FN: The Limping Child Flashcards

1
Q

Aetiology

A
  1. DDH
  2. Transient synovitis
  3. Septic synovitis
  4. Perthes
  5. Slipped Capital Femoral Epiphyses
    6 JIA/Still’s disease
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2
Q

DDH

A

Congenital hip joint deformity in which the femoral head is or can be completely/partially displaced

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3
Q

DDH epi

A

Incidence: 1/1000
Sex: F>M

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4
Q

DDH predisposing factors

A
  • FH
  • Breach presentation
  • Oligohydramnios
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5
Q

DDH presentation

A
  • Screening
  • Asymmetric skin folds
  • Limp/abnormal gait
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6
Q

DDH Ix

A

US is v. specific

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7
Q

DDH Mx

A

Maintain abduction

  • double nappeis
  • Pavlik harness
  • Plaster hip spica
  • Open reduction: derotation varus osteotomy
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8
Q

Transient Synovitis: Irritable Hip Presentation

A

Commonest cause of hip pain in children

  • 2-12 yrs
  • Sudden onset hip pain/limp
  • Often following or with viral infection
  • Not systemically unwell
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9
Q

Transient Synovitis: Irritable Hip Ix

A
  • PMN and ESR/CRP are normal
  • -ve blood cultures
  • May need joint aspiration and culture
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10
Q

Transient Synovitis: Irritable Hip Mx

A
  • Rest and analgesia

- Settles over 2-3d

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11
Q

Perthes Disease description

A

Osteochondritis of the femoral head

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12
Q

Perthes Disease epi

A

4-10 yrs

M>F = 5:1

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13
Q

Perthes Disease Presentation

A
  • Insidious onset
  • Hip pain initially, then painless
  • 10-20% bilateral
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14
Q

Perthes Disease Ix

A
  • X-rays normally initially
  • raised density of femoral head
  • Bone scan is useful
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15
Q

Perthes Disease Femoral head changes

A

Becomes fragmented and irregular

Flattening and sclerosis

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16
Q

Perthes Disease Mx

A
  1. Detected early and
17
Q

SUFE description

A
  • Postero-inferior displacement of femoral head epiphysis
  • 10-15 yrs
  • two main groups
    1. fat and sexually underdeveloped
  • Tall and thin
18
Q

SUFE Presentation

A
- Slip may be acute, chronic or acute-on chronic
Acute:
1. Groin pain
2. Shortened, externally rotated leg
3. All movements painful

20% bilateral

19
Q

SUFE Ix

A

Confirm Dx by x-ray

20
Q

SUFE Mx

A

Acute: reduce and pin epiphysis
Chronic: in situ pinning: epiphyseal reduction risks AVN

21
Q

SUFE complications

A

Chondrolysis: breakdown of articular cartilage: increase risk with surgery