Children's Orthopaedics 1: Hip Pathology and Lower Limb Development

Question 1

What is developmental dysplasia of the hip (DDH)?

Answer 1

Dislocation or subluxation of the femoral head during the perinatal period which affects the subsequent development of the hip joint

Question 2

Which gender is more commonly affected by DDH

Answer 2

Girls

Question 3

What are the risk factors of DDH

Answer 3

Fam history
Breech birth position
First born babies
Down’s

Question 4

What are the complications of untreated DDH

Answer 4

Shallow acetabulum
False acetabulum
Arthritis at a young age

Question 5

What are the signs of DDH?

Answer 5

Shortening
Asymmetric groin/thigh skin creases
Click or clunk on Ortolani or Barlow manoevres

Question 6

What is a positive ortolani test

Answer 6

reducing a dislocated hip with abduction and anterior displacement

Question 7

What is barlows test

Answer 7

dislocatable hip with flexion and posterior displacement

Question 8

What are the investigations of choice for DDH?

Answer 8

Ultrasound if less than 4-6months

X ray if older

Question 9

What is the name of the harness used to treat DDH?

Answer 9

Pavlik harness

Question 10

What is transient synovitis of the hip

Answer 10

self limiting inflammation of the synovium of a joint (most commonly hip)

Question 11

What is the most common cause of hip pain in childhood

Answer 11

transient synovotis

Question 12

how does transient synovitis present

Answer 12

limp or reluctance to weight bear
restricted motion
may have low grade fever
usually not systemically unwell

Question 13

What is the treatment of transient synovitis?

Answer 13

NSAIDs and rest

Question 14

What is perthes disease?

Answer 14

Idiopathic osteochondritis of the femoral head

Question 15

What age range does perthes usually occur?

Answer 15

4-9

Question 16

Which gender is perthes most common

Answer 16

boys (particularly active or of short stature)

Question 17

What happens to the femoral head in perthes?

Answer 17

the femoral head transiently loses its blood supply resulting in necrosis and subsequent abnormal growth

Question 18

What are the potential complications of perthes?

Answer 18

Early onset arthritis

Question 19

How does perthes present

Answer 19

pain in hip or a limp

usually unilateral

Question 20

What tests can be used if perthes is suspected

Answer 20

trendellenbeeg

Question 21

What are the clinical signs of perthes

Answer 21

loss of internal rotation (first)
loss of abduction
gluteal weakness

Question 22

What is a SUFE

Answer 22

slipped upper femoral epiphysis- the femoral head epiphysis slips inferiorly in relation tot he femoral neck

Question 23

What may predispose to a SUFE

Answer 23

hypothyroidism
renal disease
overweight

Question 24

What group of people is usually affected by SUFE?

Answer 24

pre-pubertal boys

Question 25

Where may the pain be felt in a SUFE

Answer 25

The groin (like most hip pathology)
The knee (IMPORTANT)- this may be the only feature

Question 26

Why can you get knee pain with a SUFE?

Answer 26

the obturator nerve supplies both the hip and knee joint

Question 27

What is the predominant clinical sign of a SUFE

Answer 27

loss of internal rotation of the hip

Question 28

What is genu varum?

Answer 28

Bow legs

Question 29

What is genu valgum

Answer 29

knock knees

Question 30

what is the normal range of variation

Answer 30

+/- 6 degrees

Question 31

What disease may cause genu varum

Answer 31

Blount’s disease

Question 32

Give three causes of in toeing

Answer 32

femoral neck anteversion
Internal tibial torsion
forefoot adduction

Question 33

Which type of flat fooded ness may indicate an underlying bony abnormality scuh as tarsal coalition

Answer 33

rigid flat footedness