Hip Pediatric Patho Flashcards
DDH definition
Spectrum of conditions involving Acetabular Deficiency - shallow acetab and/or lack of complete acetab.
DDH risk factors
Firstborn
Female
Family Hx
Frank breech
DDH early diagnosis
Skin creases
Ultrasound
Oralani Test
Barlow Test
Ortaloni Test
Flex/ABD - relocates hip, tests for dislocation.
(+) = click
Barlow Test
Flex/IR - dislocates hip, tests for instability.
DDH late diagnosis
Asymmetric crawling and/or walking
Limb length discrep
Limited ABDuction
Limp
Xray
DDH intervention 0-6mo
Pavlik
DDH intervention 6-18mo
Hip Spica Cast
DDH intervention 2-3yr
Move femoral head back into place manually. Either thru manipulation, traction, or surgically.
DDH intervention 3yr+
If persists, more invasive tx to get femoral head in place. Either reduction or surgery.
LCP definition
Necrosis of femoral head.
End up with bone that isn’t calcified and therefore not strong bone.
LCP risk factors
Common in caucasion/Hispanic
Age 4-8 & possibly into teens
Males 4-5x more likely
Older parents
Low birth weight
Delayed skeletal maturation
LCP presentation
Unilateral.
Limp, gait abnormality.
Pain may be activity-dependent.
Pain: Femoral N & Obturator N distrib.
LCP stages
Sclerosis of Epiphysis
Fragmentation of Epiphysis
Reossification
LCP interventions
Usually no WB or activity restrictions, more based on pain.
A-Frame Cast.
Osteotomy.
Lengthing/shortening procedure maybe needed.
SCFE definition
Femur shifts out of place, but epiphysis stays in place.
SCFE MOI
trauma
mechanical
hormonal
genetic
SCFE risk factors
obesity, mechanical stress on femoral head.
SCFE populations
8-16yo
Males 2-4x more likely
Higher weight percentile
SCFE presentation
Bilateral.
Similar s/s to LCP.
Limited ABD & ER.
Long-term = atrophy
Stable SCFE
epiphysis & femoral head in line.
Can often WB
Unstable SCFE
epiphysis & femoral head out of alignment.
Often unable to WB even w/ assist device d/t pain
Acute SCFE
blood supply is interrupted
Chronic SCFE
blood supply adapts
SCFE slip angle
how much loss of congruency/alignment (categorized as mild, moderate, severe).
SCFE treatment
Surgery: pinning + correcting alignment.
Keep in mind AVN since dealing with blood.
If you have a pt in 8-14yo range with hip, groin, thigh, or knee pain, what MUST be ruled OUT?
SCFE
