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MSK > Children’s Orthopaedics – "The Big 3" > Flashcards

Children’s Orthopaedics – "The Big 3" Flashcards

1
Q

What are the 3 main childhood hip problems?

A
  • Developmental dysplasia of the hip (DDH)
  • Perthes disease
  • Slipped upper femoral epiphysis (SUFE)
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2
Q

How common is DDH?

A
  • Aberdeen - 2.4 per 1000 births
  • F:M 6:1
  • LH:RH 3:1
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3
Q

What are the risk factors for DDH?

A
  • First Born
  • Oligohydramnios
  • Breech Presentation
  • Family History
  • Other lower limb deformities (Not TEV)
  • Increased weight (>10 lb)
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4
Q

What are the clinical features of DDH?

A
  • Ortolani’s Sign
  • Barlow’s Sign
  • Piston Motion Sign
  • The Hamstring Sign
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5
Q

What imaging do you use to identify DDH?

A
  • X-ray may show signs too late

* Use ultrasound for early diagnosis

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6
Q

How is DDH treated in <3 months?

A

90% resppond to a simple splint

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7
Q

How is DDH treated in 3 months - 1 year?

A

Closed reduction and spica cast

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8
Q

How is DDH treated in >1 year?

A

Open reduction and capsule reefing

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9
Q

How is DDH treated in >18 months?

A

Open reduction with femoral shortening ± peri-acetabular osteotomy

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10
Q

How is DDH treated in >6 years when bilateral?

A

Leave alone

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11
Q

How is DDH treated in >10 years when unilateral?

A
  • Leave alone
  • The older the child the poorer the result
  • Worst results are associated with AVN of head
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12
Q

What are the requirements to use examination to screen for DDH?

A
  • Baby relaxed and examined early

* Examiner experienced and has time

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13
Q

Why is examination less useful when screening for DDH?

A

•Does not identify all dysplastic hips

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14
Q

Why is universal ultrasound useful when screening for DDH?

A

•Eliminates number of late presenters

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15
Q

Why is universal ultrasound less useful when screening for DDH?

A
  • May not be cost effective
  • Time consuming/massive workload
  • Difficulty with compliance and follow-up
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16
Q

Why is selective ultrasound useful when screening for DDH?

A
  • Work-load manageable

* Reduces late presentation

17
Q

Why is selective ultrasound less useful when screening for DDH?

A

Late presentation will still occur

18
Q

How does Perthes disease present?

A
  • Short stature
  • Limp
  • Knee pain on exercise
  • Stiff hip joint
  • Systemically well
19
Q

Who gets Perthes disease?

A
  • Males

* Primary school age

20
Q

What is the pathology of Perthes?

A
  • Avascular necrosis o the hip
  • Possible relationship to coagulation tendency
  • Possible relationship to repeated minor trauma
  • Familial tendency
  • Classically low social status
21
Q

What are the 4 Waldenstrom stages used to describe the radiographic appearance of Perthes?

A
  1. Initial stage
  2. Fragmentation stage
  3. Reossification stage
  4. Healed stage
22
Q

What affects the prognosis of Perthes?

A
  • Age at presentation - younger do better
  • Proportion of head involved
  • Herring grade (lateral Pillar classification)
  • Radiographic “head at risk signs” Caterall
  • The nearer the head is to round, the better the outlook (Stulberg)
23
Q

How is Perthes treated?

A
  • Maintain hip motion
  • Analgesia
  • Restrict painful activities
  • Splints, physio, NWB not proven
  • “Supervised neglect” in most cases
  • Consider osteotomy in selected groups of older children (>7)
  • 10% bilateral
24
Q

How does slipped upper femoral epiphysis (SUFE) present?

A
  • Pain in hip or knee
  • Externally rotated posture & gait
  • Reduced internal rotation, especially in flexion
  • Painful to weight bear
25
Q

Who gets SUFE?

A
  • Teenage boys > girls (9 - 14 yrs)
  • 20% become bilateral
  • Many overweight
  • Small proportion endocrine abnormalities
26
Q

What 3 factors are used to classify SUFE?

A

•Acute v Chronic (3wks)
•Magnitude of slip (angle or proportion)
•Stable v unstable (Loder)
-Unstable = unable to weight-bear (poor prognosis)
-Stable = Able to weight-bear (good prognosis)

27
Q

What imaging is used to investigate SUFE?

A

Plain x-rays

28
Q

What radiographic features indicate severity of SUFE?

A
  • Mild <1/3
  • Moderate 1/3-1/2
  • Severe >1/2

All relative to width femoral neck on AP film

29
Q

What is the pathology of SUFE?

A
  • Displacement through hypertrophic zone

* Metaphysis moves anterior and proximal

30
Q

How is SUFE treated?

A

SURGICALLY
•Stable slips - usually pinned in situ
•Severe unstable slips - consider open reduction but AVN high risk

31
Q

What is Klein’s line?

A

Line drawn along superior border of femoral neck should cross at least a portion of the femoral epiphysis

32
Q

What sign is used to help identify SUFE on an AP film?

A

Trethowan’s

33
Q

What are the potential complications of SUFE?

A
  • AVN
  • Chondrolysis
  • Deformity (short, ext. rotated, limited flexion)
  • Early osteoarthritis
  • Possibility of slip on other side
  • Limb length discrepancy
  • Impingement
34
Q

How does the nature of the slip affect the risk of AVN in SUFE?

A
  • Stable slips (able to bear weight) have a low risk of AVN.

* Unstable slips (unable to bear weight) have a high risk of AVN.

MSK (28 decks)

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