Childrens orthopaedics Flashcards
describe the salter harris classification
1 - slipped 2 - above 3 - lower 4 - transverse/through 5 - ruined (crush)
give some risk factors for DDH
- female
- breech presentation
- +ve fam hx
- firstborn
- oligohydramnios
- birthweight >5
- older mothers
- prematurity
when should children be examined for DDH
at birth and at six weeks
describe ortolani test
hip starts dislocated, the test will attempt to reduce
describe the barlow test
hip starts reduced, test will attempt to dislocate
what hip is most commonly affected by DDH
left
what investigations should you do if you suspect DDH
ultrasound
Xray AP and lateral hip/pelvis
how do you manage early DDH <6 mo
reassess with USS within 3-6 weeks
moderate abduction splint with the legs flexed at 100degrees in a Pavlik harness
how do you manage delayed DDH <6 y
gradual persistent traction then closed reduction and splint
OR
gradual persistent traction then OPEN REDUCTION +/- pelvic or femoral osteotomy
what are some complications of DDH
poor development of the acetabulum and femoral epiphysis with subsequent secondary osteoarthritis
osteonecrosis as a complication of treatment
what is perthes
avascular necrosis of the femoral head (epiphysis)
what age group is most commonly affected by perthes
4-8yrs
how do you manage late DDH >6y
open reduction +/- femoral or pelvic osteotomy
none
hip arthroplasty
how does perthes present
hip pain developing progressively over a few weeks
limp
stiffness and reduced ROM of hip
what Ix should you do in perthes and what do they show
Plain Xray/ technetium bone scan
XR: widening of joint space, decreased femoral head size
