Children's Hip Disorders

Question 1

risk factors for hip problems in children

Answer 1

breech position in utero or delivery
family history
MSK abnormalities eg club foot

Question 2

what are you LOOKing for on examination?

Answer 2

asymmetry

Question 3

what are you FEELing for on examination

Answer 3

click/clunk

Question 4

what are you MOVing on examination

Answer 4

abduction

Question 5

what is the barlow manouevre?

Answer 5

adduct hip while applying a posterior force on the knee to promote dislocation

Question 6

what is the ortolani manouevre?

Answer 6

abduct hip while applying an anteror force on the femur to reduce hip joint

Question 7

when will the ortolani and barlow maouevres become invalid?

Answer 7

6 weeks

Question 8

what age are ultrasounds effective in?

Answer 8

under 3 months

Question 9

when would a child be subject to a routine ultrasound of the hip?

Answer 9

if they were breech

if they have a family history

Question 10

treatment for hip dysplasia?

Answer 10

pavlik harness

Question 11

another name for hip dysplasia?

Answer 11

developmental dysplasia of the hip

Question 12

is it common to not have any risk factors for DDH?

Answer 12

yes, 60% don’t

Question 13

treatment for a late presentation of DDH?

Answer 13

femoral and acetabular surgery

Question 14

what age would be considered a late presentation of DDH?

Answer 14

2 yrs

Question 15

Hx questions for a young child with a limp?

Answer 15

is it painful?
history of injury?
generally well/ill
do they have infection symptoms

Question 16

differentials for a young child with a hip?

Answer 16

transient synovitis
infection
late presenting DDH

Question 17

investigations for infection causing a limp?

Answer 17

WBC, CRP, ESR

maybe US or bone scan

Question 18

treatment for infection causing a limp?

Answer 18

antibiotics

aspiration

Question 19

clinical presentation of transient synovitis

Answer 19

comes on slowly, can be generally well, only slight pain on movement, bloods normal, better with rest

Question 20

main differentiator of transient synovitis from other conditions?

Answer 20

effusion on US

Question 21

clinical presentation of late presenting DDH?

Answer 21

painless, short leg, asymmetric creases, trendeleberg limp

Question 22

investigation for possible late presenting DDH?

Answer 22

x ray

Question 23

clinical presentation of perthes?

Answer 23

pain in knee
limp
pain in groin in boys aged 4-8

Question 24

other name for perthes?

Answer 24

idipathic avascular necrosis

Question 25

main disease process in perthes?

Answer 25

necrosis/sclerosis -> fragmentation -> re-ossification -> residual/remodelling

Question 26

main form of treatment for perthes?

Answer 26

reshaping the recovering head into the mould of the acetabulum to retain abduction

Question 27

does perthes have a correlation with early onset OA?

Answer 27

yes

Question 28

does perthes onset at a younger age or an older age have the better prognosis?

Answer 28

younger age (<7yrs)

Question 29

main clinical complaint in SUFE?

Answer 29

knee/distal thigh pain

Question 30

most common age for SUFE to occur?

Answer 30

10-16yrs

Question 31

is SUFE commonly bilateral?

Answer 31

yes

Question 32

pathogenesis of SUFE?

Answer 32

production of thyroid, growth and sex hormones due to the rapid growth phase in puberty weaken the physis

Question 33

what is trethowans sign?

Answer 33

line of kline (the level of the dip between the greater trochanter and head) passes above the femoral head on an x ray

Question 34

is a lateral x ray required in SUFE?

Answer 34

yes, it is essential

Question 35

what does SUFE stand for?

Answer 35

slipped upper femoral epiphysis

Question 36

is SUFE acute or chronic if it lasts 3 years?

Answer 36

acute

Question 37

when would SUFE be dubbed severe in terms of the magnitude of the slip?

Answer 37

if the angle is over 60 degrees

Question 38

treatment for SUFE?

Answer 38

stabilisation of the physis

Question 39

should you consider SUFE in an acutely painful knee in a young person?

Answer 39

yes, could be an acute unstable slip

Question 40

what other condition are acutely unstable SUFE patients at risk of?

Answer 40

avascular necrosis

Question 41

diagnosis for adolescent who can’t weight bear?

Answer 41

SUFE until proven otherwise

Question 42

investigation?

Answer 42

immediate x ray

should not weight bear until SUFE had been excluded

Question 43

common age for transient synovitis

Answer 43

2-5yrs