DDH, SUFE, Perthes Disease, Clubfoot & Osgood Schattler

Question 1

what is DDH?

Answer 1

congenital dislocation / instability of the hip resulting in abnormal development of the hip joint

Question 2

when is DDH screened for?

Answer 2

on neonatal examination at birth & 6-8 weeks

Question 3

risk factors of DDH?

Answer 3

• breech delivery
• 1st degree family history

Question 4

clinical features of DDH?

Answer 4

• Ortolani’s Sign
  
  • hip joint reduces with clunk when abducted
• Barlow’s sign
  
  • gentle posterior pressure with legs adducted results in hip dislocation

Question 5

what other clinical feature may you see in DDH?

Answer 5

asymmetric thigh/skin creases

Question 6

Ix of DDH?

Answer 6

• USS
• X-Ray if > 6 months

Question 7

management of DDH?

Answer 7

<6 months- Pavlik harness

>6 months- Surgery

>6 years - leave alone

Question 8

What is Perthes disease?

Answer 8

avascular necrosis of the femoral head of unknown aetiology

Question 9

epidemiology of Perthes?

Answer 9

from 4-12 years

• most common between 5-8

Question 10

clinical features of perthes?

Answer 10

• hip/groin pain
• referred knee pain on exercise
• limp
• short stature
• stiff hip joint ; restricted hip movements

Question 11

Ix for Perthes

Answer 11

1. x-ray- can be normal
2. MRI

Question 12

Management of Perthes?

Answer 12

Initial Mx= conservative

• Analgesia
• maintain hip motion- physio
• traction
• crutches

more severe cases= Surgery

Question 13

what is Slipped Upper Femoral Epiphyses (SUFE)?

Answer 13

head of femur is displaced along the growth plate

Question 14

epidemiology of SUFE?

Answer 14

10-15 year olds, mainly boys

Question 15

risk factors of SUFE?

Answer 15

obesity

Question 16

presentation of SUFE?

Answer 16

• hip/groin pain
• referred knee pain
• painful limp
• restricted range of hip movement

Question 17

O/E in SUFE?

Answer 17

• hip in external rotation
• reduced internal rotation

Question 18

what is associated with painful weight bearing in SUFE?

Answer 18

high risk of AVN

Question 19

Ix of SUFE

Answer 19

X-Ray

Question 20

management of SUFE?

Answer 20

surgery –> screw fixation

Question 21

complications of SUFE?

Answer 21

• AVN
• deformity
• early OA

Question 22

what is the aetiology of transient synovitis?

Answer 22

previous viral infection

Question 23

symptoms of transient synovitis?

Answer 23

• knee pain
• limp
• limited movement

Question 24

what is the most important thing to exclude in a child who presents with symptoms of transient synovitis?

Answer 24

septic arthritis

Question 25

management of transient synovitis?

Answer 25

• activity restriction
• NSAIDs

Question 26

What is Clubfoot?

Answer 26

fixed abnormal ankle position that presents at birth

Question 27

what is a risk factor for club foot?

Answer 27

breech presentation during labour

Question 28

types of clubfoot?

Answer 28

• talipes equinovirus
  
  • ankle in plantar flexion and supination
• talipes calcaneovalgus
  
  • ankle in dorsiflexion & pronation

Question 29

Mx of clubfoot?

Answer 29

Ponseti method (manipulation + cast)

Question 30

what is osgood-schattler disease?

Answer 30

inflammation at tibial tuberosity where patella ligament inserts

Question 31

epidemiology of osgood-schattler?

Answer 31

• common cause of anterior knee pain in adolescents
• typically occurs 10-15 years

Question 32

presentation of osgood-schattler?

Answer 32

• anterior knee pain
  
  • exacerbated by physical activity, kneeling & on extension
• visible /palpable hard or tender lump at tibial tuberosity

Question 33

Mx of osgood-schattler?

Answer 33

initial Mx - reducing pain & inflammation

• reduced physical activity
• ice
• NSAIDs

Question 34

Complication of osgood-schattler?

Answer 34

avulsion fracture where tibial tuberosity separated for rest of tibia- v rare