ortho Flashcards
Give the main causes of hip pain in children, by age
- developmental dysplasia of hip 0-2yrs
- septic hip 0-4 yrs
- perthes 4-8 yrs
- transient synovitis 4-8 yrs
- slipped upper femoral epiphysis 10-16 yrs
- trauma (any)
What is developmental dysplasia of the hip?
the acetabulum is shallow, predisposing to dislocation which stretches the ligaments around the joint. Can be dislocated, dislocatable or subluxatable.
Give 4 risk factors for developmental dysplasia of the hip
- girls
- firstborn
- born in breech position
- fhx
- oligohydramnios
Give 4 signs of DDH
- leg length discrepancy
- uneven skin folds on thighs
- less mobility or flexibilty on one side
- limping, toe walking or waddling gait
- barlow and ortolani test positive
How is DDH managed?
New born: pavlik harness for 1-2 months , this helps tighten the ligaments around the hip joint
6 months: closed reduction and spica cast
6 months-2 yrs: ir harness/ casts not successful open surgery is necesary
What are kochers criteria for septic arthritis?
- fever >38.5
- non weight bearing on affected side
- esr >40
- WCC> 12
What is perthes disease
where the blood supply to the growth plate of the epiphysis becomes inadequate resulting in AVN of the head of the femur. over several months the blood vessels may regrow and the bone will remodel as blood supply is returned to the dead bone tissue
How does perthes present?
- insidious onset hip or goin pain, somtimes knee pain or limb
- wasting of muscles in upper thigh
- stiffness
- shortening of leg
- usually presents age 4-10
How is perthes managed?
- most heal spontaneously
- physio + encourage swimming and avoid heavy impact
- red rest or crutches may be needed for short period of time
- plaster cast and THR may be needed in severe cases of older children
- worse prognosis if age >6 or >1/2 epiphyseal plate involved
How does transient synovitis present?
- acute onset
- limp
- pain on movement (esp int. rotation) which gradually gets worse over time
- holding the hip flexed and rotated
- usually only affects one side
- may be history of recent infection/ vaccination
- WBC may be raised but only slightly, systemically well (wont be in septic arthritis)
How is transient synovitis managed?
- rest
- NSAIDs
- should get better within 4 days
- investigate for septic arthritis if unsure
- 3% may develop perthes
What is slipper upper femoral epiphysis (SUFE) and what are risk factors?
- upper epiphysis of femur slips down and backwards off the neck of femur
- RFs: teenage boys who are overweight or rapidly growing, fhx, hyperthyroidism, can develop suddenly from minor fall but most develop gradually
How may SUFE present?
- acute onset following minor trauma, or insidious onset
- pain in hip, knee, groin
- limping
- stiffness and instability
- reduced adduction, int & ext rotation of leg**
- often in overweight childen
What are the two types of SUFE? How is it investigated?
Stable: able to weight bear
UNstable: NWB even with crutches, needs urgent treatment
Xray is needed to see klein line though epiphyses
How is SUFE managed?
in situ open fixation
