Chapter 133 - The Pediatric Hip Flashcards
risk factors for DDH
first
female
family hx
leFt»_space; right
breech
normal alpha angle in hip ultrasound
> 60degrees
normal acetabular index
<25 degrees at 12 mo
<20 degrees at 24 mo
normal lateral center edge angle
> 20
when should screening for DDH occur
4-6 weeks - too many false positives if done before this bc of ligamentous laxity (physiologic)
treatment of DDH <6months old
pavlik - can treat dislocated hip, subluxed or dysplastic
pavlik disease
deformation of the posterosuperior acetabular rim
too much abduction in a pavlik
osteonecrosis of the femoral head caused by too much abduction
too much flexion in a pavlik
femoral nerve palsy
if unable to achieve reduce hip after 3-4 weeks in pavlik then what?
discontinue pavlik
treatment of DDH in a kid 6-18 months
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
treatment of DDH in a kid >18mo
open anterior reduction, spica casting
upper limit of tx in unilateral dislocation is 10
bilateral dislocation is 6-8
outcomes of pelvic osteotomy at the time of initial DDH tx for kids 18mo to 10yr
noticibly decreases the rate of revision surgery
reconstructive POs
- salter
- pemberton
- triple
- dega
salvage POs
- chiari
- shelf
legg calve perthes disease
idiopathic osteonecrosis of the femoral ehad
boys 5x>girls
(bilateral in the same stage think of multiple epiphyseal dysplasia)
Legg Calve Perthes presentation
diagnosis of exclusion
children age 4-8
ROM with decreased abduction and internal rotation
treatment for legg calve perthes
<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)
classification of LCP - lateral pillar
non-op tx for LCP involves bracing in what position?
abduction and internal rotation
Pathoanatomy of SCFE
the femoral neck displaces anterior and superiorly to the epiphysis
risk factors for SCFE
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
where does the slip occur in SCFE
hypertrophic zone of the physis
risk of osteonecrosis in Loder unstable SCFE?
47%
risk of osteonecrosis in Loder Stable SCFE?
0%
indications for prophylactic hip pinning
open triradiate cartilage
<age 10 girl
<age 12 boy
endocrinopathy
renal osteodystrophy
hx of radiation
risk factor for osteonecrosis in SCFE
unstable scfe
hardware placement in the posterior superior femoral neck
genetic inheritance of coxa vara
autosomal dominant
what is the most sensitive view for detecting scfe?
frog leg lateral
