high yield- ortho

Question 1

what is DDH?

Answer 1

-subluxation/ dislocation of hip in the perinatal period

Question 2

what can ocur if DDH is left untreated?

Answer 2

• can cause a very shallow or false acetabulum

- severe arthritis + shortened limb

Question 3

what hip is DDH more common in?

Answer 3

left hip

Question 4

who is DDH more common in?

Answer 4

• F>M
• breech position
• oligohydramnios (low levels amniotic fluid)
• FH of DDH
• downsyndrome

Question 5

investigations for DDH?

Answer 5

Barlow’s/ Ortolani test

-if either are positive USS (cannot Xray until after 4-6 months)

Question 6

treatment for dislocates/ unstable DDH?

Answer 6

Pavlick harness (6 weeks)

Question 7

treatment for persistent dislocation> 18 months DDH?

Answer 7

-surgical open reduction/ osteotomy

Question 8

most common cause of hip pain in children?

Answer 8

transient synovitis of hip

Question 9

who more commonly gets transient synovitis of hip?

Answer 9

• recent URTI
• M>F
• ages 2 to 10 yrs

Question 10

investigations for transient synovitis of hip?

Answer 10

• Xray to exclude Perthe’s disease
• MRI to exclude ostemyelitis of proximal femur
• CRP= normal (if not normal suspect septic arthritis)

Question 11

treatment transient synovitis of hip?

Answer 11

-NSAIDs + rest

Question 12

what is Perthes disease?

Answer 12

-avascular necrosis of femoral head

Question 13

who is Perthes more common in?

Answer 13

very active boys with small stature

Question 14

presentation of Perthes?

Answer 14

• progressive unilateral pain/limp
• loss of internal rotation + loss of abduction
• positive Trendelenburgs gait (due to gluteal weakness)

Question 15

what is seen on Xray of Perthe’s?

Answer 15

‘hanging rope sign’ + widening of joint space + smaller femoral head with patchy density

Question 16

treatment of Perthe’s?

Answer 16

-regular Xrays

severe= joint replacement

regular subluxations (partial dislocations)= osteotomy of femoral head + acetebulum

Question 17

who is SUFE more common in?

Answer 17

fat pre pubescent boys

Question 18

how often is SUFE bilateral vs unilateral?

Answer 18

1/3rd bilateral

2/3rd unilateral

Question 19

what may be seen on Xray of SUFE?

Answer 19

Klein line (needs lateral view)

Question 20

treatment for SUFE?

Answer 20

urgent surgery: pin femoral head

if not there is risk of avascular necrosis

Question 21

what is diagnostic criteria for septic arthritis?

Answer 21

Kocher criteria

Question 22

treatment for septic arthritis?

Answer 22

urgent irrigation + debridement

IV antibiotics cover Gram +ve (flucloaxicillin)