Lecture 28 Children’s Orthopaedics- The Big 3 DDH, Perthes Disease and SUFE

Question 1

What are the aetiologies of developmental dysplasia of the hip (DDH)

Answer 1

Eastern Europeans
Inuit
More common in girls
More common on the left hip

Question 2

What are the risk factors for DDH

Answer 2

First born children
Oligohydraminos- reduced fluid in uterus
Breech presentation
Lower limb deformities
Increased birth weight

Question 3

What are the clinical features of DDH

Answer 3

Ortolani’s sign
Barlow’s sign
Piston motion sign
Hamstring sign

Question 4

What is the treatment for DDH

Answer 4

Splintage
• 3 months- 1-year hip becomes more stiff- spica cast and anaesthetic
• >1-year-old- open reduction
• > 18 months- femoral shortening and peri-acetabular osteotomy
• >6 years and bilateral leave alone
• > 10 years and unilateral leave alone
• The older the child the poorer the result- worst associated with AVN

Question 5

How is DDH screened

Answer 5

All babies are examined at birth

Question 6

What are the typical features of someone with Perthes Disease

Answer 6

Male
Primary school age
Short stature
Limp
Knee pain on exercise
Stiff hip joint
Systemically well

Question 7

What is the aetiology of Perthes disease

Answer 7

• Pathologically avascular necrosis of hip
• Possible relationship to coagulation tendency
• Possible relationship to repeated minor trauma
• Familial tendency
• Classically low social status

Question 8

What is the prognosis of Perthes disease

Answer 8

Younger patients do better
Dependent on proportion of head involved
The nearer the head is to the round the better the outlook

Question 9

How is Perthes disease treated

Answer 9

• Maintain hip motion
• Analgesia
• Restrict painful activities
• Splints, physio, NWB not proven
• “Supervised neglect” in most cases
• 2-3 years condition will improve
• Consider osteotomy in selected groups of older children (>7)
• 10% bilateral

Question 10

What is SUFE- Slipped Upper Femoral Epiphysis

Answer 10

• Displacement of femur through hypertrophic zone

* Metaphysis moves anterior and proximal

Question 11

What is the common clinical presentation of SUFE

Answer 11

• Left groin pain 3 months
• Teenage boys
• 20% become bilateral
• Overweight
• Small proportion endocrine abnormalities

Question 12

What are the classification of SUFE

Answer 12

• Acute
• Chronic >3 weeks
• Magnitude of slip (angle or proportion)
• Stable – able to weight bear (good prognosis)
• Unstable- unable to weight bear (poor prognosis)

Question 13

How is SUFE diagnosed

Answer 13

• Pain in hip or knee
• Externally rotated posture & gait
• Reduced internal rotation, especially in flexion
• Plain X-rays- best seen on lateral view

Question 14

How is SUFE is treated

Answer 14

Stable slips are pinned

Unstable slips- open reduction but AVN high risk