Childrens Orthopaedics

Question 1

What is the presentation of, management and complications of developmental dysplasia of the hip?

Answer 1

Presentation: ortolani sign positive (hip is dislocated and clunk is felt when reduced), Barlows sign (femoral head slips over posterior rim with palpable sensation),
Management: <3m splint, 3m-1yr closed reductions and spics cast, >1yr open reduction and capsule reefing, >18m open reduction with femoral shortening +/- periacetabular osteotomy, >6yr and bilateral leave alone, >10yr and unilateral leave alone
Complications: AVN

Question 2

What is the presentation of, management and complications of perthes disease?

Answer 2

Presentation: short stature, limp, knee pain on exercise, stiff hip joint, systemically well
Management: maintain hip motion, analgesia, restrict painful activities, >7yr consider osteotomy
Complications:

Question 3

What is the presentation of, management and complications of slipped upper femoral epiphysis?

Answer 3

Presentation: pain in hip or knee, usually teenage boys, externally rotated posture and gait, reduced internal rotation
management: operative to pin the slip
Complications: AVN, deformity,Oprah,t OA, impingement, limb length discrepancy

Question 4

How do you investigate the limping child?

Answer 4

History
Examination (look feel move)
Imaging eg X-ray and MRI