

10

(1)

Ultrasonic Problems and Difficulties with the Nucleus

10

(3)

Synovial Fold and Joint Capsule (Fig. 2.7a-d)

13

(1)

The So-Called Fluid Film

14

(1)

The Acetabulum (Fig. 2.8)

14

(6)

The Perichondriumof the Hyaline Cartilage Acetabular Roof

14

(1)

The Acetabular Labrum

15

(1)

The Acetabular Fossa

16

(1)

Definition of the Osseous Rim (Fig. 2.12)

17

(3)

The Standard Plane

The Principle of the ``Standard Plane''

20

(1)

The Importance of the Three Landmarks

21

(1)

The Problem of the Variable Bone Coverage of the Femoral Head

21

(7)

Shape of the Posterior Section

21

(1)

The Mid Section

22

(1)

Anterior Sections (Fig. 3.7)

22

(1)

Exceptions and Variations on the Typical Sectional Silhouettes

22

(3)

Definition of the Mid Section of Acetabular Roof

25

(1)

The Question of Reproducibility

25

(3)

Identifying the Anatomy and Checking the Landmarks and Tilting Effects

Anatomical Identification

28

(1)

Checking the Landmarks

28

(2)

Checking a Hip Sonogram

30

(3)

Definition of Types

Type I

33

(1)

Type II

34

(1)

Type III

34

(1)

Type IV

35

(1)

Differentiation Between Ossification and Degeneration

35

(5)

Structural Disorder (Degeneration)

36

(1)

How to Assess Echogenicity in the Hyaline Cartilage Acetabular Roof

36

(4)

Ultrasound Classification

Description

40

(3)

Basic Terms and Possible Variations

40

(2)

Exceptions to the Systematic Description

42

(1)

Systematic Reporting of a Sonogram

43

(3)

Measurement Technique

The Bony Roof Line (Fig. 7.1a)

46

(1)

Base Line (Fig. 7.2a-c)

46

(2)

Auxiliary Base Line (Help Line) (Fig. 7.2c/d)

48

(1)

Cartilage Roof Line (Fig. 7.3a-c)

48

(4)

Classification Using the Sonometer

The Alpha Values

52

(1)

Subdivision of the Type II Joint

52

(1)

The Sonographic Alpha Value and the Radiological AC Angle

53

(1)

The Beta Value

53

(2)

Type la and Type Ib Hips

53

(1)

Type D Hip

54

(1)

Classification in Premature Infants

55

(1)

Certainty of the Diagnosis

55

(4)

Instability

Elasticity ``Elastic Whipping'' (Fig. 9.1b-d)

59

(1)

Pathological Instability

60

(1)

Definition of Pathological Instability

60

(1)

Summary of the Principal Differences Between Elasticity and (Pathological) Instability

60

(4)

The Terminology of Dislocation

Scanning Technique

Preparation

64

(1)

Leading and Guiding the Mother

64

(1)

Scanning Procedure

65

(4)

Obtaining the Picture

66

(3)

Obtaining the Sonogram of the Left Hip Joint

69

(1)

Errors

69

(7)

Errors Due to Tilting the Probe

Antero-posterior Tilting

76

(1)

Postero-anterior Tilting

76

(1)

Cranio-caudal Tilting

76

(1)

Caudo-cranial Tilting

76

(1)

Cradle and Probe-Guiding Equipment (Fig. 11.1c, 11.4b)

77

(5)

Documentation and Quality

Image Documentation

82

(1)

Suggestions

82

(1)

Written Report

82

(1)

Tips for Checking and Ensuring the Quality of One's Own Sonograms

82

(2)

Principles of Ultrasound-Based Management

Basic Biomechanical Aspects Behind the Principles of Treatment

84

(1)

Goals of Treatment

84

(1)

Stages of Treatment

84

(9)

The Preparation Stage

85

(1)

The Reduction (Fig. 14.1)

85

(1)

Retention

85

(2)

The Maturation Phase (= Ossification Phase)

87

(1)

Maturation Curve

88

(5)

Why Errors Occur

93

(1)

The Problem of the Doctor

93

(1)

The Parental Problem (Compliance Problem)

93

(1)

Appendix

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Hip Sonography

3540309578

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