Hip Sonography : Diagnosis and Management of Infant Hip Dysplasia

This book is a practice-oriented manual teaching the successful examination technique developed and taught by the author known as "Graf's technique". The book is based on the author's experience of more than 20 years. It is easy to read and provides a real "hands-on" manual giving numerous practical tips. The 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 book also contains an atlas including a summary of the essential data and demonstrating correct and incorrect sonograms in different variations. Contents......Page 10 1 Technique......Page 12 1.3 Image Projection......Page 13 2 Anatomy and Ultrasound of the Normal Infant Hip Joint......Page 15 2.3 The Proximal Femur in Hip Ultrasound......Page 16 2.4 Femoral Head......Page 17 2.4.2 Ultrasonic Problems and Difficulties with the Nucleus......Page 20 2.4.3 Synovial Fold and Joint Capsule (Fig. 2.7a–d)......Page 23 2.5.1 The Perichondrium of the Hyaline Cartilage Acetabular Roof......Page 24 2.5.2 The Acetabular Labrum......Page 25 2.5.3 The Acetabular Fossa......Page 26 2.5.4 Definition of the Osseous Rim (Fig. 2.12)......Page 27 3 The Standard Plane......Page 28 3.1 The Principle of the "Standard Plane"......Page 29 3.2.1 Shape of the Posterior Section......Page 30 3.2.4 Exceptions and Variations on the Typical Sectional Silhouettes......Page 31 3.2.6 The Question of Reproducibility......Page 34 4 Identifying the Anatomy and Checking the Landmarks and Tilting Effects......Page 36 4.2 Checking the Landmarks......Page 37 4.3 Checking a Hip Sonogram......Page 39 5 Definition of Types......Page 40 5.1 Type I......Page 42 5.3 Type III......Page 43 5.5.1 Ossification......Page 44 5.5.3 How to Assess Echogenicity in the Hyaline Cartilage Acetabular Roof......Page 45 6 Ultrasound Classification......Page 47 6.1.1 Basic Terms and Possible Variations......Page 48 6.1.2 Exceptions to the Systematic Description......Page 50 6.2 Systematic Reporting of a Sonogram......Page 51 7 Measurement Technique......Page 52 7.2 Base Line (Fig. 7.2a–c)......Page 53 7.3 Cartilage Roof Line (Fig. 7.3a–c)......Page 55 8 Classification Using the Sonometer......Page 58 8.1.1 Subdivision of the Type II Joint......Page 59 8.2.1 Type Ia and Type Ib Hips......Page 60 8.2.2 Type D Hip......Page 61 8.4 Certainty of the Diagnosis......Page 62 9 Instability......Page 64 9.1 Elasticity "Elastic Whipping" (Fig. 9.1.b–d)......Page 66 9.3 Summary of the Principal Differences Between Elasticity and (Pathological) Instability......Page 67 10 The Terminology of Dislocation......Page 68 11 Scanning Technique......Page 70 11.2 Leading and Guiding the Mother......Page 71 11.3.2 Obtaining the Picture......Page 72 11.4 Errors......Page 76 12 Errors Due to Tilting the Probe......Page 82 12.4 Caudo-cranial Tilting......Page 83 12.5 Cradle and Probe-Guiding Equipment (Figs. 11.1c, 11.4b)......Page 84 13 Documentation and Quality......Page 87 13.3 Tips for Checking and Ensuring the Quality of One's Own Sonograms......Page 88 14 Principles of Ultrasound-Based Management......Page 89 14.3 Stages of Treatment......Page 90 14.3.3 Retention......Page 91 14.3.4 The Maturation Phase (= Ossification Phase)......Page 93 14.3.5 Maturation Curve......Page 94 14.4.2 The Parental Problem (Compliance Problem)......Page 99 15 Appendix......Page 100 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. A practice-oriented manual, which teaches the examination technique developed and taught by the author known as ""Graf's technique"". The first part includes the fundamentals of hip sonography, static as well as dynamic techniques, anatomical identification of the echograms, typing, a measurement technique and usability check