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MSK SB > Childhood Disorders > Flashcards

Childhood Disorders Flashcards

1
Q

what are possible complications of childhood hip disorders

A

end stage arthritis at a young age

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2
Q

what is developmental dysplasia of the hip (DDH)

A

dislocation or subluxation of the femoral head during the perinatal period which affects the subsequent development of the hip join

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3
Q

what are the risk factors for DDH

A 
FHx of DDH
Breech presentation
First born babies
Down syndrome
Presence of other congenital disorders
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4
Q

what is a Breech presentation/birth

A

baby born bottom first

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5
Q

which hip is more commonly affect

A

left hip

20% bilateral

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6
Q

what can happen if DDH is not treated

A

false acetabulum occurs proximal to the original one
causes shortened lower limb
severe arthritis
gait/mobility affected

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7
Q

what are signs of DDH

A

shortening
asymmetric groin/thigh skin creases
click or clunk on the Ortolani or Barlow manoeuvres

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8
Q

what is the Ortolani test

A

attempt to relocate a dislocated hip by abduction

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9
Q

what is the Barlow test

A

dislocataBle hip with flexion and posterior displacement

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10
Q

is ortolani/barlow test positive what is the next investigation

A

Ultrasound

before 3 months

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11
Q

after 4-6 months what is the first line investigation and why not before

A

x-ray

as the femoral head epiphysis is unossified

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12
Q

what is used as treatment of DDH caught early

A

Pavlik harness

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13
Q

what is the treatment cascade of DDH

A

> 3m closed reduction
9m open reduction
2yr bony surgery required

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14
Q

when do the instability tests become unreliable

A

after 6 weeks

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15
Q

what needs to be monitored in DDH

A

acetabular development

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16
Q

what needs to be established in a preschool child with a limp

A

painful or painless?
history of injury?
generally well or ill?

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17
Q

what infectious conditions can affect child’s hip

A

osteomyolitis

septic arthritis

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18
Q

what are features of infectious conditions affecting the hip

A

very painful - at rest + movement
refuse to weight bear
associated fever + ill health

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19
Q

Ix for infection

A

WBC, CRP/ESR, Blood culture

US for effusion

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20
Q

Tx of infection

A

broad spectrum antibiotics
Aspiration
Surgery

21
Q

what is transient synvotitis

A

self-limmiting inflammation of the synsosium of a joint, most commonly the hip.

22
Q

what is the common features of a case of TS

A

occurs after URTI
2-10y/o
M > F

23
Q

signs/symptoms of TS

A

limp
reluctance to weight bear
restricted ROM - slight pain
Low grade fever

24
Q

IX for TS

A

CRP/FBC - most normal, slightly elevated CRP
X-ray can rule out other pathologies - 1st lines
US - 2nd line, can reveal effusions

25
Q

Tx for TS

A

NSAIDs

Bed rest

26
Q

how would a late presenting DDH appear

A

painless limp
short leg
asymmetric crease
trendeleberg limp

27
Q

what is Perthes disease

A

idiopathic avascular necrosis
idiopathic osteochondritis of the femoral head
4-9 y/o
M > F

28
Q

symptoms/signs of Perthes Disease

A 
limp
limited ROM
short stature 
hyperactivity 
muscle wasting
29
Q

when is it possible to still have a near normal hip with Perthes

A

if Perthes is diagnoses early

30
Q

Ix for Perthes

A

Bilateral X-ray of the hip joints

31
Q

Tx for Perthes

A

Rest and activity modification - most
Bracing - some
Surgery - very few

32
Q

what is a possible complication of Perthes

A

early onset OA

33
Q

11 year old, pain in knee for 3 months, no Hx of injury and failed to respond to physiotherapy - DDx?

A

SUFE

34
Q

if some one presents with knee pain what must also be examined

A

the hip

35
Q

who gets SUFE

A

10-16 y/o
Obese
M > F
1/3 cases bilateral

36
Q

what is SUFE

A

Slipped Upper Femoral Epiphysis

- femoral head epiphysis slips inferiorly in relation to the femoral neck.

37
Q

what causes the femoral head to slip

A

growth plate (physis) is not strong enough to support body weight and the femoral epiphysis slips due to the strain

38
Q

what are the 3 classifications of SUFE

A

Acute
Acute on Chronic
Chronic

39
Q

symptoms of SUFE

A

pain - in groin
limp
pain - in the knee
gait - leg externally rotated

40
Q

why can pain in the hip be felt in the knee

A

due to the obturator nerve

41
Q

what is the predominant clinical sign of SUFE

A

loss of internal rotation of the hip

42
Q

Ix of SUFE

A

X-ray - AP, and LATERAL

43
Q

what can be seen on a AP X-ray to diagnose SUFE

A

Trethowan’s Sign - the line of Klein passes above the femoral head.

44
Q

why must a lateral x-ray be done

A

tells you had bad it is - i.e. prognosis dependant on the degree of the slip

45
Q

Tx of SUFE

A

Acute Unstable

  • EMERGENCY
  • urgent surgical repair

Stable SUFE
- in situ screw fixation

46
Q

what is the basic principle of SUFE Tx

A

pin femoral head to prevent further slippage

47
Q

what should an adolescent who can’t weight bear be thought to have until proven otherwise

A

SUFE

48
Q

time line for Childhood hip disorders

A 
DDH in pre or peri walker 0 – 18m 
Transient synovitis 2 – 5yr
Perthes 5 – 10 yr
SUFE 11- 15 yr
Always consider infection
49
Q

SUFE surgical treatment

A

internal fixation in-situ using a single cannulated screw

MSK SB (15 decks)

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