3- Paediatric Hip, Knee, Spine, Foot and Ankle Conditions Flashcards
What happens in developmental dysplasia of the hip (DDH)?
Dislocation/subluxation of femoral head during perinatal period
Girls are more commonly affected by DDH than boys. True/False?
True
List risk factors for DDH
Family history
Breech delivery
First-born
Down’s syndrome
List clinical features of DDH
Shortened limbs
Asymmetric groin
Thigh skin creases
Ortolani/Barlow +ve tests
Describe a +ve Ortolani test
Click upon reducing a dislocated hip with abduction + anterior displacement
Describe a +ve Barlow test
Clunk upon dislocating a hip with adduction + posterior displacement
What is the name of the special harness used to keep hips in comfortable flexion and abduction?
Pavlik harness
When does transient synovitis of the hip usually occur?
After an URT infection
Boys are less affected by transient synovitis of the hip than girls. True/False?
False
More affected
Is transient synovitis the commonest cause of hip pain in childhood?
Yes
List clinical features of transient synovitis
Limp
Reluctance to weight bear
Restricted motion
Low fever
Outline treatment for transient synovitis
NSAIDs and rest
Should resolve, if not seek other diagnosis
What is Perthes disease?
Idiopathic osteochondritis of the femoral head, causing necrosis + abnormal growth
What happens to the femoral head as a result of Perthes disease?
Loses its blood supply
Necrosis
Abnormal growth
Collapse/fracture
Who usually gets Perthes disease?
Boys 5:1 girls
Between age of 4-9
List clinical features of Perthes disease
Pain Limp Loss of internal rotation Loss of abduction Trendellenburg +ve
In slipper upper femoral epiphysis (SUFE), in which direction does the femoral head epiphysis move?
Inferiorly in relation to femoral neck
Who does SUFE typically affect?
Overweight, pre-pubertal adolescent boys
List clinical features of SUFE
Pain
Limp
PAIN IN THE KNEE (so examine hip!)
Loss of internal rotation of hip
How is SUFE treated?
Pin the femoral head to prevent further slippage
Anterior knee pain in adolescence is common. True/False?
True
At what age period is dislocation/subluxation of the patella most common?
Adolescence
What is another name for talipes equinovarus?
Clubfoot
How does clubfoot arise?
In-utero abnormal alignment of joints between talus, calcaneus and navicular
List clinical features of clubfoot
Ankle equinus (plantarflexion)
Supinated forefoot
Varus forefoot
Contracted soft tissue
Girls get clubfoot more than boys. True/False?
False
Boys 2:1 girls
Outline treatment for clubfoot
Splintage (Ponseti technique)
Surgery
Back pain in a child/adolescent is a red flag sign. True/False?
True
In scoliosis, which way does the spine curve?
Laterally
What is spondylolisthesis?
Slippage of one vertebra over another
At what spinal region does spondylolisthesis usually occur?
L4/L5
L5/S1
