Paediatric hip conditions Flashcards
first line investigation for all kids hip problems
xray
when does the problem first arise in DDH (developmental dysplasia of the hip )
perinatal period
what happens in the perinatal period in DDH (developmental dysplasia of the hip)
what does this result in
dislocation of femoral head = hip doesnt develop properly
risk factors for DDH (developmental dysplasia of the hip) (3)
breech birth
girls>boys
downs syndrome
presentation of DDH (developmental dysplasia of the hip) at birth (2)
asymmetrical extra skin fold in thigh
asymmetrical shortened limb
delayed presentation of DDH (developmental dysplasia of the hip) >2 year old (3)
painless limp
asymmetrically short leg
trendelenburg gait
what are the examination tests done on every baby after birth to screen for DDH (developmental dysplasia of the hip)
look for asymmetry
feel for click
ortolani test (opposite of barlow test)
barlow test
what is the barlow test for
how is it done
DDH (developmental dysplasia of the hip)
try and dislocate the hip posteriorly
Barlow test = looking for a dislocataBle hip
which investigation is used for DDH (Developmental dysplasia of the hip) in <3month olds
what will it show
ultrasound
dislocated hip
shallow acetabulum
which investigation if used for DDH (developmental dysplasia of the hip) in 3-6 month olds
what will it show
xray
ossified femoral head epiphysis
treatment of DDH (developmental dysplasia of the hip)
relocate hip (if >1 year old = surgery) then stabilise (eg pavlik harness)
prognosis of an early diagnosis of DDH (Developmental dysplasia of the hip)
good, 95% normal
prognosis of late diagnosis of DDH (developmental dysplasia of the hip)
what can it predispose
hip will never be normal
acetabular dysplasia
what is acetabular dysplasia
inadequate development of acetabulum
who gets acetabular dysplasia
young women
most common cause of hip pain in kids
transient synovitis of the hip (aka irritable hip)
what predisposes someone to getting transient synovitis of the hip (irritable hip)
infection (eg had the cold 2 weeks ago and now has a sore hip)
how does transient synovitis of the hip (irritable hip) present (4)
sudden onset
limp, non weight bearing
pain
previous recent infection
why do you need to do loads of investigations for transient synovitis of the hip (irritable hip)
to exclude other causes of hip pain
what investigations do you need to do for transient synovitis of the hip (irritable hip)
xray - to exclude perthes
bloods - to exclude septic arthritis
MRI - to exclude osteomyelitis
which investigation should be positive in transient synovitis of the hip (irritable hip)
inflammatory markers
treatment of transient synovitis of the hip (irritable hip)
bed rest
pain relief
self limiting condition - will be fine after a few weeks
what condition is;
idiopathic osteochondiritis (AVN) of femoral head = fracture likely = blood supply to the head of the femur is poor = poor fracture healing
perthes
bilateral perthes
skeletal dysplasia
typical patient with perthes (4)
boys
aged 4-8
hyperactive (ADHD)
short stature
presentation of perthes
hip pain
limp
Trendelenburg gait
diagnostic investigation for perthes
xray
treatment of perthes (2)
nothing
NSAIDs for pain
avoid physical activity
surgery if severe
common complication of perthes
early onset osteoarthritis
what happens in SUFE (slipped upper femoral epiphysis )
femoral head epiphysis slips inferiorly from the femoral neck
why does SUFE (slipped upper femoral epiphysis) occur
physis isnt strong enough to support body weight
risk factors for SUFE (slipped upper femoral epiphysis) (3)
boys
overweight
age 10-16
which nerve may be affected in SUFE (slipped upper femoral epiphysis)
obturator
presentation of SUFE (slipped upper femoral epiphysis)
groin/knee pain(from obturator nerve)
limp
non weight bearing (sometimes)
investigations for SUFE (slipped upper femoral epiphysis)
xrays - AP and lateral
treatment of SUFE (slipped upper femoral epiphysis)
urgent surgery - stabilisation of physis with pin
probs do both hips
complication of an unstable (non weight bearing) SUFE (slipped upper femoral epiphysis)
avascular necrosis (AVN)
