DDH, perthes, SUFE Flashcards
developmental dysplasia of hip
spectrum of conditions affecting proxomal femur and acetabulum
e. g.
- hip subluxation
- hip dislocation
DDH clinical features
\+ ortolani sign \+ barlow test leg length discrepency piston motion sign hamstring sign
ortolani’s sign
hip flexed and abducted
anterior push on trochanter
if dislocates then +
barlow’s test
hip flexed and adducted
posterior push on knee through hip
if dislocates +
DDH Ix
USS best
X-ray
DDH Rx >3mo
splint
DDH Rx 3mo-1yr
closed reduction and cast
DDH Rx >18mo
open reduction with femoral shortening
+/- peri-acetabular osteotomy
DDH Rx >6yrs
if bilateral leave alone
DDH Rx >10yrs
if unilateral leave alone
DDH selective USS screening
all babies clinically examined and if DDH suspected then USS done
all babies with risk factors
DDH risk factors
reduced intrauterine space: first pregnancy, oligohydramnios, large birth weight
breech
FH
girl
perthes disease
self limiting disease of femoral head necrosis, collapse, repair, remodelling vascular event(s) followed by revascularisation - painful and poorly functioning hip
perthes disease risk factors
boy socio-economic deprivation 4-8yrs hyper-coaguable states family tendency
perthes disease clinical features
limp short stature stiff hip limited hip ROM trendelburg's sign
perthes disease: waldenstrom stages
- initial stage
- fragmentation stage
- ossification stage
- healed stage
perthes disease Ix
hip X-ray
perthes disease prognosis
herring grade
better if younger age
better if femoral head rounder
proportion of head involved
perthe’s disease Rx
analgesia maintain hip motion restrict painful activities supervised neglect in most cases consider osteotomy in select group >7yrs if bilateral consider other conditions e.g. skeletal dysplasia
SUFE
weakness in proximal femur growth plate allows displacement of capital femoral epiphyses
most common hip problem in adolescenets
SUFE risk factors
obesity
male sex
endocrine disorders: hypothyroidism, growth hormone deficiency
SUFE classifications
acute, chronic (3wks)
magnitude of slip (angle, proportion)
stable vs unstable
SUFE clinical features
external rotation
hip, knee, groin pain
reduced internal rotation (esp in flexion)
trendelburg’s gait
SUFE Ix
hip x-ray lateral view
SUFE pathology
displacement through hypertrophic zone
metaphysis moves anteriorly and proximally
SUFE complications
avascular necrosis (esp unstable) chondrolysis deformity: short, externally rotated early OA impingement
SUFE Rx
vast majority and unstable: hip pinned in situ
severe, unstable: open reduction (risk of AV)
