Children's Orthopaedics Flashcards
What specific hip problems tend to occur in the 0-5 year olds?
- ‘Normal variant’
- Trauma
- Transient synovitis
- Osteomyelitis
- Septic arthritis
- DDH
- JIA
What specific hip problems tend to occur in the 5-10 year olds?
- Trauma
- Transient synovitis
- Osteomyelitis
- Septic arthritis
- Legg Calve Perthes disease
What specific hip problems tend to occur in the 10-15 year olds?
- Trauma
- Osteomyelitis
- Septic arthritis
- SUFE
- Chrondromalacia
- Neoplasm
DDH
Developmental Dysplasia of the Hip
What is the incidence of DDH?
- Northern Europe: 0.7 to 2.2 per 1,000
- Eastern Europe: 28.7 per 1,000
- Apaches and Navajos: 5%
What is the epidemiology of DDH?
- F:M 6:1
- Left hip 3:1
Who is there increased incidence of DDH in?
- First born
- Oligohydramnios
- Breech presentation
- Family history
- Other lower limb deformities
What are the clinical features of DDH?
Only 40% are picked up by examination
- Ortolani’s sign
- Barlow’s sign
- Piston Motion sign
Acetabular index
The angle is formed by a horizontal line connecting both triradiate cartilages (Hilgenreiner line) and a second line which extends along the acetabular roofs.
Shenton line
Imaginary line drawn along the inferior border of the superior pubic ramus
Hilgenreiner line
Imaginary line running horizontally between the inferior aspects of both triradiate cartilages of the acetabulums
Perkin line
Imaginary line perpendicular to Hilgenreiner’s line at the lateral aspects of the triradiate cartilage of the acetabulum
How is DDH managed?
- Spica cast
- Pavlik harness
What is the epidemiology of Legg Clave Perthes disease?
- M:F 5:1
- 15% bilateral
- Primary school age
How does LCP disease present?
- Short stature
- Limp
- Knee pain on exercise
- Stiff hip joint
- Systemically well
What are the phases of LCP?
- Avascular necrosis
- Fragmentation: revascularisation (pain)
- Reossification : bony healing
- Residual deformity
What is the differential for LCP disease?
Unilateral
- Septic hip
- JIA
- SCFE
- Lymphoma
Bilateral
- Hypothyroid
- Sickle cell anaemia
- Epiphyseal dysplasia
What is the treatment for LCP disease?
- Maintain hip motion
- Analgesia
- Restrict painful activities
- ‘Supervised neglect’ in most cases
- ‘Containment’
- Consider osteotomy in selected groups of older children (>7)
What is the prognosis of LCP disease?
Good if onset <9 years
SCFE/ SUFE
Slipped capital femoral epiphysis
What is the epidemiology of SUFE?
- 1-10 per 100,000
- Teenage boys> girls
- 9-14 years
- 20% become bilateral
How can SUFE be classified?
- Acute vs chronic (3 weeks)
- Stable vs unstable (Loder)
How is SUFE detected?
- Pain in hip or knee
- Externally rotated posture and gait
- Reduced internal rotation, especially in flexion
- Plain x-rays (best seen on lateral view)
What are the radiogrpahical features that separate mild from severe SUFE?
All relative to width of femoral neck on AP film
- Mild <1/3
- Moderate 1/3-2/3
- Severe >1/2
