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MSK > Childhood Hip Disorders > Flashcards

Childhood Hip Disorders Flashcards

1
Q

Developmental dysplasia of the hip

A

Dislocation or subluxation of the femoral head in the perinatal period which affects joint cevelopemtn

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2
Q

Developmental Dysplasia Risk Factors

A 
Breech birth 
Family history
GIrls
First born
Left hip more likely
Down's Syndrome
presence of other congenital disorders
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3
Q

Developmental dysplasia signs

A 
Asymmetry
Clicking/clunking when moving affected hip joint on Barlow's/ Ortolani's tests
Check abduction
Decreased leg length 
Asymmetric groin/ thigh creases
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4
Q

Developmental dysplasia late presentation

A

Normal hip movements
No pain
limp
Tiptoes on one side

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5
Q

Developmental dysplasia investigations

A

Ultrasound

  • Babies under 3 months
  • All breeched births
  • Family history of DDH

Ortolani Test
-Reducing a dislocated hip with abduction and anterior displacement

Barlow test
- Dislocatable hip with flexion/ adduction and posterior displacement

X-rays cannot be used in early cases as femoral epiphysis is not yet ossified

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6
Q

Developmental Dysplasia Treatment: Early diagnosed

A

Pavlik Harness

  • Keep hips comfortably flexed and abducted
  • Used for 6 weeks permanently snd then at night for 6 weeks in babies under 6 months

After Pavlik harness

  • Manipulation
  • Open reduction surgery
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7
Q

Developmental Dysplasia Treatment (for late DDH)

A

Combined femoral and acetabular surgery

  • Patient will never be normal
  • Allows femoral head to be shortened and rotated and the acetabulum to be deepened and reorientated.
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8
Q

Untreated Developmental Dysplasia

A

Acetabulum becomes very shallow
(false acetabulum can occur proximally)

Results in a shorter limb

Severe arthritis can occur due to reduced surface area of the joint and gait may be impacted

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9
Q

Transient Synovitis

A

Self-limiting inflammation of the synovial of the hip joint

Commonest cause of hip pain in children

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10
Q

Transient Synovitis Epidemiology

A

Boys

2-10 years old

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11
Q

Transient Synovitis Aetiology

A

Commonly preceded by URTI

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12
Q

Transient Synovitis Presentation

A

Limp
Reluctance to weight bear on affected side
Potential restriction to range of motion
Low grade fever
Not systemically unwell
Slow onset
Effusion on US

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13
Q

Transient Synovitis Investigations

A 
X-ray to exclude Perthes
CRP to exclude septic arthritis
Aspiration of hip
Open surgical drainage 
MRI can exclude osteomyelitis
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14
Q

Transient Synovitis Treatment

A

Resolves with rest

Short NSAID course

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15
Q

Perthe’s Disease

A

Idiopathic osteochondritis of the femoral head leaving to avascular necrosis

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16
Q

Perthes Disease Epidemiology

A

Boys
4-9 years old
Small and active children affected

17
Q

Perthes Disease location

A

Usually unilateral

18
Q

Stages of Perthes associated AVN

A

Necrosis/ Sclerosis
Fragmentation
Reossification
Remodelling

19
Q

Perthes Disease Signs

A

Loss of internal rotation
Loss of abduction
+ve Trendelenburg Test

20
Q

Perthes Disease consequences

A

AVN

OA

21
Q

Perthes Disease Treatment

A 
Rest
Activity modification 
Bracing 
Surgery
- Severe cases may need hip replacement 
- Subluxation of femoral head requires osteotomy of the femur or acetabulum
22
Q

SUFE

A

Slipped upper femoral epiphysis

23
Q

SUFE aetiology

A

Growth plate is not strong enough to support body weight

Can be triggered by growth spurt

24
Q

SUFE epidemiology

A

10-16 years old
Boys
Obese

25
Q

SUFE pathogenesis

A

In-balance in thyroid, growth or sex hormone as well as renal disease can cause a weakened physio causing the femoral head epiphysis to slip inferiorly in relation to the femoral neck

26
Q

SUFE presentation

A

Pain
- Felt in groin or only in knee
Limp
Loss of internal rotation

27
Q

SUFE: X-ray

A

Threthowan’s Sign
- Line of Klein passes above the femoral head isntead of through as it normally would

Requires lateral X-ray

28
Q

SUFE treatment

A

Stabilisation of physio with pins
Hip replacement
Severe acute slips
- Gentle manipulation (risk of AVN)

29
Q

Kocher Criteria (criteria for infection in children)

A

Temperature >38 degree
Unable to bear weight
CRP >20
WCC >12

MSK (35 decks)

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