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MSK WEEK 3 > childhood hip disorders > Flashcards

childhood hip disorders Flashcards

1
Q

RF for DDH

A

Breech position in utero or at delivery
FH
other MSK abnormalities
(girls, first born. left hip)

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2
Q

On exam DDH

A

lok for aysymmetry
feel for click/clunk
move- check abduction

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3
Q

When do the instability test become unreliable?

A

6 weeks

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4
Q

What is the Barlow instability test?

A

attempt to dislocate/sublux a hip that is in the joint by flexion adduction

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5
Q

What is the ortolans instability test?

A

Attempt to relocate a dislocated hip by abdcution

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6
Q

What is used ( when younger than 3 months) for imaging?

A

Ultrasound

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7
Q

What imaging is good for children older than 3 months?

A

X-ray

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8
Q

What are the principles of treatment in DDH

A

Relocate the hip
splint whilst it stabilises
monitor acetabular development

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9
Q

What is a Pavlik harness

A

flexes the hip and abducts

95% succesful

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10
Q

What is an arthogram?

A

Injecting dye into the joint

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11
Q

What is a hip spica

A

a lightweight cast from abdomen to feet
usually in for 3 months
need general anaesthetics

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12
Q

What happens for those with late presentation i.e. age 2?

A

bony surgery required

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13
Q

What is DDH?

A

Developmental dysplasia of the hip

a condition where the ‘ball and socket’ joint of the hips doesn’t properly form in babies and young children

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14
Q

A preschool child presents with a limp. WHAT INVESTIGATIONS DO YOU DO(if you suspect infection)?

A
  • blood test-WBC,CRP/ESR,blood culture

- US for effusion

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15
Q

What is the Kocher criteria

A

temp >38
unable to weight bear
CRP >20
WCC >12

Good for excluding infection

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16
Q

What is the treatment if you expect infection of the hip

A

antibiotics

aspiration/arthrotomy

17
Q

Transient synovitis

A

most common cause of acute hip pain in children aged 2-5 years.
The disease causes arthralgia and arthritis secondary to a transient inflammation of the synovium of the hip

insidious onset
low grade pyrexia
generally well
reduced movement

18
Q

What does a late presenting DDH look like?

A

Painless limp
short leg
asymmetric creases
Trendeleburg limp

19
Q

What is perthes?

A

idiopathic avascular necrosis- blood supply is cut off, it does restore itself but it takes time

less common than DDH

20
Q

Who is perthes common in?

A 
very active- may have ADHD
age 5-10
boys more common ( 4 x)
Small children
limp
21
Q

What are the four stages of perthes

A 
necrosis
sclerotic
fragmentation -starts to break apart
reossifies- blood supply reestablished
remodels- to a degree
22
Q

Treatment principles

A

Influence the shape of the recovering head
continent within the mould of the acetabulum
maintain hip abduction - rest and activity modification, bracing, surgery

23
Q

What does the outcome of Perthes?

A

she of head at the end
if younger than 7 better prognosis
risk of OA in future

24
Q

11y, pain around knee for 3 months. most likely

A

SUFE

25
Q

What is SUFE?

A 
11-15y
more common in obesity, hypothyroid or other endocrine disorders
male ( 2 x more common)
back ( 2 x more common)
often present with knee pain only
26
Q

What is trethowans sign used in?

A

SUFE

27
Q

Classification of SUFE

A

Duration ( <3 acute , >3 chronic)
magnitude <30 mild , <60 moderate and >60 severe)
stability * ( if unable to wt bear then unstable)

28
Q

acute unstable slip is a regular occurrence and should be managed symptomatically T/F

A

F- acute unstable slip is a medical emergency and lifetime outcome influenced by initial management ( GP, physio, A+E staff)

29
Q

Until proven otherwise what does an adolescent with hip/groin thigh or knee pain have

A

SUFE ( rare but important)

30
Q

What childhood hip disorder are common in which age groups

A

DDH - 0-18m
transient synovitis 2-5y
Perthes - 5-10y
SUFE - 11-15y

31
Q

What is important when taking an X-ray for SUFE

A

Get lateral so don’t miss slip

32
Q

What does SUFE stand for?

A

Slipped Upper Femoral Epiphysis

MSK WEEK 3 (8 decks)

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