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MSK > Childhood Hip Disorders > Flashcards

Childhood Hip Disorders Flashcards

1
Q

Risk factors for DDH

A

Breech position in utero
Family history
Other MSK anomalies - club foot, torticollis, girls, first born

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2
Q

What is DDH

A

Developmental dysplasia of hip

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3
Q

What are you at risk for in DDH?

A

Severe arthritis at young age

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4
Q

What will you find in examination of DDH?

A

Asymmetry - position of leg, length of leg, thigh creases

Feel a click/clunk

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5
Q

What two instability tests are there for DDH?

A

Barlow test

Ortolani test

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6
Q

What is a barlow test?

A

Attempt to dislocate a hip joint that is in joint by flexion adduction - clunk posteriorly

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7
Q

What is an Ortolani test?

A

Attempt to relocate a dislocated hip by abduction - a clunk anteriorly

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8
Q

Investigations for DDH?

A

X- Ray and USS

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9
Q

If patient was 3 months, what investigation for DDH?

A

USS - because you can’t see unossified bone on X-Ray

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10
Q

Treatment for DDH?

A

Mild disease - monitor with imaging
Moderate/persistent - Pavilk harness
Persistent dislocation with late age diagnosis - hip spica

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11
Q

Pavlik harness

A

Use full time for 6 weeks and part time for further 6 weeks

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12
Q

Hip spica

A

Immobilise for 3 months

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13
Q

Surgery for DDH

A

> 3/12 = closed reduction
9/12 = open reduction likely
2 years = bony surgery required

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14
Q

What is transient synovitis?

A

self limiting inflammation of the synovium of a joint, particularly the hip

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15
Q

Does it occur shortly after a URTI (viral)

A

True, but sometimes no cause found

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16
Q

Age of onset for transient synovitis?

A

2-10 years, with boys more affected

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17
Q

Presentation of transient synovitis?

A

Limp or reluctance to weight bear on affected side
Range of motion restricted
Fever (not systemically unwell)

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18
Q

Investigations for transient synovitis

A

USS - reveals effusion
Radiographs to exclude other diseases
CRP to exclude septic arthritis
Aspirate if any doubt

19
Q

Treatment for transient synovitis

A

Short course of NSAIDs

Resolves with rest

20
Q

What is Perthes disease?

A

Idiopathic osteochondritis of the femoral head.

Femoral head loses its blood supply resulting in necrosis

21
Q

Aetiology of Perthes?

A

Ages 4-8

22
Q

True or False

Males are affected more than females in Perthes?

A

True, 4:1, especially active, short boys

23
Q

True or False

Perthes is predominantly bilateral?

A

False - predominantly unilateral with 10% bilateral

24
Q

Presentation of Perthes?

A

Pain and a limp

25
Q

Clinical signs of Perthes?

A

Loss of internal rotation
Loss of abduction
Positive Trendellenburg test
Fragmentation of proximal femoral epiphysis on X-Ray

26
Q

Treatment for Perthes?

A

Regular X-Ray obs
Avoid physical activity
Bracing, surgery

27
Q

Prognosis of Perthes?

A

Related to age of onset
7y = early arthritis, aspherical femoral head
Severe cases = hip replacement in adolescence or early adulthood

28
Q

What are you at risk of in Perthes?

A

Early onset OA

29
Q

What is SUFE?

A

Slipped upper femoral epiphysis

30
Q

Aetiology of SUFE

A

10-16 years

31
Q

True or False

Are males more commonly affected than females?

A

True, 2:1
Also black:white = 2:1
1/3rd cases bilateral

32
Q

Presentation of SUFE

A

Pain and limp

33
Q

Where can pain in SUFE present?

A

In the knee - due to obturator nerve

34
Q

What is the predominant clinical sign of SUFE?

A

Loss of internal rotation

35
Q

What investigations would you carry out in SUFE?

A

X-Ray

36
Q

How many views would you take in the X-Ray for SUFE?

A

2, particularly a lateral view

37
Q

What is chronic SUFE?

A

3 weeks or more

38
Q

Treatment plan for SUFE?

A

Urgent pin of the femoral head

Huge degree of slip may require hip replacement

39
Q

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

A

SUFE

40
Q

Age range for CDH?

A

0-18 months

41
Q

Age range for Transient synovitis?

A

2-5 yr

42
Q

Age range for Perthes?

A

5-10 yr

43
Q

Age range for SUFE?

A

11-15 yr

MSK (4 decks)

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