congenital/developmental disease

Question 0

DDH is a spectrum

Answer 0

acetabular dysplasia
hip instability
hip dislocation

Question 1

major risk factors to developmental hip dysplasia

Answer 1

packed uterus
breech pregnancy
first born, twin, oligohydraminos

Question 2

natural hx of neonatal infants

Answer 2

DDH is asx so we need

• screening and reduction
• ultrasound to measure the angle depth of the acetabulum

Question 3

screening and reduction tests

Answer 3

ortolani

barlow

Question 4

ortolani

Answer 4

abduct hip and push it back in

Question 5

barlow

Answer 5

push hip out

Question 6

infants and DDH

Answer 6

after 2-3 months soft tissues tighten and so the baby shows limited hip abduction on one side (assym) relative to the other

Question 7

good sign for DDH in infants

Answer 7

assymmetric hip and thigh folds

Question 8

other signs that say DDH

Answer 8

thigh shortening (1<other)
Galeazzi or Allis sign

Question 9

signs of DDH in ambulatory (walking) children

Answer 9

leg-length discrepancy if one hip is dislocated
lumbar lordosis if the dislocation is bilateral
limp or waddling gait

Question 10

Tredelenburg sign

Answer 10

pelvis drops when lifitng foot off the floor; virtually shortened femur on affected side

Question 11

xray sign of DDH in ambulatory children

Answer 11

decrease in ossificaiton of femoral head (small/absent ossific nucleus) because its displaced and thus getting decreased nutrition
–we expect the normal femur to align with a vertical shenten line

Question 12

untreated ddh in older children/younger adults

Answer 12

limping w/o pain in childhood
relative weakness in one/both legs
severe osteoarthritis early in life (30s)
only tx hip replacement

Question 13

goal of tx in DDH

Answer 13

early detection and reduction in dysplasia; when reducing it be careful not to cause avascular necrosis

Question 14

methods (in order that you should try them)

Answer 14

Pavlik Harness
Abduction brace
Closed reduction and spica cast
open reduction
other

Question 15

pavlik harness

Answer 15

persistant ortolani maneuver; everytime the baby kicks it pushes its femur into the acetabulum
–wearing it for 12 weeks will cure the baby, but it’s inconvenient and can rarely produce femoral nerve palsy or avascular necrosis, so we need to readjust the harness weekly and check

Question 16

abduction brace

Answer 16

used for older kids or if harness didnt work

Question 17

closed reduction and spica cast

Answer 17

when harness/brace fail

Question 18

closed reduction

Answer 18

when all else fails

Question 19

other methods

Answer 19

traction, swaddling

Question 20

clubfoot has three deformity components

Answer 20

ankle equinus (plantar flexion)
heel varus (heel rotation to midline)
forefoot adduction

Question 21

clubfoot is associated with

Answer 21

amniotic band syndrome
arthrogryposis
larsen’s syndrome
myelomeningocele

Question 22

natural history of clubfoot

Answer 22

foot, calf, and leg are smaller and shorter than average

untreated cluvfoot itself is not painful but no treatement can lead to significant deformed painful feet

Question 23

tx clubfoot

Answer 23

nonsurfical: ponseti cast

alacarte surgery post ponseti

Question 24

pain in club foot

Answer 24

position of foot doesnt cause pain, but can lead to arthreitis with use-->pain

Question 25

ponseti cast

Answer 25

long term casting/bracing of the clubgoot in a series before surgery vs other approaches that use it for shorter time period doesnt work for 5% clubfeet, we need to do full corrective surgery

Question 26

surgery post ponseti

Answer 26

up to 15% of ponseti corrected club feet may need tibilias anterior tendon transfer

Question 27

other techniques

Answer 27

french technique surgery CAVE-carve adductus, varus equinos