5. Childhood Hip Disorders Flashcards
developmental dysplasia of the hip
invovles dislocation or subluxation of the femoral head during the perinatal period which affects the subsequent development of the joint
which hip is DDH most common in
left
20% cases bilateral
risk factors for DDH
girls
first born
FH
breech position in utero or at delivery
down syndrome
other MSK - Torticollis (crick in neck) or club foot
what can DDH lead to if untreated
shallow acetabulum - and in severe cases a false acetabulum appeats proximal to the original one with a shortened limb
severe arthritis due to reduced contact area
gait/mobility severely affected
CF of DDH
shortening
asymmetry
extra groin/thigh crease on one side
clink/clunk on Ortolani or Barlow manouevres
ortolani manouevre
relocates a subluxed or partially dislocated hip
barlow manouevre
sublux or dislocate an unstable hip
to which age are ortolani and barlow manoeuvres useful to
6 weeks
when will ortolani and barlow manouevres both be ==negative
irreducible dislocated hip - use other tests
what is important about diagnosis in DDH
early! if appropriately aligned in the first few months of life a dysplastic hip may normalise
all high risk infants have US at 2-4 weeks
all babies have hips examined on day 1 and week 6
investigations of DDH
US
Xray cannot be used until after 4-6 months as the femoral head epiphysis is unossified until then
treatment of DDH
mild - monitor with examination and US
pavlik harness
persistent dislocation over 18 months - open reduction to clear soft tissue and osteotomy to shorten and rotate femur or deepen and re orientate acetabulum in pelvis
transient synovitis of the hip
self limiting inflammation of the synovium of a joint,commonly the hip
causes of TSH
commonly occurs after an URT infection
can be idiopathic
epidemiology of TSH
age between 2 and 10
boys
what is the most common cause of hip pain in childhood
TSH
arthritis or RA must be excluded
presentation of TSH
limp or reluctance to weight bear on affected side
restricted range of motion
low grade fever
resolves with rest
investigations for TSH
radiograph to exclude Perthes
near normal CRP - exclude septic arthritis
US reveals effusion
aspirate hip if suspected bacterial infection
what is useful in an equivocal case of TSH
MRI
DD is osteomyelitis
treatment of TSH
short course of NSAIDs
rest
should resolve within few weeks, if not consider DD
what is perthes disease also called
legg calve perthes disease
Perthes Disease
idiopathic osteochondritis of the femoral head that typically affects boys between 4 and 9
occurs when the blood supply to the femoral head is temporarily disrupted - AVN
classical Perthes Disease patient
very active boys of short stature
Perthes Disease - disease progression
disease process likely secondary to avascular necrosis of the developing femoral head - osteonecrosis
fragmentation of the femoral head may occur causing it to collapse
subsequent remodelling occurs - abnormal growth
(the shape of the femoral head and incongruence of the joints determined by age of onset and amount of collapse)
OA
