7: Childhood hip disorders

Question 1

What is DDH?

Answer 1

Developmental dysplasia of the hip

Question 2

What are some risk factors for developing DDH?

Answer 2

Being delivered in breech

Family history

Other MSK problems e.g club foot, torticollis

Question 3

Who tends to get DDH?

Answer 3

First born girls

Question 4

DDH tends to affect the (left / right) hip.

Answer 4

left

Question 5

What are some signs of DDH on examination?

Answer 5

Reduced limb length

Reduced abduction

Click/clunk on Barlow/Ortolani manoeuvres

Question 6

What are carried out to determine if a child has DDH?

Answer 6

Tests

Question 7

Which scan is used to investigate suspected DDH?

Why

Answer 7

Ultrasound scan of hip

Babies have unossified bones, which won’t show up on X-ray

Question 8

Which babies are given routine ultrasound scans re: DDH?

Answer 8

Babies born in breech

Babies with a family history

Question 9

What is used to treat early DDH?

Answer 9

Pavlik harness

FLEXES and ABDUCTS the hips, allowing it to form properly

Question 10

How is a late diagnosis of DDH treated?

How is the outcome?

Answer 10

Traction (straightening?)

Open reduction

i.e a ton of surgery which is a huge burden

Outcomes poor because joint has formed abnormally

Question 11

It is extremely important to pick up DDH in a ___ check.

Answer 11

neonatal

Question 12

People diagnosed with DDH late will (often / never) go on to have normal hips.

Answer 12

never

Question 13

What are important questions to ask about a preschool child with a limp?

Answer 13

Painful / painless?

History of trauma?

Generally well or systemically ill? (Screen for septic arthritis)

Question 14

What must be excluded in the diagnosis of a preschool child with a limp?

Answer 14

Infection

Question 15

How is suspected joint / bone infection in children investigated?

Answer 15

Blood test + culture

Ultrasound for effusion

Te bone scan

Question 16

How is bone / joint infection treated?

Answer 16

Antibiotics

Debridement / aspiration

Question 17

Apart from infection, what could be responsible for hip problems in a preschool child with a limp?

Answer 17

Transient synovitis

see symptoms

Question 18

A child with a limp may be presenting late with ___.

Answer 18

DDH

Question 19

A limping pre-school child is usually ___. You must exclude ___.

Answer 19

transient synovitis

infection (osteomyelitis, septic arthritis) and DDH (poor outlook if detected late)

Question 20

What is perthes?

Answer 20

Idiopathic avascular necrosis (usually head of the femur) in kiddos

Question 21

Perthes tends to affect (boys / girls).

Who is the typical patient and how do they present?

Answer 21

boys

Young, sporty boys of short stature

Painful limp, loss of internal rotation

Question 22

In perthes, blood supply to the head of the femur is (transiently / permanently) cut off.

Answer 22

transiently

causes ischaemic effects in the mean time

Question 23

What gross changes occur to the head of the femur in perthes (due to ischaemia)?

Answer 23

Necrosis / sclerosis

Fragmentation

Re-ossification

Remodelling

Question 24

Transient AVN in perthes causes what?

Answer 24

Mis-shapen femoral head

Question 25

What happens to the acetabulum in:

a) very young
b) older

kids with perthes?

Answer 25

a) Acetabulum forms around misshapen head, functionally okay

b) Head is mishapen, acetabulum is in a fixed shape, functionally crap

Question 26

What shape does the head of the femur take in perthes?

Answer 26

Ovoid

compared to round acetabulum

Question 27

Kids with misshapen joints due to DDH and perthes are at higher risk of ___ when they’re older.

Answer 27

osteoarthritis

Question 28

How is perthes treated?

Answer 28

Aim is to keep head in the acetabulum:

maintain hip abduction - braces ?surgery

rest and activity modification

Question 29

What does SUFE stand for?

Answer 29

Slipped upper femoral epiphysis

Question 30

Kiddos presenting with knee pain who are scanned and sent home only to come back with further problems should be suspected of having what?

Answer 30

SUFE

Question 31

SUFE is more common in (boys / girls) who are also (underweight / obese).

Can it be bilateral?

Answer 31

boys , obese

1/3rd of cases are obese

Question 32

What sign indicates SUFE?

Answer 32

Trethowan’s sign

Straight line which normally passes through greater trochanter AND femoral head doesn’t do that anymore on X-ray

Question 33

What type of X-ray must be done to diagnose SUFE?

Answer 33

LATERAL X-ray

Question 34

What terms are used to classify the

a) duration
b) magnitude
c) stability

of SUFE?

Answer 34

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

Question 35

A SUFE is stable if…

Answer 35

a child can bear weight at the hip joint.

Question 36

An unstable SUFE may compromise what?

What follows?

Answer 36

Blood supply to neck of the femur

leading to AVN

Question 37

Many cases of SUFE are diagnosed ___ and have an ___ onset.

Answer 37

late

insidious

Question 38

SUFE may present ___ as sudden AVN which causes total hip death and requires a hip replacement if untreated.

Answer 38

acutely

Question 39

How is SUFE treated?

Answer 39

Stabilisation of upper femoral epiphysis with screws

Question 40

Within a year or two, SUFE patients may have ___ slips at the other hip joint.

What’s the policy for stabilisation surgery in Tayside?

Answer 40

contralateral

Do both hips at the same time

Question 41

Patients with SUFE present with what kind of pain?

Answer 41

Knee pain

Question 42

Acute unstable SUFE is an ___ - why?

Answer 42

emergency

AVN will destroy the joint

Question 43

Any adolescent who can’t weight bear has ___ until proven otherwise.

What should be done immediately?

Answer 43

SUFE

Lateral X-ray of femur / hip joint