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MSK- Paediatric Orthopaedics > Childhood Hip and Knee Conditions > Flashcards

Childhood Hip and Knee Conditions Flashcards

1
Q

What is DDH?

A

Involves dislocation/subluxation of the femoral head during the perinatal period which affects the subsequent development of the hip

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2
Q

What can DDH cause in the long term?

A

Severe arthritis at a young age, gait/mobility may be severely affected

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3
Q

What are some risk factors for DDH?

A

Breech position, family history, other MSK or congenital conditions, Down’s syndrome, female, first born

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4
Q

Most cases of DDH are in which hip?

A

Left, though 20% are bilateral

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5
Q

Do all cases of DDH have apparent risk factors?

A

No (60% do not)

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6
Q

What are some features to look for to suggest DDH?

A

Extra skin fold, asymmetry, decreased leg length

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7
Q

What is the most important movement to check when assessing for DDH?

A

Abduction, one will be stiffer than the other

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8
Q

Describe the Barlow test?

A

Abduct the hip and apply pressure on the knees, you will dislocate the hip

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9
Q

Describe the Ortolani test?

A

Flex and adduct the hip, put pressure on the greater trochanter and you will reduce the dislocated hip

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10
Q

If Ortolani and Barlow tests are positive for DDH, what test should be done next?

A

Ultrasound

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11
Q

What is the main investigation for assessing DDH in children < 6 months of age?

A

Ultrasound

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12
Q

What is the main investigation for assessing DDH in children > 6 months of age?

A

X-ray

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13
Q

Which babies should have a routine ultrasound to image the hip at birth?

A

Breech position or positive family history

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14
Q

How should you manage mild cases of DDH, with a shallow acetabulum and a mildly dislocatable but reduced hip?

A

Close examination and regular US scans

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15
Q

If there is an early diagnosis of severe DDH, how should this be managed? What are the outcomes like?

A

Pavlik harness to keep the hip in flexion/abduction and hence reduced, really good outcomes

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16
Q

Overflexion/abduction of the hip can lead to what?

A

AVN

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17
Q

If there is a late diagnosis of DDH, how is it managed? What are the outcomes?

A

Surgical open reduction, the joint will probably never be normal

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18
Q

If a child is diagnosed with DDH over 2 years old, how is this managed?

A

Combined femoral and acetabular surgery (breaking and reattaching)

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19
Q

How long is a Pavlik harness used for? What ages can it be used for?

A

6 weeks continuous, 6 weeks part-time. Used up to 4-6 months of age.

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20
Q

Those with late diagnosed DDH will go on to have what problems?

A

Early onset arthritis and hip replacement

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21
Q

If the hip joint is infected, when will there be pain?

A

At rest and on movement, the child will be resistant to movement

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22
Q

What is transient synovitis?

A

Self-limiting inflammation of the synovial (commonly hip)

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23
Q

When is transient synovitis more common?

A

Following a viral URTI

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24
Q

Which age and sex are more likely to have transient synovitis?

A

Boys, aged between 2 and 10

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25
Q

What are some pathologies that need to be excluded in a child with possible transient synovitis?

A

Septic arthritis, rheumatoid arthritis, juvenile idiopathic arthritis

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26
Q

How does a child with transient synovitis usually present?

A

A limp, or reluctance to bear weight on the affected side. Range of motion may be restricted slightly.

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27
Q

Will the child be systemically unwell in transient synovitis?

A

No, except a possible low grade fever

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28
Q

What test is used to exclude Perthes in a child with transient synovitis?

A

X-ray

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29
Q

What test can be used to exclude septic arthritis in a child with transient synovitis? What should be done if there is any doubt of this?

A

CRP (if there is any doubt the hip can be aspirated and drained)

30
Q

What is the treatment for transient synovitis?

A

Exclude a more serious cause, short course of NSAIDs

31
Q

What is the onset of transient synovitis?

