8:30 - 8:50 | Registrations & Coffee
8:50 - 9:00 | Welcome & Housekeeping
9:00 - 10:30 | 1st session – Developmental dysplasia of the hip (DDH)
Introduction to DDH
History of DDH Screening in NZ
DDH Screening
10:30 - 11:00 | Morning tea
11:00 - 12:30 | 2nd session – Screening in DDH
How we should be screening for DDH & Does it work?
Evidence for Universal Screening
DDH Treatment and benefit of early treatment.
12:30 - 13:30 | Lunch
13:30 - 15:00 | 3rd session – The Graf Method
Theory behind the Graf method
Sonoanatomy of the neonatal hip
15:00 - 15:30 | Afternoon Tea
15:30 - 17:00 | 4th session – Performing the Graf Method
Finding the Graf plane – checklists 1 & 2
How to Obtain a good image – Tips and tricks
Classification and the Sonometer/Subjective component
Reporting templates
17:00 | Close of Day
9:00 - 9:30 | Registration & Coffee
9:30 - 9:45 | - Welcome & Housekeeping
9:45 - 10:30 | Introduction to Small Group Workshops
09:45 – 10:00 | Workshop 1 – Defining the Anatomy (Checklist 1)
Practice on images to identify anatomical landmarks.
Run “Checklist 1”
1. Chondro-osseous border (ChB)
2. Femoral head
3. Synovial fold
4. Joint capsule
5. Labrum
6. Hyaline cartilage roof (of acetabulum)
7. Bony roof
8. Turning point (Bony Rim)
Draw in the labrum.
Identify the “turning point”
Concept of centred/decentred hip.
After completing checklist 1, assess if the hip is centred.
Reference diagrams page 10
10:00 – 10:15 | Workshop 2 –Useability Check (Checklist 2)
Practice on images for checklists 1 and 2.
Mark the outline of the lower limb (bright spot)
Use the lower and innermost aspect (femoral side) of the Lower limb
Run “Checklist 1”
Run “Checklist 2”
1. Lower limb of Ilium
2. Cross section through the mid portion of the bony roof
3. Labrum
Reference images page 12
10:15 – 10:30 | Workshop 3 – Scanning using Ultrasound Phantom
Instructions for mum and positioning the baby
Use of the Sonofix and Guide
Note: Do not attempt to pull the baby’s legs into full extension as babies have a flexion and external rotation contracture early on. It is not necessary for the scan.
Technique for positioning the probe on the baby
Translate probe forwards and backwards to identify the lower limb first.
Do not try to identify the plane first.
10:30 – 11:00 | Morning Tea
|
| Group 1 | Group 2 |
| 11:00 – 11:45 | Checklist 1 & 2 | Scan practice |
| 11:45 – 12:30 | Scan practice | Checklist 1 & 2 |
12:30 – 13:30 | Lunch | (Phantom station available for practice)
13:30 - 1345 Workshop 4 – Types of hip
Reference images page 14
Practice on images to classify the hip before measuring Alpha and Beta angles
Run checklist 1 – centred or decentred
Centred = Graf 1 or Graf 2 hip
Decentred = Graf 3 or Graf 4 hip
Perform Useability check (Checklist 2)
Subjective assessment of the hip–Descriptive(no measurements)
Bony roof, Bony Rim, Cartilage roof
Exception to the useability check
A decentred hip the lower limb may not be visible but you can still have a diagnosis
Classification before measurements
Graf 1 – Centred normal bony rim/roof =Mature
Graf 2 – Centred rounded bony rim/roof
Graf 3 – Decentred – Cartilage pushed up
Graf 4 – Decentred – Cartilage pushed down
13:45 – 14:00 | Workshop 5 – Measurement and Classification
Practice on images to draw the base line, bony roof line (for alpha angle) and the line for the Beta angle (turning point to the centre of labrum)
Base Line – start is where the perichondrium meets the bone of the ilium. Rotate the line on that point down until the middle of the line touches the bony rim
Bony roof line (for Alpha angle)– starts at the lower and innermost point of the lower limb. Rotated the line towards the bony rim and stop when it just touches the bony rim.
Cartilaginous roof line (for Beta angle) – From the turning point to the centre of the labrum.
Lower Limb errors: Fatty soft tissue, fovea, ligamentum teres, ossification in the triradiate cartilage.
Classification from measured angles
Graf 1 – Alpha angle ≥ 60 degrees
Graf 2 – Alpha angle 43 - 59 degrees (sub cat A, B, C)
Graf 3 – Decentred: cartilage displaced upwards: perichondrium upwards.
Graf 4 – Decentred: cartilage displaced downwards: perichondrium horizontal.
Reference diagrams page 17
14:00 – 14:15 | Workshop 6 - Tilting errors
Practice on the images recognising the types of tilting errors
Be aware of the possibility of a tilting error.
This will allow you to correct the scan plane to complete the checklists and therefore aid accurate diagnosis.
Reference diagrams page 22
|
| Group 1 | Group 2 |
| 14:15 – 14:45 | Types of hip/measurement | Scan practice |
| 14:45 – 15:15 | Scan practice | Types of hip/measurement |
15:15 – 15:45 | Afternoon Tea
15:45 – 16:15 | Questions
16:15 – 17:00 | Summary and Thanks