Childhood Hip Disorders Flashcards
Why do child x-rays look different from adult x-rays?
They have lots of cartilage
What is the epidemiology of developmental dysplasia of hips?
Female to male ratio is 8:1, more common in left hip, can be caused after birth
What are some risk factors for developmental dysplasia of the hips?
Female, relaxin hormone, breech babies, oligiohydramnios, moulded baby, first born, >4kg, multiple pregnancy
What are some screening methods for developmental dysplasia of hips?
Neonatal baby checks
Selective USS screening = breech, moulded, 1st degree relative affected
6-8 week baby check
Only picks up 60% of cases
What has the greatest impact on the outcome of developmental dysplasia of the hips?
Early diagnosis = treatment impacted by whether baby presents before 3 months
What are some features of a hip examination for developmental dysplasia of the hips?
Asymmetry, loss of knee height, less abduction in flexion, crease asymmetry, Barlow’s and Ortolani tests, moulded baby
What is Barlow’s test?
Adduction with downwards pressure causes posterior dislocation
What is Ortolani’s test?
Abduction with upwards pressure causes posterior dislocation
What imaging is used for developmental dysplasia of the hips?
Ultrasound
How is early developmental dysplasia of the hips treated?
Pavlik harness = worn for 23/24 hrs a day for 12 weeks until USS normal, night time splinting may be required for a few more weeks
What position does the Pavlik harness hold the hips in?
Abducted and flexed position (95% success rate)
What will children with late developmental dysplasia present with?
A limp = Trendelenburg’s gait
What are some features of late bilateral developmental dysplasia?
Hard to pick up, if presenting over age 8 then don’t operate
What are the treatment options for late developmental dysplasia?
Surgery, CR/OR Spica, 30% need further surgery
What is another name for Slipped Upper Femoral Epiphysis (SUFE)
SCFE
What are some risk factors for SUFE?
Age 8-18, rare, occurs earlier in girls than boys, endocrine/thyroid problems, obesity, Afro-Carribean
What are some symptoms of SCFE?
Hip, groin, thigh or knee pain (anterior knee), antalgic gait, short externally rotated lower limb, loss of internal rotation and deep flexion of lower limb, hip pain at extremes of ROM
What is the average delay in diagnosis of SCFE?
5 months = diagnosis often missed
What are the two kinds of SCFE?
Stable = occur slowly Unstable = occur suddenly
How is SCFE treated?
Hip replacement = will need lifelong revisions
What is transient synovitis?
Inflammation of the synovium (usually after viral illness)
What are some features of transient synovitis?
History of viral illness, limp, hip/groin pain, may have referred pain to knee, hip lying flexed and externally rotated, pain at extremes of hip ROM, usually symmetrical, apyrexial
How is transient synovitis diagnosed?
Kocher’s criteria, radiographs, USS
What is septic arthritis of the hip?
Intra-articular infection of hip joint = surgical emergency due to joint destruction and osteonecrosis
What are some symptoms of septic arthritis of the hip?
Short duration of symptoms, unable to weight bear, hip/groin pain, hip lying flexed and externally rotated, severe hip pain on passive movement, usually pyrexical (but may be haemodynamically stable)
How can septic arthritis arise?
Direct inoculation from trauma/surgery, haematogenous seeding, extension from adjacent bone (osteomyelitis)
How do neonates often get septic arthritis?
Spread from highly vascular metaphysis
What joints commonly get septic arthritis?
Hip, shoulder, elbow, ankle
What investigations can be done for septic arthritis?
FBC, CRP +/- ESR, blood cultures, Kocher’s criteria, radiographs, USS +/- aspiration
What is the most common causative organism of septic arthritis?
Staph. aureus
How is septic arthritis treated?
Open surgical washout, antibiotics for 6 weeks via PIC line
What is Perthes disease?
Idiopathic avascular necrosis of hip
What is the epidemiology of Perthes disease?
More common in boys, 4-8 year olds, lower socioeconomic class, bilateral in 12% but never at same time
What are the risk factors for Perthes disease?
Family history, low birth weight, passive smoke, Asian/Inuit/Central European, 30% have attention disorder
What may occur due to Perthes disease?
Functional coxa vara
How is Perthes disease treated?
Containment, restrictions, crutches/wheelchairs, rarely surgery
