Childrens Orthopaedics (DDH, Perthes disease, SUFE)

Question 1

what are the clinical features of DDH (developmental dysplasia of the hip)?

Answer 1

Ortolani’s sign, Barlows sign, piston motion sign (only pick up 40% of DDH by examination, use xray)
BOP

Question 2

what are the anatomical features of a dislocated hip

Answer 2

shenton line broken

Question 3

Mx

Answer 3

bilateral long leg hip spica cast

Question 4

outline Perthes disease (LCP)

Answer 4

Idiopathic avascular necrosis of the hip.
Insidious hip pain and limp.
Pain not received by rest or medication
more common in males 5:1, 15% bilateral, short stature, limp, knee pain, stiff hip joint,
crumbled looking head of femur on xray.

Question 5

what are the phases of LCP/ Perthes disease

Answer 5

avascular necrosis which leads to fragmentation (revascularisation)–> reossification (bone healing) –> residual deformity.

Question 6

ddx for Perthes

Answer 6

spetic hip, JIA, SCFE, lymphoma, hypothyroid, sickle, epiphyseal dysplasia, septic arthritis, transient synovitis, haemophilia,
(and stills disease. -disorder featuring inflammation, is characterized by high spiking fevers, salmon-colored rash that comes and goes, and arthritis. Still’s disease is also referred to as systemic-onset juvenile idiopathic arthritis.)

Question 7

Tx for perthes

Answer 7

Bed rest, 
traction and splints
pyshio, 
surveillance with xray, 
restriction of activities initially and if it worsens then surgery is needed. (the goal of mx is to create a spherical well-covered femoral head)
minimal weight bearing
chronic - osteotomy

maintain hip motion, analgesia, restrict painful activities,

Question 8

SCFE (slipped capital femoral epiphysis) classification

Answer 8

Displacement of the capital femoral epiphysis from the femoral neck.
slipped capital femoral epiphysis = boys get it more than girls, 20% become bilateral, pain in the hip or knee, externally rotated posture and gait, plain X-rays. Severe >1/2 (all relative to width femoral neck on AP), painful to weight bear.
Operative Tx.

Question 9

Transient synovitis

Answer 9

toddlers 3-8, px to a and e usually after a cold, cough.
sx usually less than a week old,
no high grade fever (difference between septic arthritis and this)
US bilateral effusion
Hip joint most commonly involved
tx - analgesia, resolves gradually on its own