Children's Orthopaedics 1: Hip Pathology and Lower Limb Development Flashcards
What is developmental dysplasia of the hip (DDH)?
Dislocation or subluxation of the femoral head during the perinatal period which affects the subsequent development of the hip joint
Which gender is more commonly affected by DDH
Girls
What are the risk factors of DDH
Fam history
Breech birth position
First born babies
Down’s
What are the complications of untreated DDH
Shallow acetabulum
False acetabulum
Arthritis at a young age
What are the signs of DDH?
Shortening
Asymmetric groin/thigh skin creases
Click or clunk on Ortolani or Barlow manoevres
What is a positive ortolani test
reducing a dislocated hip with abduction and anterior displacement
What is barlows test
dislocatable hip with flexion and posterior displacement
What are the investigations of choice for DDH?
Ultrasound if less than 4-6months
X ray if older
What is the name of the harness used to treat DDH?
Pavlik harness
What is transient synovitis of the hip
self limiting inflammation of the synovium of a joint (most commonly hip)
What is the most common cause of hip pain in childhood
transient synovotis
how does transient synovitis present
limp or reluctance to weight bear
restricted motion
may have low grade fever
usually not systemically unwell
What is the treatment of transient synovitis?
NSAIDs and rest
What is perthes disease?
Idiopathic osteochondritis of the femoral head
What age range does perthes usually occur?
4-9
Which gender is perthes most common
boys (particularly active or of short stature)
What happens to the femoral head in perthes?
the femoral head transiently loses its blood supply resulting in necrosis and subsequent abnormal growth
What are the potential complications of perthes?
Early onset arthritis
How does perthes present
pain in hip or a limp
usually unilateral
What tests can be used if perthes is suspected
trendellenbeeg
What are the clinical signs of perthes
loss of internal rotation (first)
loss of abduction
gluteal weakness
What is a SUFE
slipped upper femoral epiphysis- the femoral head epiphysis slips inferiorly in relation tot he femoral neck
What may predispose to a SUFE
hypothyroidism
renal disease
overweight
What group of people is usually affected by SUFE?
pre-pubertal boys
Where may the pain be felt in a SUFE
The groin (like most hip pathology) The knee (IMPORTANT)- this may be the only feature
Why can you get knee pain with a SUFE?
the obturator nerve supplies both the hip and knee joint
What is the predominant clinical sign of a SUFE
loss of internal rotation of the hip
What is genu varum?
Bow legs
What is genu valgum
knock knees
what is the normal range of variation
+/- 6 degrees
What disease may cause genu varum
Blount’s disease
Give three causes of in toeing
femoral neck anteversion
Internal tibial torsion
forefoot adduction
Which type of flat fooded ness may indicate an underlying bony abnormality scuh as tarsal coalition
rigid flat footedness
