This article describes the anatomy of the normal infant hip joint, procedural details for performing US, landmarks, the classification of US results, the measuring technique, and the US appearance of transient synovitis in older children. Progressive ossification of the posterior elements of the vertebrae hinders satisfactory examinations in older children. Īs the ultrasound beam passes through predominantly cartilaginous and incompletely ossified spinal arches in newborns and infants, US can be used to investigate both the spinal canal and cord. Premature disjunction of the neural ectoderm from the cutaneous ectoderm results in the development of spinal dysraphism, which is defined as incomplete or absent fusion of the midline neural, mesenchymal, and cutaneous structures and can be classified into three categories: spina bifida aperta, occult spinal dysraphism, and caudal spinal anomalies. During normal development, the neural folds close in toward the midline to form the neural tube. Starting on the 17th day of gestation, the neural plate thickens bilaterally to form the neural folds. To understand spinal anomalies, a knowledge of embryonic development is necessary. Īdditionally, US can thoroughly characterize nearly all spinal anomalies during the first days of life. Hip US has become the most commonly used diagnostic tool for DDH during early infancy because the early and accurate diagnosis of DDH is the most important factor contributing to appropriate treatment. US enables dynamic evaluation of the hip with stress maneuvering, as well as direct imaging of the cartilaginous portions of the hip that cannot be seen on plain radiographs. Ultrasonography (US) is the preferred modality for evaluating the hip in infants aged less than 6 months. In addition, increased joint laxity in the setting of exposure to maternal estrogens during the perinatal period may play a role in the development of DDH, and the left hip is more frequently affected than the right. Multiple risk factors have been described, including breech positioning in utero, being the first-born child, oligohydramnios, family history, female sex, and deformities (postural or structural) of the foot and torticollis. The incidence of DDH ranges from 1.5 to 20 per 1,000 births. The previous term congenital dysplasia of the hip has been replaced by developmental dysplasia of the hip, because many of the clinical manifestations of DDH may not be detectable at birth, but are recognized at a later age. DDH encompasses a wide variety of pathologic conditions, ranging from fine acetabular dysplasia to irreducible hip dislocation. Developmental dysplasia of the hip (DDH) is one of the most common causes of disability among children.
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