paediatric hip disorders Flashcards
what is genu varum?
bowed legs
angulation of distal segment of legs towards midline
what is genu valgus?
knocked knees
normal legs have a small degree
what is blount’s disease?
type of bowed legs due to growth arrest of medial tibial physis
what does blount’s disease look like on x ray?
beak like protrusion
what type of arthritis does genu varum cause?
medial osteoarthritis
what type of arthritis does genu valgus cause?
lateral osteoarthritis
what are the causes of intoeing (pigeon toed)?
femoral neck antiversion
internal tibial torsion
forefoot adduction
what do children sit like with femoral neck anti version?
W position
when does internal tibial torsion normally resolve?
seen in toddlers, resolved by age 6
when does forefoot adduction normally resolve?
resolves with time, don’t operate before aged 7/8
what are the two types of flat feet?
flexible and rigid
what causes flexible flat feet?
tibialis posterior tendon dysfunction
what may make flexible flat feet present?
when weight bearing
what is jack’s test for flat feet?
medial arch forms with dorsiflexion of big toe
what causes rigid flat feet?
underlying bony connections
what toe most commonly causes curly toes?
5th
who and where is DDH most common?
left hip in girls
what are the risk factors for DDH?
first born breach birth family history oligohydraminos Down syndrome congenital disorders (club foot)
what are complications of DDH?
limping child (late) severe arthritis (secondary)
what are the symptoms of DDH?
limbing shortening
asymmetrical limb crease
restricted abduction
how do you do Ortolani’s test?
abduction and push hip anteriorly
what is a positive Ortolani’s test?
clunking sound as femoral head relocates in acetabulum
what is Barlow’s test?
adduction and push hip posteriorly
what is a positive Barlow’s test?
clunking sound as femoral head dislocates
what is used to diagnose DDH?
ultrasound
can’t use x-ray as femoral head unossified
when can x-rays start to be used in DDH?
4-6 months
what is the treatment used for children 0-6 months old diagnosed with DDH?
Parlik harness - flexed and abducted
how long is Parlik’s harness used for?
23 hours a day for 3 months
then night time splints for a few months after
what is treatment if persistent dislocations over 18 months?
open reduction (and femoral osteotomy) (poor outcome if carried out late as joint has formed abnormally)
what is the most common cause of paediatric hip pain?
transient synovitis
who does transient synovitis most commonly affect?
boys aged 2-10
what commonly occurs prior to transit synovitis?
viral infection - URTI
what are the symptoms of transient synovitis?
limp
reluctant to weight bear
restricted range of movement
may have low grade fever
how is transient synovitis diagnosed?
diagnosis of exclusion
- essential to rule out septic arthritis
- CRP in transient synovitis would be normal
how is transient synovitis treated?
NSAIDs and rest
pain resolves in a few weeks
what is Perthes disease?
idiopathic osteochondritis of femoral head
- loss of blood supply leading to AVN and abnormal growth
what is the prognosis for Perthes disease in the young?
acetabulum forms around misshapen head - still functional
what is the prognosis for Perthes disease in older children?
head misshapen and acetabulum fixed - non functional
who is Perthes disease most common in?
boys 4-9 years
short stature
active
what are the risk factors of Perthes disease?
positive family history
low birth weight
second hand smoking
abnormal clotting - thrombophilia
what are the symptoms of Perthes disease?
limp (gradual onset, painless to start) pain in groin (hip and knee) unilateral loss of internal rotation and abduction positive Trandelenburg gait
what is seen on x-ray in Perthes disease?
joint space widening
decreased size of femoral head
collapse/deformity of femoral head
what is the conservative treatment for Perthes disease?
rest and analgesia
avoid exercise
what is the surgical management of Perthes disease?
osteotomy of femur
what is slipped upper femoral epiphysis?
femoral head epiphysis slips inferiorly from the neck of the femur
who is SUFE most common in?
boys aged 10-16
overweight and pre-pubertal
hypothyroidism or renal disease common
what is urgently needed in an adolescent who can’t weight bear?
suspected SUFE until proven otherwise
urgent lateral x-ray
how do children’s hip present in SUFE?
lying with hip externally rotated
loss of internal rotation, flexion and adduction
what is tremowen’s sign seen on x-ray in SUFE?
straight line can’t be drawn through greater trochanter and femoral head
what is the management of SUFE?
surgery
within 1-2 years patient may have contralateral slip on the other hip - do both hips at the same time
