Pediatric

Hip
Protocol
• Exam is performed to detect developmental dysplasia of the hip (DDH)
• Optimal imaging is obtained between 3 weeks and 6 months of age
• Use warm gel and a 7.5 MHz or higher linear transducer
• Patient Position
o Supine or lateral decubitus
o Neutral position is with the hip flexed 15-20°
o Flexed position is with the hip flexed 90°
• Sonographer Position
o Use one hand to hold the leg in position and the other to scan

Organ/Order Scan Plane Label Landmarks Identified

(Identify RT or
LT side)
Coronal For all coronal images:
• Gluteus muscles
HIP • Femoral head
CORONAL • Ilium
NEUTRAL
• Ischium
POSITON
• Triradiate cartilage
• Labrum
Same landmarks as above

Measure Alpha Angle and Beta Angle

HIP CORONAL
NEUTRAL
WITH
MEASUREMENT

Hip



Transverse TX W/O STRESS Hip flexed, knee in a neutral position

For all transverse images:
• Gluteus muscles
• Femoral head
• Ischium
• Labrum
• Femoral metaphysis
• Femoral shaft
TX W/O STRESS Hip flexed, knee rotated away from the
ABDUCTION midline
TX WITH STRESS With knee rotated outward push the knee
ABDUCTION toward the hip joint - Ortolani Test
TX W/O STRESS Hip flexed, with knee rotated toward the
ADDUCTION midline
TX WITH STRESS With knee rotated toward the midline push
ADDUCTION knee toward the hip joint- Barlow Test

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 Pediatric Hip
Anatomical/Image Correlation

Normal Measurement Ranges

Structure Area of Interest Plane Measurement Comments

• More widely accepted and used than Beta angle
Acetabular Roof • Smaller the angle the greater the dysplasia
Alpha Line • Line is drawn parallel to the ossified lateral wall
Angle >60° is
Angle of the ilium
Coronal normal
Denotes the slope • A second line drawn from the inferior edge of

of the bony the bony acetabulum, at the triradiate cartilage,
acetabulum to the distal part of the ilium, tangential to the
slope of the bony acetabulum (roof line)
• Angle lies between the proximal end of the
Inclination Line femur, the medial trochanter and the edge of
the acetabulum
Angle <55° is Greater the angle, the greater the dysplasia
Denotes the slope •
Beta normal Line is drawn parallel to the ossified lateral wall
of the Coronal •
Angle of the ilium
cartilaginous
A second line is drawn along the roof of the
acetabulum •
cartilaginous acetabulum (from the lateral bony
edge of the acetabulum to the labrum)

Tips
• DDH describes a range of hip dysplasias including instability, subluxation and dislocation
• Do not perform stress maneuvers on infants in Pavlik harness or splint devices
• Associations/ Risk Factors for DDH
o Caucasians
o Females
o Breech presentations at birth ( especially Frank breech—rump first with legs above head)
o Oligohydramnios while in utero
o Family history of DDH

• Clinical Indications
• Instability in the joint
• Hip “clicks”
• Limited range of motion of the affected limb
• Positive Galeazzi (Allis) test
**Only for infants 3 months or older.
• Abnormal Barlow or Ortolani maneuver If one knee is lower than the other, there may be a
• Asymmetric skin folds dislocated hip on the lower side

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