paediatric hip disorders

Question 1

what is genu varum?

Answer 1

bowed legs

angulation of distal segment of legs towards midline

Question 2

what is genu valgus?

Answer 2

knocked knees

normal legs have a small degree

Question 3

what is blount’s disease?

Answer 3

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

Question 4

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

Answer 4

beak like protrusion

Question 5

what type of arthritis does genu varum cause?

Answer 5

medial osteoarthritis

Question 6

what type of arthritis does genu valgus cause?

Answer 6

lateral osteoarthritis

Question 7

what are the causes of intoeing (pigeon toed)?

Answer 7

femoral neck antiversion
internal tibial torsion
forefoot adduction

Question 8

what do children sit like with femoral neck anti version?

Answer 8

W position

Question 9

when does internal tibial torsion normally resolve?

Answer 9

seen in toddlers, resolved by age 6

Question 10

when does forefoot adduction normally resolve?

Answer 10

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

Question 11

what are the two types of flat feet?

Answer 11

flexible and rigid

Question 12

what causes flexible flat feet?

Answer 12

tibialis posterior tendon dysfunction

Question 13

what may make flexible flat feet present?

Answer 13

when weight bearing

Question 14

what is jack’s test for flat feet?

Answer 14

medial arch forms with dorsiflexion of big toe

Question 15

what causes rigid flat feet?

Answer 15

underlying bony connections

Question 16

what toe most commonly causes curly toes?

Answer 16

5th

Question 17

who and where is DDH most common?

Answer 17

left hip in girls

Question 18

what are the risk factors for DDH?

Answer 18

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

Question 19

what are complications of DDH?

Answer 19

limping child (late)
severe arthritis (secondary)

Question 20

what are the symptoms of DDH?

Answer 20

limbing shortening
asymmetrical limb crease
restricted abduction

Question 21

how do you do Ortolani’s test?

Answer 21

abduction and push hip anteriorly

Question 22

what is a positive Ortolani’s test?

Answer 22

clunking sound as femoral head relocates in acetabulum

Question 23

what is Barlow’s test?

Answer 23

adduction and push hip posteriorly

Question 24

what is a positive Barlow’s test?

Answer 24

clunking sound as femoral head dislocates

Question 25

what is used to diagnose DDH?

Answer 25

ultrasound | can't use x-ray as femoral head unossified

Question 26

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

Answer 26

4-6 months

Question 27

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

Answer 27

Parlik harness - flexed and abducted

Question 28

how long is Parlik's harness used for?

Answer 28

23 hours a day for 3 months | then night time splints for a few months after

Question 29

what is treatment if persistent dislocations over 18 months?

Answer 29

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

Question 30

what is the most common cause of paediatric hip pain?

Answer 30

transient synovitis

Question 31

who does transient synovitis most commonly affect?

Answer 31

boys aged 2-10

Question 32

what commonly occurs prior to transit synovitis?

Answer 32

viral infection - URTI

Question 33

what are the symptoms of transient synovitis?

Answer 33

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

Question 34

how is transient synovitis diagnosed?

Answer 34

diagnosis of exclusion - essential to rule out septic arthritis - CRP in transient synovitis would be normal

Question 35

how is transient synovitis treated?

Answer 35

NSAIDs and rest | pain resolves in a few weeks

Question 36

what is Perthes disease?

Answer 36

idiopathic osteochondritis of femoral head | - loss of blood supply leading to AVN and abnormal growth

Question 37

what is the prognosis for Perthes disease in the young?

Answer 37

acetabulum forms around misshapen head - still functional

Question 38

what is the prognosis for Perthes disease in older children?

Answer 38

head misshapen and acetabulum fixed - non functional

Question 39

who is Perthes disease most common in?

Answer 39

boys 4-9 years short stature active

Question 40

what are the risk factors of Perthes disease?

Answer 40

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

Question 41

what are the symptoms of Perthes disease?

Answer 41

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

Question 42

what is seen on x-ray in Perthes disease?

Answer 42

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

Question 43

what is the conservative treatment for Perthes disease?

Answer 43

rest and analgesia | avoid exercise

Question 44

what is the surgical management of Perthes disease?

Answer 44

osteotomy of femur

Question 45

what is slipped upper femoral epiphysis?

Answer 45

femoral head epiphysis slips inferiorly from the neck of the femur

Question 46

who is SUFE most common in?

Answer 46

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

Question 47

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

Answer 47

suspected SUFE until proven otherwise | urgent lateral x-ray

Question 48

how do children's hip present in SUFE?

Answer 48

lying with hip externally rotated | loss of internal rotation, flexion and adduction

Question 49

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

Answer 49

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

Question 50

what is the management of SUFE?

Answer 50

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