Paediatric Hip Conditions Flashcards
Miss S Gill
DDH presents…
birth - 2 years
perthes presents…
4-8 years
SUFE presents…
10 - 16 years
name the 3 bones that contribute to the acetabulum
ilium
ischium
pubis
DDHencompasses a _______ of disease that includes:
_________ - a shallow or underdeveloped acetabulum;
___________;
___________
dysplasia - a shallow or underdeveloped acetabulum
subluxation
Dislocation
DDH most commonly affects what sex?
female
DDH is rarely seen in patients of what descent?
african
name the risk factors of DDH
firstborns
females
breech
FH
name the patient presentation of DDH
abnormality on screening
limping child - trendelenberg gait
pain
what are the 2 clinical tests performed in DDH?
ortolani
Barlows
name the treatment of the early presentation of DDH
pelvic harness
23 hours a day for 12 weeks
what position is the hip in a pavlik harness?
abducted
flexed
name the treatment of the late presentation of DDH
surgery
Closed reduction +/- tenotomies + spica
Open reduction + osteotomies + spica
reactive synovitis is ____________ of the ________, often secondary to a _____ illness
reactive synovitis is inflammation of the synovium, often secondary to a viral illness
what is the patient presentation in reactive synovitis?
viral illness limp and pain referred pain to knee pain at end range of movement systemically well
what is the diagnosis of reactive synovitis?
Kochers criteria
Ultrasound +/- aspiration
what does koshers criteria distinguish between?
RS and sept arthritis
koshers criteria is graded between what?
0-4
fever of 38.5
refusal to weight bear
high CRP
WBC > 12000
what is the treatment in reactive synovitis?
Self-limiting condition
Analgesia / NSAIDs
Repeat review / admission if any concern
septic arthritis of the hip joint is a medical emergency
true or false?
true
what is the patient presentation of septic arthritis of the hip?
short duration can't bear weight hip/groin pain severe pain pyrexial
how can you get septic arthritis?
trauma
surgery
osteomyelitis spread
name the number 1 bug that causes septic arthritis
staph. aureus
how do you diagnose septic arthritis of the hip?
blood test blood cultures kochers criteria radiographs US +/- aspiration
what is the treatment in septic arthritis?
open surgical washout
antibiotics 6/52
what is (Legg-Calve-) Perthes disease?
avascular necrosis of the hip
what is the cause of (Legg-Calve-) Perthes disease?
idiopathic - unknown
in what sex is (Legg-Calve-) Perthes disease more common?
males
what age is (Legg-Calve-) Perthes disease more common?
4-8 years old
bilateral (Legg-Calve-) Perthes disease is seen at the same time
true or false?
false - NEVER at the same time!
what are the risk factors of (Legg-Calve-) Perthes disease?
FH low birth weight second hand smoke asian inuit central european
what happens in (Legg-Calve-) Perthes disease?
osteonecrosis occurs secondary to disruption of blood supply to femoral head
name the 4 stages in (Legg-Calve-) Perthes disease
initial
fragmentation
reossification
remodelling
the younger at presentation, the better the prognosis in (Legg-Calve-) Perthes disease
true or false?
true
whats the diagnosis in (Legg-Calve-) Perthes disease?
radiographs and MRI
what is the aim in treatment of (Legg-Calve-) Perthes disease?
to keep the femoral head round whilst the process self-terminates
what is the treatment in (Legg-Calve-) Perthes disease?
restrict weight-bearing
physiotherapy
surgery only in young with severe disease or older with secondary osteoarthritis
what does SUFE stand for?
slipped upper femoral epiphysis
SUFE is a condition affecting the ________ femoral ______ that leads to slippage of the __________ relative to the _________.
SUFE is a condition affecting the PROXIMAL femoral PHYSIS that leads to slippage of the METAPHYSIS relative to the EPIPHYSIS
what age range of patients does SUFE affect?
10-16 years
what are the risk factors in SUFE?
male
obesity
endocrine disorders
diagnosis of SUFE is via radiograph and MRI
true or false?
true
what is the treatment in SUFE?
SURGERY
Percutaneous pinning of the hip
+/- pinning of the other side
+/- open reduction if a very severe slip
what bone makes up the superior part of the obturator foramen and which bone makes up the inferior part?
superior - pubis
inferior - ischium
whats the difference between rubbish and an Irish girl?
rubbish gets you picked up
