Ch 3 - Rehumatology: Atraumatic arthritis Flashcards

1
Q

What is congenital hip dislocation?

A

Dislocated hip at birth

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2
Q

What are etiologic factors of congenital hip dislocation?

A
  • 1st born: tight uterine and ABD musculature of mother
  • Inhibits fetal movement
  • Breech position
  • Left hip > right
  • Hormonal factors
  • MC in whites
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3
Q

Desribe Barlow’s test.

A

Start with hip in flexion and abduction, then the femoral head is dislocated on hip flexion and adduction

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4
Q

Desribe Ortolani’s test.

A

Hip is relocated on hip flexionand abduction

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5
Q

When are x-rays useful in congenital hip dislocation?

A
  • Not useful until 6 weeks

* Negative finding on x-ray does not rule out a dislocation

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6
Q

What is seen on x-ray in congenital hip dislocation?

A
  • Proximal and lateral migrationof the femoral headfromthe acetabulum
  • Acetabular dysplasia
  • Delayed ossification
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7
Q

What is the goal in treatment of congenital hip dislocation?

A

Return the hip to its normal position until there is resolution of the pathologic changes

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8
Q

What are position devices used in treatment of congenital hip dislocation?

A

Triple diapers
Frejka pillows
Splints: Craig, Von Rosen-Pavlik harness

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9
Q

Describe the Von Rosen-Pavlik harness.

A

Allows hip motion within the safe zone while maintaining abduction

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10
Q

What are complications associated with congenital hip dislocation?

A

AVN

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11
Q

What is slipped capital femoral epiphysis (SCFE)?

A

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

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12
Q

What is the onset of SCFE?

A
  • Males:females 2:1
  • 13 to 16 y males
  • 11–13 y females
  • Bilateral involvement: 30%–40%
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13
Q

What are etiologic factors of SCFE?

A
  • Strain on the growth plate
  • During its growth spurt 2/2 inc wt •Endocrinopathies
  • Growth hormone abnormalities
  • Down syndrome
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14
Q

What is the most common etiologic factor of SCFE?

A

Hypothyroidism

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15
Q

What is the clinical presentation of SCFE?

A
  • Altered gait

* Pain in the groin, medial thigh, and knee

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16
Q

Describe the presentation of chronic slip of SCFE.

A

Most common
Loss of IR
Hip rolls into ER w/ flexion

17
Q

Describe the presentation of an acute slip of SCFE.

A

Trauma, sudden onset of pain on weight bearing

18
Q

What is Acute or chronic chondrolysis?

A

Erosion and Degeneration of the cartilage inflaming the synovial membrane on activity

19
Q

What x-ray views are needed to diagnose a SCFE?

A

AP and frog-leg views of the hip/pelvis

20
Q

How is SCFE graded?

A

Grading based on degree of displacement of the epiphysis
Grade I: <33%
Grade II: 33% to 50%
Grade III: >50%

21
Q

What are non-surgical treatments for SCFE?

A
  • Bedrest-weight relief
  • Prevention of further displacement
  • Traction, body casts, hormonal therapy
22
Q

What is the preferred treatmente for SCFE?

A

Surgery: Knowles pinning

23
Q

What are complications of SCFE?

A
  • Chondrolysis
  • AVN
  • OA
24
Q

What is Legg–Calve–Perthes disease?

A

Idiopathic AVN of the femoral head

25
Q

What is the onset of Legg–Calve–Perthes disease?

A
  • 2 to 12 yo
  • Boys&raquo_space; girls
  • Majority—unilateral
26
Q

What happens if the onset of Legg–Calve–Perthes disease is >12 yo?

A

It is considered AVN not LCPD

27
Q

What are etiologic factors of Legg–Calve–Perthes disease?

A
  • Bone age low for age results in short stature
  • Etiology unknown
  • Hypothyroid ABN
28
Q

What is the clinical presentation of Legg–Calve–Perthes disease?

A
  • Mild or no pain
  • Stiffness
  • Painless limp> antalgic gait
  • Hip flexion contracture
  • ABD and IR restricted
  • Disuse atrophy
  • Short stature
29
Q

What x-ray views should be used for Legg–Calve–Perthes disease?

A

Frog-leg views of hip/pelvis

30
Q

What are radiographic findings of Legg–Calve–Perthes disease?

A
  1. Growth arrest: avascular stage
  2. Subchondral fracture “crescent sign”
  3. Resorption
  4. Re-ossification
  5. Healed
31
Q

What are goals of treatment for Legg–Calve–Perthes disease?

A
  1. Eliminate hip pain
  2. Restoration of motion
  3. Prevent femoral head collapse
32
Q

Describe weight bearing restrictions in Legg–Calve–Perthes disease?

A

Permit weight bearing of the femoral head to assist healing and remodeling

33
Q

What are containment techniques for Legg–Calve–Perthes disease?

A

Abduction braces
Petrie casts
Toronto brace
Salter stirrup

34
Q

What are surgical techniques for Legg–Calve–Perthes disease?

A

Epiphysiodesis

Valgus osteotomy

35
Q

What are complications of Legg–Calve–Perthes

A

AVN

36
Q

What is the most common cause of hip pain in kids (preadolescents)?

A

Acute transient synovitis

Self-limiting with good outcome

37
Q

What are causes of AVN?

A
“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