DDH, perthes, SUFE

Question 1

developmental dysplasia of hip

Answer 1

spectrum of conditions affecting proxomal femur and acetabulum

e. g.
- hip subluxation
- hip dislocation

Question 2

DDH clinical features

Answer 2

\+ ortolani sign
\+ barlow test
leg length discrepency 
piston motion sign 
hamstring sign

Question 3

ortolani’s sign

Answer 3

hip flexed and abducted
anterior push on trochanter
if dislocates then +

Question 4

barlow’s test

Answer 4

hip flexed and adducted
posterior push on knee through hip
if dislocates +

Question 5

DDH Ix

Answer 5

USS best

X-ray

Question 6

DDH Rx >3mo

Answer 6

splint

Question 7

DDH Rx 3mo-1yr

Answer 7

closed reduction and cast

Question 8

DDH Rx >18mo

Answer 8

open reduction with femoral shortening

+/- peri-acetabular osteotomy

Question 9

DDH Rx >6yrs

Answer 9

if bilateral leave alone

Question 10

DDH Rx >10yrs

Answer 10

if unilateral leave alone

Question 11

DDH selective USS screening

Answer 11

all babies clinically examined and if DDH suspected then USS done
all babies with risk factors

Question 12

DDH risk factors

Answer 12

reduced intrauterine space: first pregnancy, oligohydramnios, large birth weight
breech
FH
girl

Question 13

perthes disease

Answer 13

self limiting disease of femoral head
necrosis, collapse, repair, remodelling 
vascular event(s) followed by revascularisation - painful and poorly functioning hip

Question 14

perthes disease risk factors

Answer 14

boy
socio-economic deprivation 
4-8yrs
hyper-coaguable states
family tendency

Question 15

perthes disease clinical features

Answer 15

limp 
short stature
stiff hip 
limited hip ROM 
trendelburg's sign

Question 16

perthes disease: waldenstrom stages

Answer 16

1. initial stage
2. fragmentation stage
3. ossification stage
4. healed stage

Question 17

perthes disease Ix

Answer 17

hip X-ray

Question 18

perthes disease prognosis

Answer 18

herring grade
better if younger age
better if femoral head rounder
proportion of head involved

Question 19

perthe’s disease Rx

Answer 19

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

Question 20

SUFE

Answer 20

weakness in proximal femur growth plate allows displacement of capital femoral epiphyses

most common hip problem in adolescenets

Question 21

SUFE risk factors

Answer 21

obesity
male sex
endocrine disorders: hypothyroidism, growth hormone deficiency

Question 22

SUFE classifications

Answer 22

acute, chronic (3wks)
magnitude of slip (angle, proportion)
stable vs unstable

Question 23

SUFE clinical features

Answer 23

external rotation
hip, knee, groin pain
reduced internal rotation (esp in flexion)
trendelburg’s gait

Question 24

SUFE Ix

Answer 24

hip x-ray lateral view

Question 25

SUFE pathology

Answer 25

displacement through hypertrophic zone

metaphysis moves anteriorly and proximally

Question 26

SUFE complications

Answer 26

avascular necrosis (esp unstable)
chondrolysis 
deformity: short, externally rotated
early OA
impingement

Question 27

SUFE Rx

Answer 27

vast majority and unstable: hip pinned in situ

severe, unstable: open reduction (risk of AV)