FN: The Limping Child Flashcards
Aetiology
- DDH
- Transient synovitis
- Septic synovitis
- Perthes
- Slipped Capital Femoral Epiphyses
6 JIA/Still’s disease
DDH
Congenital hip joint deformity in which the femoral head is or can be completely/partially displaced
DDH epi
Incidence: 1/1000
Sex: F>M
DDH predisposing factors
- FH
- Breach presentation
- Oligohydramnios
DDH presentation
- Screening
- Asymmetric skin folds
- Limp/abnormal gait
DDH Ix
US is v. specific
DDH Mx
Maintain abduction
- double nappeis
- Pavlik harness
- Plaster hip spica
- Open reduction: derotation varus osteotomy
Transient Synovitis: Irritable Hip Presentation
Commonest cause of hip pain in children
- 2-12 yrs
- Sudden onset hip pain/limp
- Often following or with viral infection
- Not systemically unwell
Transient Synovitis: Irritable Hip Ix
- PMN and ESR/CRP are normal
- -ve blood cultures
- May need joint aspiration and culture
Transient Synovitis: Irritable Hip Mx
- Rest and analgesia
- Settles over 2-3d
Perthes Disease description
Osteochondritis of the femoral head
Perthes Disease epi
4-10 yrs
M>F = 5:1
Perthes Disease Presentation
- Insidious onset
- Hip pain initially, then painless
- 10-20% bilateral
Perthes Disease Ix
- X-rays normally initially
- raised density of femoral head
- Bone scan is useful
Perthes Disease Femoral head changes
Becomes fragmented and irregular
Flattening and sclerosis
Perthes Disease Mx
- Detected early and
SUFE description
- Postero-inferior displacement of femoral head epiphysis
- 10-15 yrs
- two main groups
1. fat and sexually underdeveloped - Tall and thin
SUFE Presentation
- Slip may be acute, chronic or acute-on chronic Acute: 1. Groin pain 2. Shortened, externally rotated leg 3. All movements painful
20% bilateral
SUFE Ix
Confirm Dx by x-ray
SUFE Mx
Acute: reduce and pin epiphysis
Chronic: in situ pinning: epiphyseal reduction risks AVN
SUFE complications
Chondrolysis: breakdown of articular cartilage: increase risk with surgery
