![]() FIGURE 32.1 Sprengel deformity. Anteroposterior radiograph of the left shoulder of a 1-year-old boy demonstrates a high position of the left scapula typical of Sprengel deformity. |
![]() FIGURE 32.2 Klippel-Feil syndrome and Sprengel deformity. Anteroposterior radiograph of the left shoulder of a 13-year-old boy with Klippel-Feil syndrome shows an elevated scapula (arrow). |
TABLE 32.1 Radiographic Criteria for the Diagnosis of Madelung Deformity | ||||||||||||||||||||||||||||||||
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TABLE 32.2 Most Effective Radiographic Projections and Radiologic Techniques for Evaluating Common Anomalies of the Pelvic Girdle and Hip | ||||||||||||||||||||||||||||||||||||||||||
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TABLE 32.3 Clinical Manifestations of CDH | ||||||||||
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The Hilgenreiner line or Y-line, which is drawn through the superior part of the triradiate cartilage, is itself a valuable indicator of femoroacetabular relations and serves as the basis for all other indicators.
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The acetabular index, which is an angle formed by a line tangent to the acetabular roof and the Y-line, cannot alone be diagnostic of dislocation, because it can occasionally exceed 30 degrees in normal subjects. Generally, however, values greater than 30 degrees are considered abnormal and indicate impending dislocation. Some investigators propose that only angles in excess of 40 degrees are significant.
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The Perkins-Ombredanne line, which is drawn perpendicular to the Y-line through the most lateral edge of the ossified acetabular cartilage, is helpful in determining subluxation and dislocation of the hip. The intersection of this line with the Y-line creates four quadrants; normally, the medial aspect of the femoral neck or the ossified capital femoral epiphysis falls in the lower medial quadrant.
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The Shenton-Menard line, which forms a smooth arc through the medial aspect of the femoral neck and the superior border of the obturator foramen, may be interrupted in subluxation or dislocation of the hip. Even under normal circumstances, however, the arc may not be smooth if the radiograph is obtained with the hip in external rotation and adduction.
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The Andrén-von Rosen line, which is drawn on a radiograph obtained with the hips abducted 45 degrees and internally rotated, describes the relation of the longitudinal axis of the femoral shaft to the acetabulum (Fig. 32.9). In dislocation or subluxation of the hip, this line bisects or falls above the anterosuperior iliac spine.
![]() FIGURE 32.14 CT of the normal hips. Axial section of both hips in a 19-month-old infant shows good congruity of the acetabula and femoral heads, which are centered over the triradiate cartilage. |
![]() FIGURE 32.15 CT of congenital hip dislocation. Axial section through the proximal femora and hips of a 6-month-old boy shows posterolateral dislocation of the left hip. The right hip is normal. |
![]() FIGURE 32.16 Ultrasound of congenital hip dysplasia. (A) On the coronal 3D ultrasound image of the left hip in a 3-day-old girl (lower left) the acetabulum (A) appears shallow, and subluxation of the femoral head can be observed at the intersection of the ilium (I) line with the medial third of the femoral head (FH). On the reconstructed axial image (upper left), the femoral head is subluxated but still in contact with the acetabulum. On the sagittal image (upper right), only the peripheral segment of femoral head is visualized. (B) A sagittal image of a normal left hip (left) is shown for comparison. Note that femoral head (FH) is centered over the ilium line (I). A sagittal image of a subluxated head (right) clearly shows distortion of femoral head-ilium line relationship. (From Gerscovich EO et al., 1994, with permission.) |
![]() FIGURE 32.17 3D ultrasound of congenital hip dysplasia. (A) Craniocaudal projection (bird’s-eye view) of a normal left hip shows the ilium (I) projecting over the midportion of the femoral head (FH) (arrows outline its contour). (B) Craniocaudal projection of a subluxated left hip shows that the ilium (I) projects over the medial portion of the femoral head (FH) (arrows outline its contour). The femoral head is laterally displaced. (From Gerscovich EO, et al., 1994, with permission.) |
Type I |
This is usually seen in neonates. The changes along the acetabular margins are mild. The femoral head, which is anteverted but spherically normal, is not completely covered by acetabular cartilage. This may lead to variable instability, particularly in extension and adduction of the hip. The labrum may also be deformed. |
Type II |
The hips are subluxed, and the cartilaginous labrum shows eversion. The femoral head is normally anteverted but shows a loss of sphericity. The acetabulum is shallower than in type I, and the failure of the acetabular roof to ossify laterally leads to an increased acetabular angle. |
Type III |
There is significant deformity of the acetabulum and femoral head, which is posterosuperiorly dislocated, leading to the formation of a false acetabulum by eversion of the labrum. The limbus is hypertrophied, and the ligamentum teres is elongated and pulled, bringing with it the transverse acetabular ligament. This situation compromises the acetabular space, precluding complete reduction. |
Type A |
The femoral head is present, and the femoral segment is short. There is a varus deformity of the femoral neck. The acetabulum is normal. |
Type B |
The femoral head is present, but there is an absence of bony connection between it and the short femoral segment. The acetabulum exhibits dysplastic changes. |
Type C |
The femoral head is absent or represented only by an ossicle. The femoral segment is short and tapered proximally. The acetabulum is severely dysplastic. |
Type D |
The femoral head and acetabulum are absent. The femoral segment is rudimentary, and the obturator foramen is enlarged. |

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