Children's hip disorders Flashcards
What are the risk factors for DDH?
Female Firstborn Left hip Family history Breech position in utero or during birth Other MSK abnormalities e.g. club foot
What does DDH stand for?
Developmental dysplasia of the hip
What is DDH?
Dislocation or subluxation of the femoral head in utero resulting in abnormal development of the hip
What is the result of untreated DDH?
Shallow acetabulum/false acetabulum
Reduced surface contact resulting in severe arthritis
This affects mobility and gait, often severely
What is Ortolani’s test?
Attempting to relocate a dislocated hip by abduction
What is Barlow’s test?
Attempting to sublux or dislocate a hip by flexion adduction
What signs on examination are indicative of a DDH?
Click/clunk on Barlow’s or Ortolani’s test
Shortened limb
Asymmetrical groin or thigh skin creases
How does a Pavlik’s harness work?
Holds the hips in flexion and abduction, maintaining reduction
How successful is Pavlik’s harness in treating DDH?
In children aged less than 4-6 months there is a success rate of 85-95%
How long is a Pavlik’s harness worn for?
6 weeks
How is DDH in children >18 months generally treated?
Open reduction
What investigation should follow a positive Barlow’s or Ortolani’s test?
Ultrasound in <4-6 months (bone has not yet ossified so Xray is usually not helpful)
What is the most common cause of childhood hip pain?
Transient synovitis
What other diagnoses must be excluded in transient synovitis and how can they be excluded?
Septic arthritis (joint aspiration) Osteomyelitis (MRI) Perthes (Xray) Juvenile idiopathic arthritis Rheumatoid arthritis
How is transient synovitis treated?
It is self-limiting, so rest and NSAIDs
Another diagnosis must be considered if this is not successful
What can often precede a transient synovitis?
Upper respiratory tract infection
What group of children are most commonly affected by Perthe’s?
Hyperactive boys
Short
Aged 4-9
What is Perthe’s disease?
Idiopathic osteochondrosis of the femoral head
How does Perthe’s disease cause problems?
There is avascular necrosis of the femoral head
This can result in femoral head collapse
Remodelling occurs and can result in osteoarthritis depending on the age of the child and the severity of the collapse
This can result in hip replacement in adolescence or early adulthood
What is first line treatment of Perthe’s disease?
Regular Xray and avoidance of physical activity
What percentage of Perthe’s disease can be maintained by regular Xray and avoidance of physical activity?
50% generally are successfully managed this way
What changes can occur at the femoral head in Perthe’s disease?
It can become flattened, widened and ashperical
What is SUFE?
Slipped upper femoral epiphysis - femoral head epiphysis slips inferiorly in relation to the femoral neck
Who is most commonly affected by SUFE?
Overweight pre-pubertal boys
Which conditions can predispose to SUFE?
Hypothyroidism
Renal disease
What may precede a SUFE?
A growth spurt
How common are bilateral SUFE’s?
1/3 of cases are bilateral
How might a SUFE present?
Pain in groin or in knee
Limp
Why might pain from a SUFE present only in the knee?
Obturator nerve supplies both the knee and the hip
What is the predominant clinical sign in SUFE?
Loss of internal rotation
What imaging should be ordered in suspected SUFE?
Both AP and lateral Xray
What is the treatment of SUFE?
Pin the femoral head to prevent further slippage
