Ch 3 - Rehumatology: Atraumatic arthritis Flashcards
What is congenital hip dislocation?
Dislocated hip at birth
What are etiologic factors of congenital hip dislocation?
- 1st born: tight uterine and ABD musculature of mother
- Inhibits fetal movement
- Breech position
- Left hip > right
- Hormonal factors
- MC in whites
Desribe Barlow’s test.
Start with hip in flexion and abduction, then the femoral head is dislocated on hip flexion and adduction
Desribe Ortolani’s test.
Hip is relocated on hip flexionand abduction
When are x-rays useful in congenital hip dislocation?
- Not useful until 6 weeks
* Negative finding on x-ray does not rule out a dislocation
What is seen on x-ray in congenital hip dislocation?
- Proximal and lateral migrationof the femoral headfromthe acetabulum
- Acetabular dysplasia
- Delayed ossification
What is the goal in treatment of congenital hip dislocation?
Return the hip to its normal position until there is resolution of the pathologic changes
What are position devices used in treatment of congenital hip dislocation?
Triple diapers
Frejka pillows
Splints: Craig, Von Rosen-Pavlik harness
Describe the Von Rosen-Pavlik harness.
Allows hip motion within the safe zone while maintaining abduction
What are complications associated with congenital hip dislocation?
AVN
What is slipped capital femoral epiphysis (SCFE)?
Femoral head may slip, displacing it medially and posteriorly in relation to the shaft of the femur at the level of the proximal femoral epiphysis
What is the onset of SCFE?
- Males:females 2:1
- 13 to 16 y males
- 11–13 y females
- Bilateral involvement: 30%–40%
What are etiologic factors of SCFE?
- Strain on the growth plate
- During its growth spurt 2/2 inc wt •Endocrinopathies
- Growth hormone abnormalities
- Down syndrome
What is the most common etiologic factor of SCFE?
Hypothyroidism
What is the clinical presentation of SCFE?
- Altered gait
* Pain in the groin, medial thigh, and knee
Describe the presentation of chronic slip of SCFE.
Most common
Loss of IR
Hip rolls into ER w/ flexion
Describe the presentation of an acute slip of SCFE.
Trauma, sudden onset of pain on weight bearing
What is Acute or chronic chondrolysis?
Erosion and degeneration of the cartilage inflaming the synovial membrane on activity
What x-ray views are needed to diagnose a SCFE?
AP and frog-leg views of the hip/pelvis
How is SCFE graded?
Grading based on degree of displacement of the epiphysis
Grade I: <33%
Grade II: 33% to 50%
Grade III: >50%
What are non-surgical treatments for SCFE?
- Bedrest-weight relief
- Prevention of further displacement
- Traction, body casts, hormonal therapy
What is the preferred treatment for SCFE?
Surgery: Knowles pinning
What are complications of SCFE?
- Chondrolysis
- AVN
- OA
What is Legg–Calve–Perthes disease?
Idiopathic AVN of the femoral head
What is the onset of Legg–Calve–Perthes disease?
- 2 to 12 yo
- Boys»_space; girls
- Majority—unilateral
What happens if the onset of Legg–Calve–Perthes disease is >12 yo?
It is considered AVN not LCPD
What are etiologic factors of Legg–Calve–Perthes disease?
- Bone age low for age results in short stature
- Etiology unknown
- Hypothyroid ABN
What is the clinical presentation of Legg–Calve–Perthes disease?
- Mild or no pain
- Stiffness
- Painless limp> antalgic gait
- Hip flexion contracture
- ABD and IR restricted
- Disuse atrophy
- Short stature
What x-ray views should be used for Legg–Calve–Perthes disease?
Frog-leg views of hip/pelvis
What are radiographic findings of Legg–Calve–Perthes disease?
- Growth arrest: avascular stage
- Subchondral fracture “crescent sign”
- Resorption
- Re-ossification
- Healed
What are goals of treatment for Legg–Calve–Perthes disease?
- Eliminate hip pain
- Restoration of motion
- Prevent femoral head collapse
Describe weight bearing restrictions in Legg–Calve–Perthes disease?
Permit weight bearing of the femoral head to assist healing and remodeling
What are containment techniques for Legg–Calve–Perthes disease?
Abduction braces
Petrie casts
Toronto brace
Salter stirrup
What are surgical techniques for Legg–Calve–Perthes disease?
Epiphysiodesis
Valgus osteotomy
What are complications of Legg–Calve–Perthes
AVN
What is the most common cause of hip pain in kids (preadolescents)?
Acute transient synovitis
Self-limiting with good outcome
What are causes of AVN?
“PLASTIC RAGS” P—pancreatitis L—lupus A—alcohol S—steroids T—trauma I—idiopathic, infection C—caisson disease, collagen vascular disease
R—radiation
A—amyloid
G—gaucher’s disease
S—sickle cell
