DDH, SUFE, Perthes Disease, Clubfoot & Osgood Schattler Flashcards
what is DDH?
congenital dislocation / instability of the hip resulting in abnormal development of the hip joint
when is DDH screened for?
on neonatal examination at birth & 6-8 weeks
risk factors of DDH?
- breech delivery
- 1st degree family history
clinical features of DDH?
- Ortolani’s Sign
- hip joint reduces with clunk when abducted
- Barlow’s sign
- gentle posterior pressure with legs adducted results in hip dislocation
what other clinical feature may you see in DDH?
asymmetric thigh/skin creases
Ix of DDH?
- USS
- X-Ray if > 6 months
management of DDH?
<6 months- Pavlik harness
>6 months- Surgery
>6 years - leave alone
What is Perthes disease?
avascular necrosis of the femoral head of unknown aetiology
epidemiology of Perthes?
from 4-12 years
- most common between 5-8
clinical features of perthes?
- hip/groin pain
- referred knee pain on exercise
- limp
- short stature
- stiff hip joint ; restricted hip movements
Ix for Perthes
- x-ray- can be normal
- MRI
Management of Perthes?
Initial Mx= conservative
- Analgesia
- maintain hip motion- physio
- traction
- crutches
more severe cases= Surgery
what is Slipped Upper Femoral Epiphyses (SUFE)?
head of femur is displaced along the growth plate
epidemiology of SUFE?
10-15 year olds, mainly boys
risk factors of SUFE?
obesity
presentation of SUFE?
- hip/groin pain
- referred knee pain
- painful limp
- restricted range of hip movement
O/E in SUFE?
- hip in external rotation
- reduced internal rotation
what is associated with painful weight bearing in SUFE?
high risk of AVN
Ix of SUFE
X-Ray
management of SUFE?
surgery –> screw fixation
complications of SUFE?
- AVN
- deformity
- early OA
what is the aetiology of transient synovitis?
previous viral infection
symptoms of transient synovitis?
- knee pain
- limp
- limited movement
what is the most important thing to exclude in a child who presents with symptoms of transient synovitis?
septic arthritis
management of transient synovitis?
- activity restriction
- NSAIDs
What is Clubfoot?
fixed abnormal ankle position that presents at birth
what is a risk factor for club foot?
breech presentation during labour
types of clubfoot?
- talipes equinovirus
- ankle in plantar flexion and supination
- talipes calcaneovalgus
- ankle in dorsiflexion & pronation
Mx of clubfoot?
Ponseti method (manipulation + cast)
what is osgood-schattler disease?
inflammation at tibial tuberosity where patella ligament inserts
epidemiology of osgood-schattler?
- common cause of anterior knee pain in adolescents
- typically occurs 10-15 years
presentation of osgood-schattler?
- anterior knee pain
- exacerbated by physical activity, kneeling & on extension
- visible /palpable hard or tender lump at tibial tuberosity
Mx of osgood-schattler?
initial Mx - reducing pain & inflammation
- reduced physical activity
- ice
- NSAIDs
Complication of osgood-schattler?
avulsion fracture where tibial tuberosity separated for rest of tibia- v rare
