Childhood Hip Disorders

Question 1

Why do child x-rays look different from adult x-rays?

Answer 1

They have lots of cartilage

Question 2

What is the epidemiology of developmental dysplasia of hips?

Answer 2

Female to male ratio is 8:1, more common in left hip, can be caused after birth

Question 3

What are some risk factors for developmental dysplasia of the hips?

Answer 3

Female, relaxin hormone, breech babies, oligiohydramnios, moulded baby, first born, >4kg, multiple pregnancy

Question 4

What are some screening methods for developmental dysplasia of hips?

Answer 4

Neonatal baby checks
Selective USS screening = breech, moulded, 1st degree relative affected
6-8 week baby check
Only picks up 60% of cases

Question 5

What has the greatest impact on the outcome of developmental dysplasia of the hips?

Answer 5

Early diagnosis = treatment impacted by whether baby presents before 3 months

Question 6

What are some features of a hip examination for developmental dysplasia of the hips?

Answer 6

Asymmetry, loss of knee height, less abduction in flexion, crease asymmetry, Barlow’s and Ortolani tests, moulded baby

Question 7

What is Barlow’s test?

Answer 7

Adduction with downwards pressure causes posterior dislocation

Question 8

What is Ortolani’s test?

Answer 8

Abduction with upwards pressure causes posterior dislocation

Question 9

What imaging is used for developmental dysplasia of the hips?

Answer 9

Ultrasound

Question 10

How is early developmental dysplasia of the hips treated?

Answer 10

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

Question 11

What position does the Pavlik harness hold the hips in?

Answer 11

Abducted and flexed position (95% success rate)

Question 12

What will children with late developmental dysplasia present with?

Answer 12

A limp = Trendelenburg’s gait

Question 13

What are some features of late bilateral developmental dysplasia?

Answer 13

Hard to pick up, if presenting over age 8 then don’t operate

Question 14

What are the treatment options for late developmental dysplasia?

Answer 14

Surgery, CR/OR Spica, 30% need further surgery

Question 15

What is another name for Slipped Upper Femoral Epiphysis (SUFE)

Answer 15

SCFE

Question 16

What are some risk factors for SUFE?

Answer 16

Age 8-18, rare, occurs earlier in girls than boys, endocrine/thyroid problems, obesity, Afro-Carribean

Question 17

What are some symptoms of SCFE?

Answer 17

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

Question 18

What is the average delay in diagnosis of SCFE?

Answer 18

5 months = diagnosis often missed

Question 19

What are the two kinds of SCFE?

Answer 19

Stable = occur slowly
Unstable = occur suddenly

Question 20

How is SCFE treated?

Answer 20

Hip replacement = will need lifelong revisions

Question 21

What is transient synovitis?

Answer 21

Inflammation of the synovium (usually after viral illness)

Question 22

What are some features of transient synovitis?

Answer 22

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

Question 23

How is transient synovitis diagnosed?

Answer 23

Kocher’s criteria, radiographs, USS

Question 24

What is septic arthritis of the hip?

Answer 24

Intra-articular infection of hip joint = surgical emergency due to joint destruction and osteonecrosis

Question 25

What are some symptoms of septic arthritis of the hip?

Answer 25

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)

Question 26

How can septic arthritis arise?

Answer 26

Direct inoculation from trauma/surgery, haematogenous seeding, extension from adjacent bone (osteomyelitis)

Question 27

How do neonates often get septic arthritis?

Answer 27

Spread from highly vascular metaphysis

Question 28

What joints commonly get septic arthritis?

Answer 28

Hip, shoulder, elbow, ankle

Question 29

What investigations can be done for septic arthritis?

Answer 29

FBC, CRP +/- ESR, blood cultures, Kocher’s criteria, radiographs, USS +/- aspiration

Question 30

What is the most common causative organism of septic arthritis?

Answer 30

Staph. aureus

Question 31

How is septic arthritis treated?

Answer 31

Open surgical washout, antibiotics for 6 weeks via PIC line

Question 32

What is Perthes disease?

Answer 32

Idiopathic avascular necrosis of hip

Question 33

What is the epidemiology of Perthes disease?

Answer 33

More common in boys, 4-8 year olds, lower socioeconomic class, bilateral in 12% but never at same time

Question 34

What are the risk factors for Perthes disease?

Answer 34

Family history, low birth weight, passive smoke, Asian/Inuit/Central European, 30% have attention disorder

Question 35

What may occur due to Perthes disease?

Answer 35

Functional coxa vara

Question 36

How is Perthes disease treated?

Answer 36

Containment, restrictions, crutches/wheelchairs, rarely surgery