Childhood Hip Disorders Flashcards
Risk factors for DDH
Breech position in utero
Family history
Other MSK anomalies - club foot, torticollis, girls, first born
What is DDH
Developmental dysplasia of hip
What are you at risk for in DDH?
Severe arthritis at young age
What will you find in examination of DDH?
Asymmetry - position of leg, length of leg, thigh creases
Feel a click/clunk
What two instability tests are there for DDH?
Barlow test
Ortolani test
What is a barlow test?
Attempt to dislocate a hip joint that is in joint by flexion adduction - clunk posteriorly
What is an Ortolani test?
Attempt to relocate a dislocated hip by abduction - a clunk anteriorly
Investigations for DDH?
X- Ray and USS
If patient was 3 months, what investigation for DDH?
USS - because you can’t see unossified bone on X-Ray
Treatment for DDH?
Mild disease - monitor with imaging
Moderate/persistent - Pavilk harness
Persistent dislocation with late age diagnosis - hip spica
Pavlik harness
Use full time for 6 weeks and part time for further 6 weeks
Hip spica
Immobilise for 3 months
Surgery for DDH
> 3/12 = closed reduction
9/12 = open reduction likely
2 years = bony surgery required
What is transient synovitis?
self limiting inflammation of the synovium of a joint, particularly the hip
Does it occur shortly after a URTI (viral)
True, but sometimes no cause found
Age of onset for transient synovitis?
2-10 years, with boys more affected
Presentation of transient synovitis?
Limp or reluctance to weight bear on affected side
Range of motion restricted
Fever (not systemically unwell)
Investigations for transient synovitis
USS - reveals effusion
Radiographs to exclude other diseases
CRP to exclude septic arthritis
Aspirate if any doubt
Treatment for transient synovitis
Short course of NSAIDs
Resolves with rest
What is Perthes disease?
Idiopathic osteochondritis of the femoral head.
Femoral head loses its blood supply resulting in necrosis
Aetiology of Perthes?
Ages 4-8
True or False
Males are affected more than females in Perthes?
True, 4:1, especially active, short boys
True or False
Perthes is predominantly bilateral?
False - predominantly unilateral with 10% bilateral
Presentation of Perthes?
Pain and a limp
Clinical signs of Perthes?
Loss of internal rotation
Loss of abduction
Positive Trendellenburg test
Fragmentation of proximal femoral epiphysis on X-Ray
Treatment for Perthes?
Regular X-Ray obs
Avoid physical activity
Bracing, surgery
Prognosis of Perthes?
Related to age of onset
7y = early arthritis, aspherical femoral head
Severe cases = hip replacement in adolescence or early adulthood
What are you at risk of in Perthes?
Early onset OA
What is SUFE?
Slipped upper femoral epiphysis
Aetiology of SUFE
10-16 years
True or False
Are males more commonly affected than females?
True, 2:1
Also black:white = 2:1
1/3rd cases bilateral
Presentation of SUFE
Pain and limp
Where can pain in SUFE present?
In the knee - due to obturator nerve
What is the predominant clinical sign of SUFE?
Loss of internal rotation
What investigations would you carry out in SUFE?
X-Ray
How many views would you take in the X-Ray for SUFE?
2, particularly a lateral view
What is chronic SUFE?
3 weeks or more
Treatment plan for SUFE?
Urgent pin of the femoral head
Huge degree of slip may require hip replacement
An adolescent who cannot weight bear has what unless proven otherwise?
SUFE
Age range for CDH?
0-18 months
Age range for Transient synovitis?
2-5 yr
Age range for Perthes?
5-10 yr
Age range for SUFE?
11-15 yr
