Hip Pathologies (mainly paediatric) Flashcards
Transient synovitis presentation
Diagnosis of exclusion, most common hip pain in children 2-10
Hip pain following viral URTI/autoimmune
Worry about septic arthritis/juvenile idiopathic arthritis if other joints involved
Transient synovitis treatment
Self-limiting with rest + analgesia
Perthes’ Disease pathology
Idiopathic avascular necrosis of femoral head, 10% of cases bilateral
Ischaemia is self-healing but remodelling of bone distorts epiphysis -> abnormal ossification
Perthes’ Disease presentation
3-11 years, 4x more likely in boys
Hip pain progressively over weeks
Limp, stiffness+reduced ROM in hip
Perthes’ Disease diagnosis
X ray: early shows widening of joint space, late shows decreased femoral head size/flattening
Perthes’ Disease treatment
Less severe (<1/2 fem head affected on lateral, joint space depth preserved) bed rest and NSAIDs until pain-free then XR monitoring Severe (>1/2 fem head affected, narrowing of total joint space) then surgery
Perthes’ Disease complications
OA earlier than normal and hip replacement needed, better prognosis in younger <6 yrs
Slipped upper femoral epiphysis presentation
10-16 yrs, 20% bilateral, 50% obese
Epiphysis slips down and back
90% can weight-bear but limping and pain in groin/anterior thigh/knee
Flexion, abduction, medial rotation limited
Slipped upper femoral epiphysis diagnosis
AP + lateral xray shows displaced growth plate
Slipped upper femoral epiphysis complications
Delayed diagnosis can result in progression of slip
Avascular necrosis of femoral head
Early OA
Slipped upper femoral epiphysis treatment
Surgery - early internal fixation to stabilise slippage - encourage physeal closure
Developmental dysplasia of the hip risk factors
Breech birth (caesarean or vaginal) Inc birth weight Postmaturity Oligohydramnios Older mother Sibling with DDH
Developmental dysplasia of the hip diagnosis
US up to 4.5mths, pelvic xray after
Clinical hip tests
DDH clinical tests - Reducible dislocation
Ortolani manoeuvre - Child’s hip flexed + abducted, push greater trochanter to relocate hip into acetabulum, clunk if positive
DDH clinical tests - Sublux/dislocate unstable hip
Barlow manoeuvre - Hip flexed + adducted, axial load on femur dislocates femoral head if positive
DDH clinical tests - shortening of femur due to DDH
Galeazzi test - Child supine with flexed hips + feet flat on table touching buttocks, different height knees is positive test, negative if both dislocated
Developmental dysplasia of the hip signs
Widened perineum
Buttock flattened on affected side
Unequal leg length/groin creases
Limited abduction if >3 mths
Developmental dysplasia of the hip treatment
Delay treatment for 6 wks from diagnosis to see if spontaneously resolves
<6mths flexion-abduction splint (Pavlik Harness, beware avascular necrosis)
6-18mths closed reduction
>18 mths open reduction with corrective osteotomy for femur/pelvis as needed
Club foot (talipes equinovarus) conditions
Foot is:
Inverted
Adducted relative to hindfoot (which is in varus)
Plantarflexion deformity
Club foot treatment
Ponseti method - foot manipulated + repeatedly placed in long leg plaster cast to correct forefoot adduction + hindfoot varus, gradual correction
If needed, soft tissue release 6-12mths with further surgery on bones later in childhood
Posterior hip dislocation presentation
RTC, knee strikes dashboard
Femoral head felt in buttock
Leg is flexed, internally rotated, adducted and shortened
Often associated with # of femoral head/neck/shaft
Posterior hip dislocation complications
Sciatic nerve laceration/stretch/compression
Equinus foot deformity if untreated
Posterior hip dislocation treatment
Reduction under GA <4 hrs to prevent AVN
Traction for 3 weeks promotes joint capsule healing
