Children's Orthopaedics- DDH, Perthes and SUFE Flashcards
In what populations is developmental dysplasia of the hip more common?
More common in eastern Europe than northern Europe
Very common in inuits but almost never occurs in Africa
Affects girls more than boys (6:1)
Affects left hip three times more than right hip
What is the result of untreated DDH?
Patients leg will always be shorter and patient will always have a limp
What are the risk factors for DDH?
- First born
- Female
- Oligohydramnios
- Breech presentation (even if C-section performed)
- Family history
- Other lower limb deformities
- Increased weight
What tests can be used to examine a baby for DDH?
Ortolantis sign (inability to passively abduct a hip in an infant)
Barlows sign
Piston motion sign
Hamstring sign
Only around 40% of DDH is picked up on examination
What investigations can be used in DDH?
Ultrasound scan
X-rays in infants greater than three months
How is developmental dysplasia of the hip treated?
If child less than three months, splint (curative in 90%)
Three months to a year- closed reduction with spica cast for three months
Over a year requires surgery to remove whatever is blocking the hip and a hip replacement
Over 18 months- open repair with femoral shortening +/- peri-acetabular osteotomy
When does treatment of DDH in older children require treatment?
In older children (6+) lateral disease then no treatment is required
Over age 10 and unilateral requires no treatment
What are the possible complications of surgical treatment of DDH?
Avascular necrosis due to femoral artery damage
Describe the screening of DDH
- Clinical examination (good if baby relaxed and examined early, examiner experienced but still doesn’t identify all DDH)
- Universal ultrasound screening (time consuming, difficulty with compliance, eliminates number of late presenters)
- Selective ultrasound screening (reduces late presentations but late presenters will always occur)
Selective ultrasound screening is based upon appropriate risk factors ie breech position babies
What populations are most commonly affected by Perthe’s disease?
Boys (>90%)
Usually aged 5-10
Short stature
How does Perthes disease present?
Presents with: Limp Knee pain on exercise Stiff hip joint Patients usually systemically well
How does Perthes develop pathologically?
Avascular necrosis of hip due to interrupted blood supply to hip. It is not known why this causes Perthes but there is a slight familial tendency and patients are classically of low social status.
What are prognostic indicators in Perthes?
Indicators of a good prognosis are: Presenting <5 Proportion of femoral head involved Herring grade Once head is remodelled, the closer it is to round the better the prognosis
How is Perthes managed?
Maintaining hip motion important Restriction of painful activities Splints and physiotherapy not helpful Children monitored to identify who will require surgery (older children with more severe disease) Osteotomy performed in ~1/5 patients
What is SUFE?
Slipper upper femoral epiphyses
Involves a superiorly slipped femoral epiphysis through the growth plate
