paediatric hip conditions Flashcards
painless limp in a toddler ?
development dysplasia of the hip
what are the risk factors associated with DDH ?
female
first born
family history
breech presentation
what is the pathology associated with DDH ?
defective shallow acetabulum
coxa valga
how is screening for DDH done ?
barlow and ortolani test
what is the barlow test ?
dislocating a dislocatable hip
exit click
what is the ortolani test ?
reduce a dislocatable hip
click of entry
what is the primary modality oof imaging for DDH ?
ultrasound from birth up to 4 months of age
what is the primary imaging modality for DDH after 4 months ?
X-ray
what is the management for DDH ?
non operative - pavlik harness ( for less than 6 months of age)
closed reduction + hip spica for older babies
operative - Open reduction + hip spica (> 18 months )
Open reduction + femoral osteotomy
or pelvic osteotomy or both
what is perthes disease ?
avascular necrosis of the femoral head in children
what is the most important prognostic factor of perthes’ disease ?
sphericity of the femoral head
head to acetabulum congruence
what are the 3 stages associated with perthes disease ?
fragmentation
reossification
remodelling
what is the clinical picture of perthes disease ?
hip groin knee pain
what is notedd on examination of a patient with perthes’ disease ?
loss of internal rotation and abduction
antalgic gait early
trendelenburg gait late
limb length discrepancy
what view must be viewed in order to properly see perthes disease ?
AP and frog lateral view
what is SUFE ?
Slipped upper femoral epiphysis , happens due to proximal femoral growth plate weakness
what type of patients are more likely to have SUFE ?
obese males
what are the diseases associated with SUFE ?
hypothyroidism
growth hormone deficiency
what are the indications for endocrine work up in SUFE ?
child is under 10 years old
or his weight is more than the 50th percentile
what is the clinical presentation of SUFE ?
externally rotated limb
loss of internal rotation
what is the sign seen on AP view on xray of SUFE ?
melting ice cream cone sign
what is the treatment for SUFE ?
must be operative
Percutaneous in-situ fixation
Contralateral prophylactic fixation
what is irritable hip ?
trransient synovitis
what is the most common cause of hip pain in the paediatric age group ?
irritable hip
what must irritable hip differentiated from ?
septic arthritis
SUFE
what are the causes of irritable hip ?
usually post viral infection
after an allergic reaction
a diagnosis of exclusion
what is the prognosis for irritable hip ?
self limiting condition
a painful joint with limitation in movement is ?
septic arthritis until proven otherwise
what is the most important factor to rule out septic arthritis ?
CRP
