Paedeatric Hip Conditions Flashcards
When is DDH likely to present?
Birth to 2 years
When is Perthes likely to present?
4-8 years with peak at 6 years
When is SUFE likely to present?
10-16 years with peak at 12/13 years
What 3 bones does the acetabulum form from?
Ilium
Ischium
Pubis
What allingment are all children born with?
Valgus anteroverted femoral heads
What is DDH?
A disorder of abnormal development resulting in dysplasia and possible subluxation or dislocation of the hip secondary to capsular laxity and mechanical factors
What is included in the spectrum of DDH?
Dysplasia - shallow acetabulum
Subluxation
Dislocation
What is the epidemiology of DDH?
Most common ortho disorder in newborns
Most common in left hips in females
What is the pathophysiology of DDH?
Intial instability though to be caused by maternal and fetal laxity, genetic laxity and intrauterine and postnatal malpositioning
What is the pathoanatomy of DDH?
Initial instability leads to dysplasia
Dysplasia lead to gradual dislocation
What condition in mothers can lead to DDH?
Elhers danos
What are the risk factors for developing DDH?
Firstborns MUCH more common in females Breech presentation FMH Oligohydraminos
What is the presentation of DDH?
Early presentation: abnormality on baby screening test
Late presentation: limping child, trendelenberg gait, pain later in life
How is DDH diagnosed?
Clinical exam
Ultrasound
Radiographs later on
What abnormalities are seen on examination of DDH?
Inspection: leg lengths, restricted abduction, skin crease asymmetry
Ortolani and Barlows test
What is barlows test?
Flex hip and push backwards to try to dislocate hip
What is ortolanis test?
Abduct the hip to try to relocate the femur
Ortolani - OUT
How is DDH treated in an early presentation?
23hrs a day for up to 12 weeks until USS is normal
Then night time splinting for a few more weeks
Hips in an abducted and flexed postion
What is the treatment for a late presentation of DDH?
Closed reduction or open reduction
What is reactive synovitis?
Inflammation of the synovium, often secondary to a viral illness
What is the presentation of reactive synovitis of the hip?
Often Hx of viral illness Limp and hip/groin pain May present with referred pain to knee Hip lying flexed and externally rotated Pain at end range of hip movements Usually systemically well
How is reactive synovitis diagnosed?
Kochers critera
Ultrasound +/- aspiration
What is included in Kochers critera?
Fever of 38.5 or above
Refusal to weight bear
CRP over 2.0
Serum WBC >12,000
How is reactive synovitis treated?
Self-limiting conditon
Analgesia/ NSAIDs
Repeat review
What is septic arthrtis?
Intra-articular infection of the hip joint
Why is septic arthrtis a surgical emergency?
High bacterial load that causes sepsis
Destruction of the joint to proteolytic enzymes - pus is chondrocytic
Potential for osteonecrosis of the hip
How will septic arthritis present?
Short duration of symptoms Ubable to weight bear Hip lying flexed/ externally rotated Severe hip pain on passive movement Usually pyrexial
What is kochers critera?
To distinguish between RS and SA
If all are positive then it is SA, if 0/1/2 then likely to be RS
What is the pathophysiology of septic arthritis?
Direct inoculation from trauma or surgery
Haematogenous seeding
Extension from osteomyelitic bone
What is the most likely organism to cause SA?
Staph aureus
How is SA diganosed?
Blood tests - FBC, CRP Blood cultures Kochers critera Radiographs Ultrasound +/- aspiration in theatre
How is SA treated?
Open surgical washout with samples prior to antibiotis
Usually anterior approach
What is perthes disease?
Idiopathic AVN of the hip
What are risk factors for developing perthes disease?
Postive family history
Low birth weight
Second hand smoke
What gender is predisposed to perthes?
Males
What is the pathophysiology of perthes?
Osteonecrosis secondary to disruption of blood supply to femoral head followed by revascularisation with subsequent resorption and later collapse
Creeping substitution provides pathway for remodelling after collapse
What are the different stages of perthes?
Initial
Fragmentation
Reossification
Remodelling
What is a good prognostic factor for perthes?
Younger the age the better the prognosis due to the fact the bone still has alot of growth to do
What is the presentation of perthes?
Gradual onset of painless limp Sometimes intermittent groin pain Hip stiffness (internal rotation and abduction)
How is perthes disease diagnosed?
Radiographs
MRI
How is perthes disease diagnosed?
Restrict weight bearing
Maintain ROM with physiotherapy
Surgery in young patients with severe diseae and deformity
What is SUFE?
A condition affecting the proximal femoral physis that leads to slippage of the metaphysis relative to the epiphysis
What are the risk factors for SUFE?
Males
Obesity
Endocrine disoders: GH deficiency, panhypopitutarism, hypothyrodism
How will SUFE present?
Variable length of symptom development
Groin pain
Antalgic limp
Obligatory external rotation of hip flexion
How is SUFE diagnosed?
Radiographs
MRI
How is SUFE treated?
Surgery; percutaneous pinning of the hip
