Children's orthopaedics - The Big 3 Flashcards
Which ethnicities have highest incidence of DDH?
Inuits (eskimo) 25%
Apaches and navajo 5%
What are some risk factors for DDH?
First Born Oligohydramnios Breech Presentation Family History Other lower limb deformities (Not TEV) Increased weight (>10 lb)
What are some signs to test for in DDH?
Ortolani’s Sign
Barlow’s Sign
Piston Motion Sign
The Hamstring Sign
What is Ortolani’s sign?
Examiner abducts hip and applies anterior force to reduce hip joint
Palpable sensation of the femoral head slipping into the acetabulum
What is Barlow’s sign?
Examiner adducts hip and applies posterior force to promote dislocation
Used identify unstable hip which can be passively dislocated
What is a good test for DDH?
USS should be used for early diagnosis
X-rays may show too late as femur does not ossify until about 3 months
How would an infant <3 months with DDH be treated?
90% respond to simple splint
How is a 3-12 month old child treated for DDH?
Closed reduction and spica cast
How is a 12-18 month old child treated for DDH?
Open reduction with femoral shortening
Peri-acetabular osteotomy
How are children over 6 years treated for DDH?
Nada
How does Perthe’s disease usually present?
Male Primary school age Short stature Limp Knee pain on exercise Stiff hip Systemically well
What are some possible causes of DDH?
Avascular necrosis of hip Coagulation tendency Repeated minor trauma Family history Often low social status
What are the 4 Waldenstrom stages of DDH radiographic appearance?
Initial
Fragmentation
Reossification
Healed
What are some significant factors in prognosis for DDH?
Younger do better
Proportion of head involved
Herring grade
We want head as round as possible for good prognosis
How is DDH managed?
Maintain hip motion Analgesia Restrict painful activity Splints Physio Consider osteotomy for older children >7
What is SUFE?
Slipped Upper Femoral Epiphysis
What are some risk factors for SUFE?
Many overweight
Small proportion endocrine abnormalities
Teenage boys 9-14
How does SUFE present?
Pain in hip or knee
Externally rotated posture and gait
Reduced internal rotation, especially in flexion
Plain x-rays
What is the pathology of SUFE?
Displacement through hypertrophic zone
Metaphysis moves anterior and proximal
How is SUFE treated surgically?
Usually pinned in situ
Maybe open reduction if unstable
What is Trethowan’s sign?
Used to diagnose slipped capital femoral epiphysis (also called slipped upper femoral epiphysis)
In this sign, the line of Klein passes above the femoral head
How might SUFE progress?
AVN Chondrolysis Deformity Early osteoarthritis Possibility of slip on other side Limb length discrepancy Impingement
What are some possible deformities from SUFE?
Short
Externally rotated
Limited flexion
What is AVN?
Avascular necrosis
Is AVN more likely in stable or unstable SUFE slips?
Unstable
