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MSK > Paediatric Hip Conditions > Flashcards

Paediatric Hip Conditions Flashcards

1
Q

what hip conditions can cause the ‘limping child’ presentations

A 
DDH (developmental dysplasia of the hip)
reactive synovitis 
septic arthritis 
perthes 
SUFE
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2
Q

when do you get DDH

A

birth- 2 years (and plus)

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3
Q

when do you get perthes

A

4-8 ( 6 years peak)

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4
Q

when do you get SUFE

A

10-16 years

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5
Q

why does children acetabulum look like it has a hole in it

A

as just cartilage, ossifies over time

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6
Q

why are x rays not as good for hip joints in kids

A

as a lot of femoral head will be cartilage- ultrasound better

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7
Q

at what age does the greater trochanter show on an x ray

A

age 6

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8
Q

what is developmental dysplasia of the hip

A

disorder of abnormal development resulting in dysplasia and possible subluxation of the hip secondary to capsular laxity and mechanical factors

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9
Q

describe the dysplasia in DDH

A

shallow or underdeveloped acetabulum

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10
Q

what is capsular laxity more common in females

A

as they have more ligamentous laxity

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11
Q

what is the most common orthopaedic disorder in newborns

A

DDH

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12
Q

in who and which hip is DDH most common

A

in females in left hip (due to position in utero)

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13
Q

can you get bilateral DDH

A

yes 20% of cases

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14
Q

why is DDH seen in native american and laplanders but not africans

A

as papoose buts babys legs straight but baby sling puts hips in safety position- flexed and abducted

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15
Q

what is the pathphysiology of DDH

A

maternal and fetal laxity, genetic laxity, intrauterine and postnatal malpositioning= initial instability

initial instability=dysplasia

dysplasia= gradual dislocation

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16
Q

what happens in newborns when the femoral head isn’t properly positioned in the acetabulum

A

normal growth of femoral head and acetabulum not stimulated

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17
Q

what are the risk factors for DDH

A 
first borns 
breech postition 
family history 
6 x more common in females
oligohydramnios (not enough amniotic fluid)
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18
Q

what is the presentation of DDH

A

abnormality on screening (early)

limping child (late):
- trendellenberg gait

pain in later life, secondary arthritic changes

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19
Q

what should be done in clinical examination of DDH in new borns

A

inspection: leg lengths, restricted abduction, skin crease asymmetry

ortolani test- abducting the hips to try and relocate hip, fingers push femur forwards into acetabulum (already Out)

barlow test- pushing backwards to try to dislocate hip

20
Q

what is the treatment for early presentation DDH

A

pavlik harness- keeps hips abducted and flexed- 23 hours a day for up to 12 weeks

21
Q

what is the treatment for late presenting DDH

A

surgery

  • closed reduction +/- tenotomies + spica
  • open reduction +/- osteotomies + spica
22
Q

what criteria distinguishes between reactive are septic arthritis

A

kochers criteria; fever, refusal to bear weight, ESR, serum WBC, CRP

23
Q

what is the presentation of reactive arthritis

A 
Hx of viral illness
limp and hip/groin pain 
may present with referred pain to knee 
hip lying flexed/ externally rotated 
pain at end range of hip movements 
systemically well. apyrexial
24
Q

how do you diagnose reactive synovitis

A

kochers, ultrasound (fluid in hip) +/- aspiration

25
Q

what is the treatment for reactive synovitis

A

self limiting
analgesia/ NSAIDs
repeat review/ admission if any concern

26
Q

why is septic arthritis a surgical emergency

A

high bacterial load that causes sepsis
destruction of the joint due to proteolytic enzymes
potential for osteonecrosis of the hip due to increased pressures

27
Q

what is the presentation of hip septic arthritis

A 
short duration of symptoms 
unable to weight bear and hip/groin pain 
hip lying flexed/externally rotated 
severe hip pain on passive movement
usually pyrexial
28
Q

how can septic arthritis get into the joint

A

direct inoculation (trauma/ surgery)

haematogenous seeding

extension from adjacent bone (osteomyelitis)

can develop from contiguous spread from osteomyelitis

29
Q

septic arthritis can psread from highly vasular metaphysis to joints (common in neonates who have transphyseal vessels). what joints have intra articular metaphysis

A

hip, shoulder, elbow, ankle

30
Q

what is the most common causative organisms of septic arthritis of the hip

A

staph aureus

31
Q

how do you diagnose septic arthritis

A

blood test, blood cultures, kochers criteria, radiographs, ultrasound +/- aspiration

32
Q

what is the treatment for septic arthritis

A

open surgical washout

antibiotics

33
Q

what is perthes disease

A

avascular necrosis of the hip (idiopathic)

34
Q

who gets perthes

A

4-8 year olds, more common in boys, higher in lower socioeconomic class

35
Q

what are the risk factors for perthes

A

positive family history,
low birth weight,
second hand smoke,
asian, inuit and central american decent

(abnormal clotting factors, repeated trauma. mechanical overload)

36
Q

what is the pathophysiology of perthes disease

A

osteonecrosis occurs secondary to disruption of blood supply to femoral head

followed by revascularisation with subsequent resorption and later collapse

creeping substitution pathway for remodelling after collapse

37
Q

what are the stages of perthes disease

A

initial
fragmentation
reossification
remodelling

38
Q

what factors can improve prognosis of perthes

A

younger age at presentation

preservation of a round femoral head

39
Q

how does perthes present

A 
gradual onset of painless limp 
sometimes intermittent groin pain 
hip stiffness 
(internal rotation and abduction) 
limp- trendellenberg, antalgic
40
Q

how do you diagnose perthes

A

radiographs, MRI

41
Q

what is the treatment for perthes

A

keep femoral head round whilst the process self terminates
restrict weight bearing
physio to maintain ROM

surgery in severe disease/ deformity

42
Q

what is SUFE

A

slipped upper femoral epiphysis

affects proximal femoral physis- leads to slippage of the metaphysis relative to the epiphysis

43
Q

what are the risk factors for SUFE

A 
males 
obesity 
endocrine disorders 
-growth hormone deficiency 
-panhypopituritarism 
-hypothyroidism 
growth spurts
44
Q

how does SUFE present

A 
groin pain (or knee/ thigh) 
limp 
-externally rotated foot 
-antalgic 
obligatory external rotation on hip rotation
45
Q

how do you diagnose SUFE

A

radiographs, MRI

46
Q

what is the treatment of SUFE

A

surgery- percutaneous pinning of the hip

MSK (71 decks)

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