Hip Pediatric Patho

Question 1

DDH definition

Answer 1

Spectrum of conditions involving Acetabular Deficiency - shallow acetab and/or lack of complete acetab.

Question 2

DDH risk factors

Answer 2

Firstborn
Female
Family Hx
Frank breech

Question 3

DDH early diagnosis

Answer 3

Skin creases
Ultrasound
Oralani Test
Barlow Test

Question 4

Ortaloni Test

Answer 4

Flex/ABD - relocates hip, tests for dislocation.
(+) = click

Question 5

Barlow Test

Answer 5

Flex/IR - dislocates hip, tests for instability.

Question 6

DDH late diagnosis

Answer 6

Asymmetric crawling and/or walking
Limb length discrep
Limited ABDuction
Limp
Xray

Question 7

DDH intervention 0-6mo

Answer 7

Pavlik

Question 8

DDH intervention 6-18mo

Answer 8

Hip Spica Cast

Question 9

DDH intervention 2-3yr

Answer 9

Move femoral head back into place manually. Either thru manipulation, traction, or surgically.

Question 10

DDH intervention 3yr+

Answer 10

If persists, more invasive tx to get femoral head in place. Either reduction or surgery.

Question 11

LCP definition

Answer 11

Necrosis of femoral head.
End up with bone that isn’t calcified and therefore not strong bone.

Question 12

LCP risk factors

Answer 12

Common in caucasion/Hispanic
Age 4-8 & possibly into teens
Males 4-5x more likely
Older parents
Low birth weight
Delayed skeletal maturation

Question 13

LCP presentation

Answer 13

Unilateral.
Limp, gait abnormality.
Pain may be activity-dependent.
Pain: Femoral N & Obturator N distrib.

Question 14

LCP stages

Answer 14

Sclerosis of Epiphysis
Fragmentation of Epiphysis
Reossification

Question 15

LCP interventions

Answer 15

Usually no WB or activity restrictions, more based on pain.
A-Frame Cast.
Osteotomy.
Lengthing/shortening procedure maybe needed.

Question 16

SCFE definition

Answer 16

Femur shifts out of place, but epiphysis stays in place.

Question 17

SCFE MOI

Answer 17

trauma
mechanical
hormonal
genetic

Question 18

SCFE risk factors

Answer 18

obesity, mechanical stress on femoral head.

Question 19

SCFE populations

Answer 19

8-16yo
Males 2-4x more likely
Higher weight percentile

Question 20

SCFE presentation

Answer 20

Bilateral.
Similar s/s to LCP.
Limited ABD & ER.
Long-term = atrophy

Question 21

Stable SCFE

Answer 21

epiphysis & femoral head in line.
Can often WB

Question 22

Unstable SCFE

Answer 22

epiphysis & femoral head out of alignment.
Often unable to WB even w/ assist device d/t pain

Question 23

Acute SCFE

Answer 23

blood supply is interrupted

Question 24

Chronic SCFE

Answer 24

blood supply adapts

Question 25

SCFE slip angle

Answer 25

how much loss of congruency/alignment (categorized as mild, moderate, severe).

Question 26

SCFE treatment

Answer 26

Surgery: pinning + correcting alignment.
Keep in mind AVN since dealing with blood.

Question 27

If you have a pt in 8-14yo range with hip, groin, thigh, or knee pain, what MUST be ruled OUT?

Answer 27

SCFE