growth and development problems Flashcards
what does FAI stand for
femoroacetabular impingement syndrome
why does FAI occur
hip bones do not form normally during the childhood growing years
what is CAM type FAI
asymmetric femoral head with decreased head : neck ratio
who usually presents with CAM type FAI
young athletic males
what is a pincer type FAI
acetabular overhang
who usually presents with pincer type FAI
females
consequences of FAI
- Damage to the labrum and tears
- Damage to cartilage
- OA in later life
clinical presentation of FAI
activity related pain in the groin
difficulty sitting
clinical signs of FAI
- C sign positive
- FADIR provocation test positive
management of pincer impingement
Peri-acetabular osteotomy
what does SUFE stand for
slipped upper femoral epiphysis
what is SUFE
femoral head epiphysis slips inferiorly in relation to the femoral neck
who does SUFE usually present in
overweight pre‐pubertal adolescent boys
clinical presentation of SUFE
Hip, groin, thigh or knee pain with limp
can be bilateral
clinical signs of SUFE
- Antalgic gait
- lower limb: short, externally rotated, loss of internal rotation, loss of deep flexion
- pain at extreme hip range of movement
management of SUFE
urgent surgery to pin the femoral head
what is perthes disease
idiopathic avascular necrosis of the developing femoral head
who usually presents with perthes disease
boys 4-9
risk factors for perthes
family history, low birth weight, passive smoking, asian
pathophysiology of perthes
femoral head transiently loses its blood supply resulting in necrosis with subsequent abnormal growth
clinical presentation of perthes
pain and a limp
first clinical sign of perthes
loss of internal rotation
what is transient synovitis
Self‐limiting inflammation of the synovium of a joint
where does transient synovitis commonly affect
the hip
what does transient synovitis usually follow
viral URTI
typical presentation of transient synovitis
boys 2-10
clinical presentation of transient synovitis
limp/reluctance to bear weight
restricted ROM
hip lying flexed/ externally rotated
kochers criteria for transient synovitis
- WCC >12
- inability to bear weight
- temp >38.5
- ESR >40 or raised CRP
management of transient synovitis
NSAIDs and rest
what is developmental dysplasia
dislocation or subluxation of the femoral head during the perinatal period which affects the subsequent development of the hip joint
name some risk factors for developmental dysplasia
female, breech, first born, >4kg, multiple pregnancy
which hip is more commonly affected by developmental dysplasia
left hip
clinical signs of developmental dysplasia
asymmetry
loss of knee height
crease asymmetry
less abduction in flexion
2 examination tests for developmental dysplasia and findings
barlows test: hip dislocates posteriorly
ortolanis test: flexion and abduction reduces femoral head into acetabulum
investigation of developmental dysplasia
USS
management of early developmental dysplasia
pavlik harness for 23 hrs a day until USS is normal
management of late developmental dysplasia
closed or open reduction spica
what is traction apophysis
excessive pull by a large tendon causes damage to the unfused apophysis to which it is attached
what is osgood-schlatters disease
traction apophysitis at tibial tubercle
who gets osgood-schlatters disease
adolescent active boys
how does osgood-schlatters disease present
knee pain + swelling
leaves a prominent bony lump
name 2 other sites of traction apophysitis
patella
achilles
what is osteochondritis dissecans
area of the surface of the knee loses its blood supply
when is osteochondritis dissecans most common
adolescence
clinical presentation of osteochondritis dissecans
knee pain and recurrent infusions
management of osteochondritis dissecans
usually heal or resolve spontaneously
what is another name for patellofemoral dysfunction
anterior knee pain
who usually presents with patellofemoral dysfunction
adolescent girls
what is another name for patellar tendonitis
jumpers knee
what is another name for club foot
congenital talipes equinovarus
what is club foot
newborn’s feet appear to be rotated internally at the ankle
risk factors for club foot
- More common in males
- Family history
- Breech presentation
- Oligohydramnios
what causes club foot
abnormal alignment of the joints between the talus, calcaneus and navicular results in contractures of the soft tissues
management of club feet
ponsetti technique: splinting and casting
what are rockerbottom feet
rigid flat form deformity
give 2 examples of conditions that rockerbottom feet feature in
patau’s
edwards syndrome
clinical presentation of rockerbottom feet
feet are gently curved upwards at both ends
management of rockerbottom feet
vertical talus casting/manipulation
