Ortho - DDH, Perthes, Transient synovitis, SUFE

Question 1

What is developmental dysplasia of the hip?

Answer 1

Failure of hip joint to develop properly into a spherical socket with complete acetabulum, leading to propensity to sublux and dislocate

Question 2

What are the complications of dysplasia, subluxation, and dislocation?

Answer 2

Dysplasia - Early hip osteoarthritis (30-40yrs)
Subluxation - 10-20ys OA
Dislocation - limp, pain, early OA

Question 3

Name 4 risk factors for DDH. What is the strongest risk factor?

Answer 3

First born child
Female
Breech
Oligohydramnios
Macrosomia
Other ‘packaging’ problems (torticollis, plagiocephaly, talipes)
First degree relative - strongest risk factor

Question 4

What 2 examinations do you do for DDH in a newborn (

Answer 4

Barlow - flex hip to 90 degrees, adduct and press down (try to dislocate)
Ortolani - abduct flexed hip (try to relocate)

Question 5

How do you identify DDH if > 4 weeks on examination?

Answer 5

Decreased abduction

Galeazzi’s sign (bring feet to bottom in supine position, see if 1 knee is lower than other knee)

Question 6

What Ixs are best for DDH if > 5 months or

Answer 6

5 months - X-ray

Question 7

What is the main treatment for DDH?

Answer 7

Brace treatment to stabilise hip

Question 8

What is Perthes’ disease? What ages are usually affected? What do they present with?

Answer 8

Avascular necrosis of capital femoral epiphysis. Usually 4-8 years. Present with hip pain and limp with restricted hip movement on examination. Can be bilateral.

Question 9

What is transient synovitis? What ages are usually affected? What do they present with? 1 important Ddx?

Answer 9

A limp secondary to a viral infection (usually URTI). Usually in 3-8 year olds. Present with painful limp 1-2 weeks after viral URTI. Otherwise afebrile and well. Can have some decrease in hip ROM (especially internal rotation). Severe decrease in ROM suggests septic arthritis. Diagnosis of exclusion

Question 10

What is SUFE? What ages are usually affected? What do they present with?

Answer 10

Slipped Up Femoral Epiphysis. Late childhood/early adolescence. Will often be a fat kid presenting with pain in hip or knee and limp. Hip looks short, externally rotated, with decreased ROM. Can be bilateral

Question 11

Name 2 general pieces of advice for a child with a limp. When should you refer a limp to a speciality team?

Answer 11

Bed rest
Adequate analgesia - NSAIDS +/- paracetamol

Refer if there’s suspicion of septic arthritis/osteomyelitis, SUFE, Perthes, malignancy, if child’s presented multiple times, or if symptoms > 4 weeks.

Question 12

Name 6 Ddx (can be quite general) for a child with a limp

Answer 12

Infection (osteomyelitis/septic arthritis)
Trauma (fracture)
Rheumatological (juvenile arthritis, reactive arthritis, vasculitis)
Malignancy (ALL, bone tumours)
NAI
Developmental problems (DDH, Perthes, SUFE)
Transient synovitis
Appendicitis
Testicular torsion
Functional limp

Question 13

Name 4 red flags for a child with a limp

Answer 13

Fever and severe pain (septic arthritis)
Constitutional symptoms of malignancy
Completely non-weightbearing
Inconsistent Hx (injury doesn’t match Hx, or you don’t think child’s development matches Hx) - NAI