Hip pain in children

Question 1

Causes of hip pain in children

Answer 1

1. DDH
2. Congenital subluxation of hip and acetabular dysplasia
3. Transient synovitis
4. Perthes
5. Septic arthritis/osteomyelitis
6. SCFE
7. Bone cyst - fractures

Question 2

DDH c/f

Answer 2

Developmental dysplasia of hip
1. Femoral head underdeveloped
2. 5 F’s
●Female
●First born
●Fam h/o
●Foot abnormalities
●Funny delivery - Csec,
breech/transverse
3. BARlow (head goes out),
ortolani (head comes back in) tests
Can be diagnostic upto 2 months
4. USG - >2months
5. Xray - > 6months

Question 3

DDH diagnosis

Answer 3

1. BARlow (head goes out),
   Ortolani (head comes back in) tests
   Can be diagnostic upto 2 months
   Screening day1, until discharge, 6wks
2. USG - >2months
3. Xray - > 6months
   ●Halingers line - top of femur
   heads(not aligned)
   ●*Shentons line - broken
   Perkins line

Question 4

DDH complications

Answer 4

Delayed walking
Limping
(Head out of Acetabulum)

Question 5

DDH Mx

Answer 5

0-6months:
Abduction splint (Pavlik harness)

3-18months:
Reduction (open/closed) and cast(pelvic spica)

> 18months:
Open reduction, +/- osteotomy

Question 6

Perthes disease

Answer 6

1. Avascular necrosis of femur head
2. Male, 4-8yrs limping, pain
3. Limited Abd & IR
4. Xray comparing both heads of femur
5. Mx: Immediate refer to surgeon
6. Course:
   Flattening of head, osteoarthritis
   (OR)
   Heal

Question 7

**Transient synovitis c/f

Answer 7

1. Irritable hip syndrome
2. Synovial inflammation - self limiting
3. Post URTI/viral infection
4. Abd > IR, all limitations
5. Imp DD: Septic arthritis (fever)

Question 8

Transient synovitis diagnosis, mx

Answer 8

Blood tests, ESR, Xray normal
USG - fluid in joint

Mx: self limiting (with in 7 days)
Bed rest
Crutches

f/u Xray 4-6months to exclude perthes

Question 9

SCFE

Answer 9

Slipped capital femoral epiphysis
1. Obese, 10-15yrs
2. IR> all movement limitations
3. Xray - Hip AND KNEE
4. Mx:
●Rest
●Urgent referral
●Acute - reduction via traction (to prevent avascular necrosis) and pin(best)

Question 10

Septic arthritis

Answer 10

1. Acute pain, restriction of joint, fever
2. Xray, USG, CBP, ESR, Bone scan
3. Confirmation: needle aspiration
4. IV antibiotics, joint washout - arthotomy

DD: Irritable hip syndrome/Transient synovitis

Question 11

Septic arthritis vs osteomyelitis

Answer 11

SA - diffused pain

OM- point tenderness