Childhood Disorders Flashcards
what are possible complications of childhood hip disorders
end stage arthritis at a young age
what is developmental dysplasia of the hip (DDH)
dislocation or subluxation of the femoral head during the perinatal period which affects the subsequent development of the hip join
what are the risk factors for DDH
FHx of DDH Breech presentation First born babies Down syndrome Presence of other congenital disorders
what is a Breech presentation/birth
baby born bottom first
which hip is more commonly affect
left hip
20% bilateral
what can happen if DDH is not treated
false acetabulum occurs proximal to the original one
causes shortened lower limb
severe arthritis
gait/mobility affected
what are signs of DDH
shortening
asymmetric groin/thigh skin creases
click or clunk on the Ortolani or Barlow manoeuvres
what is the Ortolani test
attempt to relocate a dislocated hip by abduction
what is the Barlow test
dislocataBle hip with flexion and posterior displacement
is ortolani/barlow test positive what is the next investigation
Ultrasound
before 3 months
after 4-6 months what is the first line investigation and why not before
x-ray
as the femoral head epiphysis is unossified
what is used as treatment of DDH caught early
Pavlik harness
what is the treatment cascade of DDH
> 3m closed reduction
9m open reduction
2yr bony surgery required
when do the instability tests become unreliable
after 6 weeks
what needs to be monitored in DDH
acetabular development
what needs to be established in a preschool child with a limp
painful or painless?
history of injury?
generally well or ill?
what infectious conditions can affect child’s hip
osteomyolitis
septic arthritis
what are features of infectious conditions affecting the hip
very painful - at rest + movement
refuse to weight bear
associated fever + ill health
Ix for infection
WBC, CRP/ESR, Blood culture
US for effusion
Tx of infection
broad spectrum antibiotics
Aspiration
Surgery
what is transient synvotitis
self-limmiting inflammation of the synsosium of a joint, most commonly the hip.
what is the common features of a case of TS
occurs after URTI
2-10y/o
M > F
signs/symptoms of TS
limp
reluctance to weight bear
restricted ROM - slight pain
Low grade fever
IX for TS
CRP/FBC - most normal, slightly elevated CRP
X-ray can rule out other pathologies - 1st lines
US - 2nd line, can reveal effusions
Tx for TS
NSAIDs
Bed rest
how would a late presenting DDH appear
painless limp
short leg
asymmetric crease
trendeleberg limp
what is Perthes disease
idiopathic avascular necrosis
idiopathic osteochondritis of the femoral head
4-9 y/o
M > F
symptoms/signs of Perthes Disease
limp limited ROM short stature hyperactivity muscle wasting
when is it possible to still have a near normal hip with Perthes
if Perthes is diagnoses early
Ix for Perthes
Bilateral X-ray of the hip joints
Tx for Perthes
Rest and activity modification - most
Bracing - some
Surgery - very few
what is a possible complication of Perthes
early onset OA
11 year old, pain in knee for 3 months, no Hx of injury and failed to respond to physiotherapy - DDx?
SUFE
if some one presents with knee pain what must also be examined
the hip
who gets SUFE
10-16 y/o
Obese
M > F
1/3 cases bilateral
what is SUFE
Slipped Upper Femoral Epiphysis
- femoral head epiphysis slips inferiorly in relation to the femoral neck.
what causes the femoral head to slip
growth plate (physis) is not strong enough to support body weight and the femoral epiphysis slips due to the strain
what are the 3 classifications of SUFE
Acute
Acute on Chronic
Chronic
symptoms of SUFE
pain - in groin
limp
pain - in the knee
gait - leg externally rotated
why can pain in the hip be felt in the knee
due to the obturator nerve
what is the predominant clinical sign of SUFE
loss of internal rotation of the hip
Ix of SUFE
X-ray - AP, and LATERAL
what can be seen on a AP X-ray to diagnose SUFE
Trethowan’s Sign - the line of Klein passes above the femoral head.
why must a lateral x-ray be done
tells you had bad it is - i.e. prognosis dependant on the degree of the slip
Tx of SUFE
Acute Unstable
- EMERGENCY
- urgent surgical repair
Stable SUFE
- in situ screw fixation
what is the basic principle of SUFE Tx
pin femoral head to prevent further slippage
what should an adolescent who can’t weight bear be thought to have until proven otherwise
SUFE
time line for Childhood hip disorders
DDH in pre or peri walker 0 – 18m Transient synovitis 2 – 5yr Perthes 5 – 10 yr SUFE 11- 15 yr Always consider infection
SUFE surgical treatment
internal fixation in-situ using a single cannulated screw
