Hip problems Flashcards
Developmental Dysplasia of the Hip
Often picked up on newborn examination Barlow's test, Ortolani's tests are positive Unequal skin folds / leg length 1-3% of neonates 20% bilateral, left hip more than right
Transient Synovitis (irritable hip)
Typical age group = 2-10 years
Acute hip pain associated with viral infection
Commonest cause of hip pain in children
Perthes disease
Degenerative condition affecting hip joints - avascular necrosis of femoral head
4-8 years
5 times more common in boys, 10% of cases bilateral
Features:
Hip pain - develops gradually over a few weeks
Limp
Stiffness and reduced ROM
Widening of joint space, decreased femoral head size / flattening
Slipped Upper Femoral Epiphysis
Typical age group = 10-15 years
Most common in obese children and boys
Displacement of the femoral head epiphysis postero-inferiorly
Bilateral slip in 20%
May present acutely following trauma or more commonly with chronic, persistent symptoms
Features: knee or distal thigh pain common, loss of internal rotation
Juvenile Idiopathic Arthritis (JIA)
< 16 years, > 3 months
Pauciarticular refers to cases where 4 or less joints are affected (60%)
Features: joint pain and swelling (usually medium sized joints e.g. knees, ankles, elbows), limp, ANA may be positive (associated with uveitis)
Septic Arthritis
Acute hip pain associated with systemic upset
Inability / severe limitation of affected joint
DDH RF
Girls (80%) First born Breech delivery (vaginal or caesarean) Oligohydramnios Multiple pregnancy Prematurity Neuromuscular disorder FH
Indications for hip USS (DDH)
FH of DDH or possible DDH (hip problems in early life)
Breech at any point after 36 weeks
Breech at delivery if delivery < 36 weeks
Suspicion of DDH on clinical testing
Management of DDH
Most unstable hips stabilise spontaneously by 2-6 weeks age
Harness / splint used to maintain hip reduction as soon as diagnosis confirmed
Surgery: no response to harness / splint, late diagnosis and not suitable for harness / splint
