Approach to the Paediatric Hip Flashcards
What are the three significant hip conditions in paediatrics?
DDH, Perthes disease, SUFE
What does DDH stand for?
Developmental Dysplasia of the Hip
What is the main characteristic of DDH?
Poor development of the hip
What are the risk factors for DDH?
- Breech
- Family history
- Female
- Multiple pregnancy
- Oligohydramnios
What clinical findings are seen in neonates or infants with DDH?
- Barlow and Ortolani tests
- Uneven skin creases
- Limb length discrepancy
- Limited abduction
- Telescoping
What clinical findings can be observed in older children with DDH?
- Waddling gait
- Hyperlordosis
At what age can X-rays be used to investigate DDH?
From about 5 months
What imaging technique can assess the hip before ossification begins?
Ultrasound
What is Broken Shenton’s line in the context of DDH?
Intact on one side and broken on the other
What is the typical management for DDH in children aged 0-6 months?
Pavlik Harness
What is the management of DDH for children aged 6-16 months?
Closed reduction under anaesthesia, followed by hip spica and abduction cast
What is the management approach for DDH in children over 16 months with failed closed reduction?
Open reduction of the hip
What age group is most commonly affected by Perthes disease?
Children between 4 and 8 years old
What is the main pathology of Perthes disease?
Idiopathic avascular necrosis of the femoral head
What are the stages of Perthes disease?
- Stage 1: Initial
- Stage 2: Fragmentation
- Stage 3: Re-ossification
- Stage 4: Healed
What are common X-ray findings in Perthes disease during the fragmentation stage?
Femoral head collapse, lateral uncovering, widened medial joint space
What is the aim of treatment for Perthes disease?
Ensure the femoral head remains contained within the acetabulum
What is SUFE?
Slipped upper femoral epiphysis
What is a key misconception about SUFE?
The epiphysis remains in-situ; it is the femoral neck that rotates and shortens
What age group is most affected by SUFE?
Children between 10 and 14 years old
What are common clinical features of SUFE?
- Hip and/or knee pain
- External rotation of the affected leg
- Trendelenburg gait
- Obligatory external rotation on hip flexion
What is Klein’s line in the context of SUFE?
A line drawn along the superior border of the femoral neck that should pass through the head
What is the typical management for SUFE?
In-situ pinning of the femoral head
What important assessment should be made in children presenting with knee pain?
Assess the hip for pathology
