Chapter 133 - The Pediatric Hip

Question 1

risk factors for DDH

Answer 1

first
female
family hx
leFt&raquo_space; right
breech

Question 2

normal alpha angle in hip ultrasound

Answer 2

> 60degrees

Question 3

normal acetabular index

Answer 3

<25 degrees at 12 mo
<20 degrees at 24 mo

Question 4

normal lateral center edge angle

Answer 4

> 20

Question 5

when should screening for DDH occur

Answer 5

4-6 weeks - too many false positives if done before this bc of ligamentous laxity (physiologic)

Question 6

treatment of DDH <6months old

Answer 6

pavlik - can treat dislocated hip, subluxed or dysplastic

Question 7

pavlik disease

Answer 7

deformation of the posterosuperior acetabular rim

Question 8

too much abduction in a pavlik

Answer 8

osteonecrosis of the femoral head caused by too much abduction

Question 9

too much flexion in a pavlik

Answer 9

femoral nerve palsy

Question 10

if unable to achieve reduce hip after 3-4 weeks in pavlik then what?

Answer 10

discontinue pavlik

Question 11

treatment of DDH in a kid 6-18 months

Answer 11

can try pavlik but it will fail

open reduction (anterior or medial approach), spica

must get some sort of 3D imaging after casting to confirm youre actually reduced

Question 12

treatment of DDH in a kid >18mo

Answer 12

open anterior reduction, spica casting

upper limit of tx in unilateral dislocation is 10
bilateral dislocation is 6-8

Question 13

outcomes of pelvic osteotomy at the time of initial DDH tx for kids 18mo to 10yr

Answer 13

noticibly decreases the rate of revision surgery

Question 14

reconstructive POs

Answer 14

• salter
• pemberton
• triple
• dega

Question 15

salvage POs

Answer 15

• chiari
• shelf

Question 16

legg calve perthes disease

Answer 16

idiopathic osteonecrosis of the femoral ehad
boys 5x>girls
(bilateral in the same stage think of multiple epiphyseal dysplasia)

Question 17

Legg Calve Perthes presentation

Answer 17

diagnosis of exclusion
children age 4-8
ROM with decreased abduction and internal rotation

Question 18

treatment for legg calve perthes

Answer 18

<6yo, without complete lateral pillar collapse
- non-surgical
80% with good outcome

> 8 -> surgical containment of the femoral head (esp lateral pillar b and BC border groups)

Question 19

classification of LCP - lateral pillar

Answer 19

Question 20

non-op tx for LCP involves bracing in what position?

Answer 20

abduction and internal rotation

Question 21

Pathoanatomy of SCFE

Answer 21

the femoral neck displaces anterior and superiorly to the epiphysis

Question 22

risk factors for SCFE

Answer 22

males (2:1)
unilateral at the time of presentation
Hispanic, polynesian, african american

elevated LEPTIN levels

endocrinopathies: hypothyroidism, diabetes, panhypopituitarism, growth hormone abnormalities, hypertension

obesity, increased femoral retroversion

Question 23

where does the slip occur in SCFE

Answer 23

hypertrophic zone of the physis

Question 24

risk of osteonecrosis in Loder unstable SCFE?

Answer 24

47%

Question 25

risk of osteonecrosis in Loder Stable SCFE?

Answer 25

0%

Question 26

indications for prophylactic hip pinning

Answer 26

open triradiate cartilage
<age 10 girl
<age 12 boy
endocrinopathy
renal osteodystrophy
hx of radiation

Question 27

risk factor for osteonecrosis in SCFE

Answer 27

unstable scfe
hardware placement in the posterior superior femoral neck

Question 28

genetic inheritance of coxa vara

Answer 28

autosomal dominant

Question 29

what is the most sensitive view for detecting scfe?

Answer 29

frog leg lateral