Childhood hip disorders Flashcards
What are features of a history which make developmental dysplasia of the hip more likely?
Child
What might you find on examination of a child with developmental dysplasia of the hip?
Asymmetrical groin creases Position Leg length Clunk/click Positive barlow and ortolani tests
What are the barlow and ortolani instability tests?
Barlow - attempt to dislocate a hip that by flexing and adduction
Ortolani - attempt to relocate a dislocated hip by abduction
What imaging modalities can be used to investigate suspected developmental dysplasia of the hip?
X-ray if epiphysis calcified (>3-6m)
Ultrasound (
How is developmental dysplasia of the hip treated?
Relocate (closed >3m ; open >9m)
Splint (pavlik harness)
Monitor acetabular development
Surgery if >2y
How is surgery carried out for developmental dysplasia of the hip?
Pre-op gallows traction
Arthrogram
Osteotomy
Hip spica immobilisation 3 months post-op
Which questions are important to ask in a pre-school child with a limp?
Painful or painless?
History of injury?
Generally well or ill?
What features of a limp would point to infection?
Pain at rest Pain on movement Resistance to movement Systemically unwell (fever) Infection elsewhere Susceptible
How is suspected bone infection in a child investigated?
Bloods (FBC, inflammatory markers, culture)
X-ray unhelpful
USS for effusion
Tech bone scan
How should bone infection in children be treated?
Antibiotics
Aspiration
Arthrotomy
How does transient synovitis present?
Insidious onset (post viral infection) Slight pain Low grade fever/no fever Generally well Usually no reduced movement
What are the results for investigation of transient synovitis?
Bloods normal
USS effusion
How is transient synovitis treated?
Conservative - resolves with rest
How does a developmental dysplasia of the hip present late?
Painless limp
Asymmetric hip creases
Short leg
Trendelenberg gait
How should a suspected late presenting developmental dysplasia of the hip be investigated?
X-ray
What is perthes disease?
Idiopathic avascular necrosis
Which age group gets perthes?
4-8
Which gender gets perthes more commonly?
Boys
How does perthes present?
Small children
Active children
Limp
How is perthes treated?
Maintenance of hip abduction -
Rest and activity modification
Bracing
Surgery
Can perthes be bilateral?
Rarely yes
Perthes is associated with a better prognosis if it occurs below age 7. T/F
True
What can perthes cause?
Secondary osteoarthritis
How does SUFE present?
Adolescent in rapid growth (10-16) Obesity Male Black May or may not be bilateral
How is a SUFE investigated and what should be seen?
X-ray (AP & lateral)
trethowans/kline sign
In which direction does a SUFE slip?
Inferior
Anterior
How is a SUFE classified?
Mild - 3 wks, >60, inability to weight bear
Is an acute unstable hip an emergency?
Yes - risk of avascular necrosis in SUFE
What does an adolescent who is unable to weight bear have?
SUFE until proven otherwise
refer for immediate x-ray
