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FINALS > paediatric hip disorders > Flashcards

paediatric hip disorders Flashcards

1
Q

what is genu varum?

A

bowed legs

angulation of distal segment of legs towards midline

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2
Q

what is genu valgus?

A

knocked knees

normal legs have a small degree

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3
Q

what is blount’s disease?

A

type of bowed legs due to growth arrest of medial tibial physis

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4
Q

what does blount’s disease look like on x ray?

A

beak like protrusion

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5
Q

what type of arthritis does genu varum cause?

A

medial osteoarthritis

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6
Q

what type of arthritis does genu valgus cause?

A

lateral osteoarthritis

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7
Q

what are the causes of intoeing (pigeon toed)?

A

femoral neck antiversion
internal tibial torsion
forefoot adduction

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8
Q

what do children sit like with femoral neck anti version?

A

W position

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9
Q

when does internal tibial torsion normally resolve?

A

seen in toddlers, resolved by age 6

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10
Q

when does forefoot adduction normally resolve?

A

resolves with time, don’t operate before aged 7/8

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11
Q

what are the two types of flat feet?

A

flexible and rigid

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12
Q

what causes flexible flat feet?

A

tibialis posterior tendon dysfunction

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13
Q

what may make flexible flat feet present?

A

when weight bearing

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14
Q

what is jack’s test for flat feet?

A

medial arch forms with dorsiflexion of big toe

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15
Q

what causes rigid flat feet?

A

underlying bony connections

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16
Q

what toe most commonly causes curly toes?

A

5th

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17
Q

who and where is DDH most common?

A

left hip in girls

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18
Q

what are the risk factors for DDH?

A 
first born
breach birth 
family history 
oligohydraminos 
Down syndrome 
congenital disorders (club foot)
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19
Q

what are complications of DDH?

A 
limping child (late)
severe arthritis (secondary)
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20
Q

what are the symptoms of DDH?

A

limbing shortening
asymmetrical limb crease
restricted abduction

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21
Q

how do you do Ortolani’s test?

A

abduction and push hip anteriorly

22
Q

what is a positive Ortolani’s test?

A

clunking sound as femoral head relocates in acetabulum

23
Q

what is Barlow’s test?

A

adduction and push hip posteriorly

24
Q

what is a positive Barlow’s test?

A

clunking sound as femoral head dislocates

25
Q

what is used to diagnose DDH?

A

ultrasound

can’t use x-ray as femoral head unossified

26
Q

when can x-rays start to be used in DDH?

A

4-6 months

27
Q

what is the treatment used for children 0-6 months old diagnosed with DDH?

A

Parlik harness - flexed and abducted

28
Q

how long is Parlik’s harness used for?

A

23 hours a day for 3 months

then night time splints for a few months after

29
Q

what is treatment if persistent dislocations over 18 months?

A 
open reduction (and femoral osteotomy) 
(poor outcome if carried out late as joint has formed abnormally)
30
Q

what is the most common cause of paediatric hip pain?

A

transient synovitis

31
Q

who does transient synovitis most commonly affect?

A

boys aged 2-10

32
Q

what commonly occurs prior to transit synovitis?

A

viral infection - URTI

33
Q

what are the symptoms of transient synovitis?

A

limp
reluctant to weight bear
restricted range of movement
may have low grade fever

34
Q

how is transient synovitis diagnosed?

A

diagnosis of exclusion

  • essential to rule out septic arthritis
  • CRP in transient synovitis would be normal
35
Q

how is transient synovitis treated?

A

NSAIDs and rest

pain resolves in a few weeks

36
Q

what is Perthes disease?

A

idiopathic osteochondritis of femoral head

- loss of blood supply leading to AVN and abnormal growth

37
Q

what is the prognosis for Perthes disease in the young?

A

acetabulum forms around misshapen head - still functional

38
Q

what is the prognosis for Perthes disease in older children?

A

head misshapen and acetabulum fixed - non functional

39
Q

who is Perthes disease most common in?

A

boys 4-9 years
short stature
active

40
Q

what are the risk factors of Perthes disease?

A

positive family history
low birth weight
second hand smoking
abnormal clotting - thrombophilia

41
Q

what are the symptoms of Perthes disease?

A 
limp (gradual onset, painless to start) 
pain in groin (hip and knee) 
unilateral 
loss of internal rotation and abduction 
positive Trandelenburg gait
42
Q

what is seen on x-ray in Perthes disease?

A

joint space widening
decreased size of femoral head
collapse/deformity of femoral head

43
Q

what is the conservative treatment for Perthes disease?

A

rest and analgesia

avoid exercise

44
Q

what is the surgical management of Perthes disease?

A

osteotomy of femur

45
Q

what is slipped upper femoral epiphysis?

A

femoral head epiphysis slips inferiorly from the neck of the femur

46
Q

who is SUFE most common in?

A

boys aged 10-16
overweight and pre-pubertal
hypothyroidism or renal disease common

47
Q

what is urgently needed in an adolescent who can’t weight bear?

A

suspected SUFE until proven otherwise

urgent lateral x-ray

48
Q

how do children’s hip present in SUFE?

A

lying with hip externally rotated

loss of internal rotation, flexion and adduction

49
Q

what is tremowen’s sign seen on x-ray in SUFE?

A

straight line can’t be drawn through greater trochanter and femoral head

50
Q

what is the management of SUFE?

A

surgery

within 1-2 years patient may have contralateral slip on the other hip - do both hips at the same time

FINALS (25 decks)

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