childhood hip disorders Flashcards
RF for DDH
Breech position in utero or at delivery
FH
other MSK abnormalities
(girls, first born. left hip)
On exam DDH
lok for aysymmetry
feel for click/clunk
move- check abduction
When do the instability test become unreliable?
6 weeks
What is the Barlow instability test?
attempt to dislocate/sublux a hip that is in the joint by flexion adduction
What is the ortolans instability test?
Attempt to relocate a dislocated hip by abdcution
What is used ( when younger than 3 months) for imaging?
Ultrasound
What imaging is good for children older than 3 months?
X-ray
What are the principles of treatment in DDH
Relocate the hip
splint whilst it stabilises
monitor acetabular development
What is a Pavlik harness
flexes the hip and abducts
95% succesful
What is an arthogram?
Injecting dye into the joint
What is a hip spica
a lightweight cast from abdomen to feet
usually in for 3 months
need general anaesthetics
What happens for those with late presentation i.e. age 2?
bony surgery required
What is DDH?
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
A preschool child presents with a limp. WHAT INVESTIGATIONS DO YOU DO(if you suspect infection)?
- blood test-WBC,CRP/ESR,blood culture
- US for effusion
What is the Kocher criteria
temp >38
unable to weight bear
CRP >20
WCC >12
Good for excluding infection
What is the treatment if you expect infection of the hip
antibiotics
aspiration/arthrotomy
Transient synovitis
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
What does a late presenting DDH look like?
Painless limp
short leg
asymmetric creases
Trendeleburg limp
What is perthes?
idiopathic avascular necrosis- blood supply is cut off, it does restore itself but it takes time
less common than DDH
Who is perthes common in?
very active- may have ADHD age 5-10 boys more common ( 4 x) Small children limp
What are the four stages of perthes
necrosis sclerotic fragmentation -starts to break apart reossifies- blood supply reestablished remodels- to a degree
Treatment principles
Influence the shape of the recovering head
continent within the mould of the acetabulum
maintain hip abduction - rest and activity modification, bracing, surgery
What does the outcome of Perthes?
she of head at the end
if younger than 7 better prognosis
risk of OA in future
11y, pain around knee for 3 months. most likely
SUFE
What is SUFE?
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
What is trethowans sign used in?
SUFE
Classification of SUFE
Duration ( <3 acute , >3 chronic)
magnitude <30 mild , <60 moderate and >60 severe)
stability * ( if unable to wt bear then unstable)
acute unstable slip is a regular occurrence and should be managed symptomatically T/F
F- acute unstable slip is a medical emergency and lifetime outcome influenced by initial management ( GP, physio, A+E staff)
Until proven otherwise what does an adolescent with hip/groin thigh or knee pain have
SUFE ( rare but important)
What childhood hip disorder are common in which age groups
DDH - 0-18m
transient synovitis 2-5y
Perthes - 5-10y
SUFE - 11-15y
What is important when taking an X-ray for SUFE
Get lateral so don’t miss slip
What does SUFE stand for?
Slipped Upper Femoral Epiphysis
