Limping Child

Question 1

Define Developmental dysplasia of hip

Answer 1

Abnormal growth of hip due to ligamentous laxity and shallow acetabulum. Can be caused by tight swaddling of hips (hip adduction)

Question 2

Signs of DDH

Answer 2

• stiff hip joint
• painful knee or groin
• limp
• leg length discrepancy
• ortolani test positive

Question 3

Complications of DDH

Answer 3

• Avascular necrosis of femoral head
• hip stifness
• painless limp progressing to early arthritis

Question 4

Management of DDH

Answer 4

• Pavlik harness if less than 6m
• Closed reduction +/- hip spica greater than 6m
• Open reduction greater than 2 y/o

Question 5

Define Perthes Disease

Answer 5

Collapsed or fractured femoral head caused by disruption of blood supply to femoral head (AVN)

Question 6

Signs of Perthes

Answer 6

-Groin/knee pain
-decreased ROM
-limp
-leg length discrepancy
(typically 3-11 years old)

Question 7

Management of Perthes

Answer 7

Principles: Reduce pain, prevent loss of ROM, minimise femoral deformity

• removal of mechanical pressure from hip joint (traction, brace, physio, surgery)
• No Mx if less than 6 y/o
• non-weight bearing exercise is good (swimming and cycling)