1 - hip disorders Flashcards
what are 3 bones of hip bones?
- ilium
- pubis
- ischium
= they gradually ossify throughout growth and join with cartilage
what is development dysplasia of hip?
= condition where the ball and socket joint of the hips does not properly form in babies and young children
- more common in females than males (mostly because of hormones)
aetiology of hip dysplasia?
= multifactorial “perfect storm”
- breech
- 1st baby
- big baby
- multiple pregnancies (twins etc)
how is developmental dysplasia of hip diagnosed?
neonatal checks and ultrasounds
what is done in baby hip examination?
- look for asymmetry (leg length or foot turned)
- loss of knee height (lie on back and feet together)
- crease asymmetry (soft sign, not super reliable
- stiffness in hip, if less abduction
what is the barlow test?
physical test to diagnose DDH
- adduction with downward pressure →posterior dislocation
- if unstable femoral head slip out acetabulum, positive test = indicates that the hip is dislocatable
what is the ortolani test?
physical test to diagnose DDH
- abduction with upwards lift
- positive test if hear clunk sound which is dislocating
what is treatment of early diagnosis of DDH?
- pavlik harness 23-24 hrs a day for up to 12 weeks until USS normal then night splinting
- position of hips in harness is abducted & flexed
what is slipped upper femoral epiphysis?
- when growth plate getting towards fusing
- minor trauma can predispose to injure so slipped head
- generally 10-16 yr olds, in pubertal growth spurt
why is slipped upper femoral epiphysis missed a lot?
not that common and nerve supply to hip also gives supply to knee, so often children feel pain in knee
what is common seen in examination of slipped upper femoral epiphysis?
- antalgic gait = painful limp
- lower limb is painful to rotate, pain in deep movement
what is treatment of slipped upper femoral epiphysis??
pin
what is perthes disease?
- idiopathic avascular necrosis of hip
- more common in males, common in 4-8 yr olds
- can happen on both sides but if happens on both sides then doesn’t happen at same time
- flattened femoral head
what is treatment for perthes disease?
blood supply from circumflex femoral artery, blood supply dies off for femoral head. it grows back by itself and hip re-ossifies so aim of treatment is to reduce pressure on head
so try restrict movement (very tricky), often in a cast to maintain hip and minimise degenerative changes
what is transient synovitis?
= inflammation of synovium often secondary to viral illness
