Hip Dysfunction: DDH, Perthes, SCFE (Kowalski) Flashcards
Which of the following is NOT one of the epidemiological “five Fs” of developmental dysplasia of the hip?
A. first born
B. female
C. family history
D. frank breech positioning
E. fava beans
E. Dr. Kowalski also had “foot abnormalities” like metatarsus adductus, club foot, etc. as the 5th F; other sites list the 5th F as “fluid” (referring to oligohydramnios - too little amniotic fluid) which is thought to have an impact on foot development.
What causes DDH?
femoral head does not apply proper pressure to the acetabulum, and so the acetabulum becomes shallow and flat and the femoral head subluxes
What 3 tests are used to diagnose DDH?
Barlow (sublux the hip), Ortolani (reduce the hip), Galeazzi (knee height difference)
*babies also may have asymmetric skin folds indicating hip dysplasia
*This is a great video showing a positive Ortolani test
major complication of DDH left untreated
severe degenerative changes and early joint replacement (due to formation of “pseudo acetabulum”
idiopathic, avascular necrosis of the femoral head that affects mostly hyperactive caucasian boys age 4-10, though tends to be more severe in girls who have it
legg-calve-perthes
*occasionally bilateral but never in the same stages on both hips; if it IS in the same stage, it is likely a genetic skeletal dysplasia
treatment for DDH
with early diagnosis, Pavlik harness. with later diagnosis, surgical reduction
Which of the following statements about Legg-Calves-Perthes is TRUE?
A. As long as diagnosis is made by age 10, outcome is usually good
B. Always presents with painful limp
C. Though there are several methods used to treat, consensus is casting and bed rest with traction
D. Maintaining a round hip joint is key to a good joint
D
A is false: poor outcome is associated with diagnosis > age 8 and goot outcome with diagnosis < age 6. Ages 6-8 do generally well with intervention.
B is false: sometimes a limp is the only presenting symptom and is not always painful
C is false: there is no consensus on treatment. Current options inlcude external fixation (to stabilize bone and soft tissue), femoral osteotomy (reshaping of the upper end of the femur), and acetabuloplasty (hip socket augmentation).
condition characterized by displacement of the proximal femoral metaphysis through the growth plate (below), usually in obese males nearing the end of skeletal maturity
slipped capital femoral epiphysis (SCFE)
The pathology of SCFE is due to an abnormally wide zone of:
A. hypertrophy
B. ossification
C. calcification
D. proliferation
A - the growth plate in these patients is unusually widened due to abnormal zone of hypertrophy, which can account for up to 80% of the epiphyseal plate in affected patients.
*she says this is important to know
Which of these is NOT a risk factor for SCFE?
A. Hispanic or African American
B. Overweight
C. Adolescence
D. Female
D. Males get this 2.5 times more than females. Other suspected factors include:
- seasonality: fall and spring
- low SES
- underlying endocrine abnormalities
- trauma
gold standard for SCFE treatment?
in-situ screw fixation
*if it’s a young child with high risk of a SCFE in the other hip, the surgeon may put a prophylactic pin in that one too. Open reduction is only used for unstable slips.
major complication associated with untreated SCFE?
avascular necrosis of the femoral head
limited abduction, leg length difference and a waddling gait in an older child suggest what condition has occurred bilaterally?
developmental dysplasia of the hip (DDH)
*in the newborn, it’s barlow, ortolani, galleazzi and asymmetric skin folds