Children's Hip Disorders Flashcards
risk factors for hip problems in children
breech position in utero or delivery
family history
MSK abnormalities eg club foot
what are you LOOKing for on examination?
asymmetry
what are you FEELing for on examination
click/clunk
what are you MOVing on examination
abduction
what is the barlow manouevre?
adduct hip while applying a posterior force on the knee to promote dislocation
what is the ortolani manouevre?
abduct hip while applying an anteror force on the femur to reduce hip joint
when will the ortolani and barlow maouevres become invalid?
6 weeks
what age are ultrasounds effective in?
under 3 months
when would a child be subject to a routine ultrasound of the hip?
if they were breech
if they have a family history
treatment for hip dysplasia?
pavlik harness
another name for hip dysplasia?
developmental dysplasia of the hip
is it common to not have any risk factors for DDH?
yes, 60% don’t
treatment for a late presentation of DDH?
femoral and acetabular surgery
what age would be considered a late presentation of DDH?
2 yrs
Hx questions for a young child with a limp?
is it painful?
history of injury?
generally well/ill
do they have infection symptoms
differentials for a young child with a hip?
transient synovitis
infection
late presenting DDH
investigations for infection causing a limp?
WBC, CRP, ESR
maybe US or bone scan
treatment for infection causing a limp?
antibiotics
aspiration
clinical presentation of transient synovitis
comes on slowly, can be generally well, only slight pain on movement, bloods normal, better with rest
main differentiator of transient synovitis from other conditions?
effusion on US
clinical presentation of late presenting DDH?
painless, short leg, asymmetric creases, trendeleberg limp
investigation for possible late presenting DDH?
x ray
clinical presentation of perthes?
pain in knee
limp
pain in groin in boys aged 4-8
other name for perthes?
idipathic avascular necrosis
main disease process in perthes?
necrosis/sclerosis -> fragmentation -> re-ossification -> residual/remodelling
main form of treatment for perthes?
reshaping the recovering head into the mould of the acetabulum to retain abduction
does perthes have a correlation with early onset OA?
yes
does perthes onset at a younger age or an older age have the better prognosis?
younger age (<7yrs)
main clinical complaint in SUFE?
knee/distal thigh pain
most common age for SUFE to occur?
10-16yrs
is SUFE commonly bilateral?
yes
pathogenesis of SUFE?
production of thyroid, growth and sex hormones due to the rapid growth phase in puberty weaken the physis
what is trethowans sign?
line of kline (the level of the dip between the greater trochanter and head) passes above the femoral head on an x ray
is a lateral x ray required in SUFE?
yes, it is essential
what does SUFE stand for?
slipped upper femoral epiphysis
is SUFE acute or chronic if it lasts 3 years?
acute
when would SUFE be dubbed severe in terms of the magnitude of the slip?
if the angle is over 60 degrees
treatment for SUFE?
stabilisation of the physis
should you consider SUFE in an acutely painful knee in a young person?
yes, could be an acute unstable slip
what other condition are acutely unstable SUFE patients at risk of?
avascular necrosis
diagnosis for adolescent who can’t weight bear?
SUFE until proven otherwise
investigation?
immediate x ray
should not weight bear until SUFE had been excluded
common age for transient synovitis
2-5yrs
