musculoskeletal disorders Flashcards
1
Q
RFs of DDH
A
- female sex: 6 times greater risk
- breech presentation
- positive family history
- firstborn children
- oligohydramnios
- birth weight > 5 kg
- congenital calcaneovalgus foot deformity
2
Q
when do u screen for DDH
A
the following infants require a routine ultrasound examination
- > first-degree family history of hip problems in early life
- > breech presentation at or after 36 weeks gestation, irrespective of presentation at birth or mode of delivery
- > multiple pregnancy
all infants are screened at both the newborn check and also the six-week baby check using the Barlow and Ortolani tests
3
Q
clincial examination of DDH
A
- Barlow test: attempts to dislocate an articulated femoral head
- Ortolani test: attempts to relocate a dislocated femoral head
- other important factors include:
symmetry of leg length
level of knees when hips and knees are bilaterally flexed
restricted abduction of the hip in flexion
4
Q
imaging of DDH
A
- > ultrasound is generally used to confirm the diagnosis if clinically suspected uNTIL 3M of age
- plain films shentons line should form a smooth arc
- > however, if the infant is > 4.5 months then x-ray is the first line investigation
5
Q
Mx of DDH
A
- > most unstable hips will spontaneously stabilise by 3-6 weeks of age
- > Pavlik harness (dynamic flexion-abduction orthosis) in children younger than 4-5 months
- > older children may require surgery - osteotomy and hip realignment
6
Q
presentation of perthes
Ix
Mx
A
hip pain
5-12 years
- xray - flattened femoral head
remove pressure from joint to allow normla development
- physio
7
Q
presentation of slipped upper femoral epiphysis
Ix
Mx
A
- obese male
- pain referred to knee
- limitation to internal rotation is usually seen
xray - femoral head displaced and falling inferolaterally (like a melting ice cream cone) The Southwick angle gives indication of disease severity
mx
bed rest and non-weight bearing
