Childhood hip disorders

Question 1

What are features of a history which make developmental dysplasia of the hip more likely?

Answer 1

Child

Question 2

What might you find on examination of a child with developmental dysplasia of the hip?

Answer 2

Asymmetrical groin creases
Position
Leg length 
Clunk/click
Positive barlow and ortolani tests

Question 3

What are the barlow and ortolani instability tests?

Answer 3

Barlow - attempt to dislocate a hip that by flexing and adduction
Ortolani - attempt to relocate a dislocated hip by abduction

Question 4

What imaging modalities can be used to investigate suspected developmental dysplasia of the hip?

Answer 4

X-ray if epiphysis calcified (>3-6m)

Ultrasound (

Question 5

How is developmental dysplasia of the hip treated?

Answer 5

Relocate (closed >3m ; open >9m)
Splint (pavlik harness)
Monitor acetabular development
Surgery if >2y

Question 6

How is surgery carried out for developmental dysplasia of the hip?

Answer 6

Pre-op gallows traction
Arthrogram
Osteotomy
Hip spica immobilisation 3 months post-op

Question 7

Which questions are important to ask in a pre-school child with a limp?

Answer 7

Painful or painless?
History of injury?
Generally well or ill?

Question 8

What features of a limp would point to infection?

Answer 8

Pain at rest
Pain on movement
Resistance to movement
Systemically unwell (fever)
Infection elsewhere 
Susceptible

Question 9

How is suspected bone infection in a child investigated?

Answer 9

Bloods (FBC, inflammatory markers, culture)
X-ray unhelpful
USS for effusion
Tech bone scan

Question 10

How should bone infection in children be treated?

Answer 10

Antibiotics
Aspiration
Arthrotomy

Question 11

How does transient synovitis present?

Answer 11

Insidious onset (post viral infection)
Slight pain
Low grade fever/no fever
Generally well 
Usually no reduced movement

Question 12

What are the results for investigation of transient synovitis?

Answer 12

Bloods normal

USS effusion

Question 13

How is transient synovitis treated?

Answer 13

Conservative - resolves with rest

Question 14

How does a developmental dysplasia of the hip present late?

Answer 14

Painless limp
Asymmetric hip creases
Short leg
Trendelenberg gait

Question 15

How should a suspected late presenting developmental dysplasia of the hip be investigated?

Answer 15

X-ray

Question 16

What is perthes disease?

Answer 16

Idiopathic avascular necrosis

Question 17

Which age group gets perthes?

Answer 17

4-8

Question 18

Which gender gets perthes more commonly?

Answer 18

Boys

Question 19

How does perthes present?

Answer 19

Small children
Active children
Limp

Question 20

How is perthes treated?

Answer 20

Maintenance of hip abduction -
Rest and activity modification
Bracing
Surgery

Question 21

Can perthes be bilateral?

Answer 21

Rarely yes

Question 22

Perthes is associated with a better prognosis if it occurs below age 7. T/F

Answer 22

True

Question 23

What can perthes cause?

Answer 23

Secondary osteoarthritis

Question 24

How does SUFE present?

Answer 24

Adolescent in rapid growth (10-16)
Obesity 
Male
Black 
May or may not be bilateral

Question 25

How is a SUFE investigated and what should be seen?

Answer 25

X-ray (AP & lateral)

trethowans/kline sign

Question 26

In which direction does a SUFE slip?

Answer 26

Inferior

Anterior

Question 27

How is a SUFE classified?

Answer 27

Mild - 3 wks, >60, inability to weight bear

Question 28

Is an acute unstable hip an emergency?

Answer 28

Yes - risk of avascular necrosis in SUFE

Question 29

What does an adolescent who is unable to weight bear have?

Answer 29

SUFE until proven otherwise

refer for immediate x-ray