Paediatric Hip Disorders

Question 1

What is DDH?

Answer 1

developmental dysplasia of the hip where there is dislocation or subluxation of the femoral head in the perinatal period

Question 2

Risk factors for DDH (5)

Answer 2

Female sex, breech birth, family history, other MSK abnormalities, first born

Question 3

Screening methods used for DDH

Answer 3

Ortolani test, Barlow test, USS

Question 4

How does the ortolani test work?

Answer 4

reducing the dislocated hip with abduction and anterior displacement

Question 5

How does the barlow test work?

Answer 5

dislocatable hip with flexion and posterior displacement

Question 6

Signs of DDH

Answer 6

shortening of the limb, asymmetric groin/thigh skin creases, +ve ortolani/barlow tests

Question 7

Why are x-rays not useful in the diagnosis of DDH?

Answer 7

the joints are mostly cartilage

Question 8

How do you treat mildly dislocatable DDH?

Answer 8

watchful waiting and regular screening

Question 9

How do you treat more persistenly dislocatable DDH?

Answer 9

Pavlik harness

Question 10

How is a Pavlik harness used?

Answer 10

worn full-time for 6 weeks, then part-time for another 6 weeks - used to keep hips in comfortable flexion and abduction

Question 11

What age can the Pavlik harness be used?

Answer 11

up to 4-6months

Question 12

How is late/persistent DDH treated?

Answer 12

open reduction +/- osteotomy of the femur or pelvis

Question 13

What is transient synovitis of the hip?

Answer 13

self-limiting inflammation of the synovium of the joint, most commonly the hip

Question 14

Common features of transient synovitis of the hip

Answer 14

boys>girls, age 2-10 years, post-URTI (common), generally well with slightly reduced movement

Question 15

Important DDx to exclude when considering transient synovitis of the hip (6)

Answer 15

delayed DDH presentation; perthes disease; septic arthritis; osteomyelitis; juvenile idiopathic arthritis; rheumatoid arthritis

Question 16

Treatment of transient synovitis of the hip

Answer 16

short course of NSAIDs and rest - should resolve in a few weeks

Question 17

What is Perthes disease?

Answer 17

idiopathic avascular necrosis of the femoral head with subsequent abnormal growth

Question 18

Common features of perthes disease (4)

Answer 18

boys > girls (4:1); ages 4-8; bilateral in 10%; small, active humans

Question 19

Prognosis in perthes disease is determined by…

Answer 19

age of onset with older children faring worse

Question 20

Presentation of perthes disease…

Answer 20

pain, limp, loss of internal rotation, loss of abduction, trendelenberg gait

Question 21

4 stages of perthes disease

Answer 21

1. necrosis/sclerosis (1-14 months) 2. fragmentation (2-35 months) 3. reossification (2-122 months) 4. residual remodelling

Question 22

Treatment in perthes disease focusses on…

Answer 22

influencing the shape of the recovering head and maintaining the mould of the acetabulum

Question 23

Treatment principles in perthes disease

Answer 23

Maintain hip abduction, rest and activity modification works for the majority. A small number may need surgery.