ortho Flashcards
A 7-year-old with a one day history of a painful right hip. Just about able to walk but painful. Looks flushed and has a temperature of 38.7ºC
Dx?
Septic arthritis/osteomyelitis
The child is too unwell to make a diagnosis of transient synovitis
An 8-month-old child is noted to have a discrepancy between the skin creases behind the right and left hips
Dx?
Development dysplasia of the hip
An obese 13-year-old boy presents with a two week history of right sided knee pain associated with a stiff right hip. There is no history of trauma
Dx?
Slipped upper femoral epiphysis
what is Perthes’ disease?
degenerative condition affecting the hip joints of children, typically between the ages of 4-8 years.
due to avascular necrosis of the femoral head, specifically the femoral epiphysis.
Impaired blood supply to the femoral head –> bone infarction.
Perthes’ disease is more common in…
boys (5x)
10% bilateral
what are the features of Perthes’ disease?
1) hip pain: develops progressively over a few weeks
2) limp
3) stiffness and reduced range of hip movement
4) x-ray: early changes include widening of joint space, later changes include decreased femoral head size/flattening
how to dx Perthes’ disease?
1) plain x-ray
2) technetium bone scan or MRI if normal x-ray and symptoms persist
what are the complications of Perthes’ disease?
1) osteoarthritis
2) premature fusion of the growth plates
what is the mx of Perthes’ disease?
1) To keep the femoral head within the acetabulum: cast, braces
2) If less than 6 years: observation
3) Older: surgical management with moderate results
4) Operate on severe deformities
what are the risk factors of developing developmental dysplasia of the hip (DDH)?
1) female (6x)
2) breech
3) +ve fam hx
4) firstborn
5) oligohydramnios
6) birth wt >5kg
7) congenital calcaneovalgus foot deformity
how is screening for DDH done?
1) routine ultrasound examination for infants with:
- 1st degree fam hx of hip problems in early life
- breech presentation at/after 36 weeks gestation
- multiple pregnancy
2) all infants screened at newborn baby check and 6-week baby check using Barlow and Ortolani tests
what is a Barlow test?
attempts to dislocate an articulated femoral head
what is an Ortolani test?
attempt to relocate a dislocated femoral head
what are the other important factors to look out for on clinical examination of the hip for DDH?
- symmetry of leg length
- level of knees when hips and knees are bilaterally flexed
- restricted abduction of the hip in flexion
what is used to confirm dx of DDH?
ultrasound
however, if infant >4.5 months, then X-ray is first line
what is the mx for DDH?
- 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
why is a slipped upper femoral epiphysis (SUFE) an emergency?
risk of avascular necrosis of the femoral head –> immediate referral to paediatric orthopaedics.
in whom is a SUFE classically seen in?
- 10-15 years old
- More common in obese children and boys
how does a SUFE present?
May present acutely following trauma or more commonly with chronic, persistent symptoms
what are the features of a SUFE?
- hip, groin, medial thigh or knee pain
- loss of internal rotation of the leg in flexion
- bilateral slip in 20% of cases
how is a SUFE diagnosed?
AP and lateral X ray (typically frog-leg) views
how is a SUFE managed?
internal fixation: typically a single cannulated screw placed in the center of the epiphysis (growth plate)
what should you do for a child < 3 years old presenting with an acute limp?
urgent assessment in secondary care as they are at higher risk of septic arthritis and child maltreatment
- Acute onset
- Usually accompanies viral infections, but the child is well or has a mild fever
- More common in boys, aged 2-12 years
Transient synovitis