A

Insidious

32
Q

When should patients with transient synovitis be seen again if the pain has not gone?

A

A few weeks

33
Q

What is Perthes disease?

A

Idiopathic osteochondritis of the femoral head

34
Q

Who does Perthes disease typically occur in?

A

Between ages 4-9, more common in small boys who are hyperactive

35
Q

How does Perthes disease usually present?

A

Pain and a limp (though can be painless)

36
Q

Can Perthes be bilateral?

A

Yes, but usually not at the same time

37
Q

If Perthes occurs in both hips at the same time, what can this suggest?

A

Underlying skeletal dysplasia

38
Q

What happens to the femoral head in Perthes?

A

It gradually loses its blood supply, resulting in necrosis with subsequent abnormal growth

39
Q

What are indicators of a worse prognosis in Perthes?

A

Older age, AVN

40
Q

What will an incongruent joint as a result of Perthes lead to?

A

Early onset arthritis and possible hip replacement at a young age

41
Q

What is the general treatment for Perthes disease?

A

X-ray monitoring and avoidance of activity

42
Q

What position is it best for the hip to be in in Perthes?

A

Abduction

43
Q

Onset below what age implies a better prognosis in Perthes?

A

< 7

44
Q

Who does SUFE tend to affect?

A

Pre-pubertal adolescent boys (10-16) who are overweight

45
Q

What happens in SUFE?

A

The femoral head epiphysis slips inferiorly in relation to the femoral neck

46
Q

Pain is the main feature of SUFE, where can this pain be?

A

In the groin, or sometimes only in the knee

47
Q

SUFE causing pain in the hip and knee is due to nerve supply from where?

A

Obturator nerve

48
Q

What movement is the first to be lost in SUFE?

A

Internal rotation

49
Q

What may precede the onset of SUFE? What may not have occurred?

A

May be precede by a growth spurt, often puberty is delayed

50
Q

Can SUFE be bilateral?

A

Yes, about a third of cases. Treat for both even if not present.

51
Q

What ethnic group is SUFE more common in?

A

Black children

52
Q

What other conditions may predispose to SUFE?

A

Hypothyroidism and renal disease

53
Q

What imaging is essential in SUFE?

A

Lateral x-ray

54
Q

SUFE can tear vessels can cause a risk of what?

A

AVN

55
Q

Is AVN in SUFE reversible?

A

No, if not caught then the hip can die

56
Q

What is the management for SUFE?

A

Pinning of the physis in situ (bilateral)

57
Q

Can stable slips become unstable in SUFE?

A

Yes

58
Q

An adolescent who cannot weight bear has what until proven otherwise?

A

SUFE

59
Q

If you suspect emergency SUFE, what should be done?

A

Immediate x-ray (including lateral) and do not weight bear

60
Q

What implies a worse prognosis in SUFE?

A

The greater the degree of the slip

61
Q

What can SUFE result in in the long term?

A

Early hip replacement

62
Q

What should always be checked in a young person presenting with knee pain?

A

Hips for SUFE

63
Q

What makes knee extensor mechanism problems common in adolescence?

A

Increased weight and more sporting activities

64
Q

What is a specific type of knee extensor mechanism problem which may occur in adolescence and is self limiting but ay require physio?

A

Patellar tendonitis

65
Q

Anterior knee pain is more common in which sex?

A

Females

66
Q

What are some reasons the anterior knee pain is more common in girls?

A

Muscle imbalance, ligamentous laxity, skeletal predisposition

67
Q

What is the treatment of anterior knee pain?

A

Self-Limiting, physio may help

68
Q

What may very rare, resistant cases of anterior knee pain require?

A

Surgery (tibial tubercle transfer)

69
Q

What types of meniscal tears are children and young people more likely to get?

A

Peripheral or bucket handle tears

70
Q

Do young people with meniscal tears have a good recovery rate?

A

Yes

MSK- Paediatric Orthopaedics (6 decks)

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