7: Childhood hip disorders Flashcards
What is DDH?
Developmental dysplasia of the hip
What are some risk factors for developing DDH?
Being delivered in breech
Family history
Other MSK problems e.g club foot, torticollis
Who tends to get DDH?
First born girls
DDH tends to affect the (left / right) hip.
left
What are some signs of DDH on examination?
Reduced limb length
Reduced abduction
Click/clunk on Barlow/Ortolani manoeuvres
What are carried out to determine if a child has DDH?
Tests
Which scan is used to investigate suspected DDH?
Why
Ultrasound scan of hip
Babies have unossified bones, which won’t show up on X-ray
Which babies are given routine ultrasound scans re: DDH?
Babies born in breech
Babies with a family history
What is used to treat early DDH?
Pavlik harness
FLEXES and ABDUCTS the hips, allowing it to form properly
How is a late diagnosis of DDH treated?
How is the outcome?
Traction (straightening?)
Open reduction
i.e a ton of surgery which is a huge burden
Outcomes poor because joint has formed abnormally
It is extremely important to pick up DDH in a ___ check.
neonatal
People diagnosed with DDH late will (often / never) go on to have normal hips.
never
What are important questions to ask about a preschool child with a limp?
Painful / painless?
History of trauma?
Generally well or systemically ill? (Screen for septic arthritis)
What must be excluded in the diagnosis of a preschool child with a limp?
Infection
How is suspected joint / bone infection in children investigated?
Blood test + culture
Ultrasound for effusion
Te bone scan
How is bone / joint infection treated?
Antibiotics
Debridement / aspiration
Apart from infection, what could be responsible for hip problems in a preschool child with a limp?
Transient synovitis
see symptoms
A child with a limp may be presenting late with ___.
DDH
A limping pre-school child is usually ___. You must exclude ___.
transient synovitis
infection (osteomyelitis, septic arthritis) and DDH (poor outlook if detected late)
What is perthes?
Idiopathic avascular necrosis (usually head of the femur) in kiddos
Perthes tends to affect (boys / girls).
Who is the typical patient and how do they present?
boys
Young, sporty boys of short stature
Painful limp, loss of internal rotation
In perthes, blood supply to the head of the femur is (transiently / permanently) cut off.
transiently
causes ischaemic effects in the mean time
What gross changes occur to the head of the femur in perthes (due to ischaemia)?
Necrosis / sclerosis
Fragmentation
Re-ossification
Remodelling
Transient AVN in perthes causes what?
Mis-shapen femoral head
What happens to the acetabulum in:
a) very young
b) older
kids with perthes?
a) Acetabulum forms around misshapen head, functionally okay
b) Head is mishapen, acetabulum is in a fixed shape, functionally crap
What shape does the head of the femur take in perthes?
Ovoid
compared to round acetabulum
Kids with misshapen joints due to DDH and perthes are at higher risk of ___ when they’re older.
osteoarthritis
How is perthes treated?
Aim is to keep head in the acetabulum:
maintain hip abduction - braces ?surgery
rest and activity modification
What does SUFE stand for?
Slipped upper femoral epiphysis
Kiddos presenting with knee pain who are scanned and sent home only to come back with further problems should be suspected of having what?
SUFE
SUFE is more common in (boys / girls) who are also (underweight / obese).
Can it be bilateral?
boys , obese
1/3rd of cases are obese
What sign indicates SUFE?
Trethowan’s sign
Straight line which normally passes through greater trochanter AND femoral head doesn’t do that anymore on X-ray
What type of X-ray must be done to diagnose SUFE?
LATERAL X-ray
What terms are used to classify the
a) duration
b) magnitude
c) stability
of SUFE?
a) Duration: acute < 3/52, chronic > 3/52
b) Magnitude: mild, moderate and severe depending on degree of slip
c) Stability: stable/unstable depending on ability to bear weight
A SUFE is stable if…
a child can bear weight at the hip joint.
An unstable SUFE may compromise what?
What follows?
Blood supply to neck of the femur
leading to AVN
Many cases of SUFE are diagnosed ___ and have an ___ onset.
late
insidious
SUFE may present ___ as sudden AVN which causes total hip death and requires a hip replacement if untreated.
acutely
How is SUFE treated?
Stabilisation of upper femoral epiphysis with screws
Within a year or two, SUFE patients may have ___ slips at the other hip joint.
What’s the policy for stabilisation surgery in Tayside?
contralateral
Do both hips at the same time
Patients with SUFE present with what kind of pain?
Knee pain
Acute unstable SUFE is an ___ - why?
emergency
AVN will destroy the joint
Any adolescent who can’t weight bear has ___ until proven otherwise.
What should be done immediately?
SUFE
Lateral X-ray of femur / hip joint
