Paediatric hip disorders - week 23

Question 1

Differentials of limps in all aged children?

Answer 1

Infection
JIA
Non accidental injury

Question 2

What is Developmental dysplasia of the hip (DDH)?

Answer 2

Ball and socket of hip not form correctly
Potential subluxation or dislocation of hip

Question 3

Who is affected by DDH?

Answer 3

New born infants
0-4 yrs

Question 4

Risk factors of DDH?

Answer 4

Family history of DDH
Breeched baby
Female sex
Fixed foot deformity
Torticollis

Question 5

presentation of DDH?

Answer 5

leg length discrepancy
limitations in hip abduction
Asymmetrical buttock creases
Hip locking/clicking
Pain

Trendelenburg gait (>1 year old)

Question 6

Investigations for DDH?

Answer 6

Barlow’s test (adducting the hip, if unstable hip, palpable sensation of subluxation or dislocation)

Ortolani’s test (posterior dislocation of the hip joint)

USS

AP Pelvic Xray

Question 7

Mangement of DDH?

Answer 7

Under 6 months: Pavlik harness
6 – 18 months (or failure of Pavlik harness): closed reduction and spica casting
Greater than 18 months (or failure of closed reduction): operative management (open reduction and hip reconstruction)

Question 8

Complications of DDH?

Answer 8

Recurrence
transient femoral nerve palsy from Pavlik brace
Avascular necrosis (median circumflex femoral artery)

Question 9

What is Perthes disease?

Answer 9

idiopathic avascular necrosis of proximal femoral epiphysis

Question 10

Risk factors of Perthes disease?

Answer 10

Age 4-10
Male
Family history
Caucasian
Around passive smoking

Question 11

Presentation of Perthes disease?

Answer 11

Limp (can be painless)
Hip stiffness with loss of internal rotation and abduction
Pain
Antalgic gait
Muscle spasms
Leg length discrepancy (late finding)

Question 12

Investigation of Perthes disease?

Answer 12

AP pelvic xray
‘frog-leg’ lateral X-ray

Question 13

Mangement of Perthes disease?

Answer 13

Physio
NSAIDs
Immobilise hip
Activity limitation

Surgical - osteotomy

Question 14

Complications of Perthes?

Answer 14

OA
joint stiffness and immobility
shortened limb length

Question 15

What is slipped capital femoral epiphysis (SCFE)?

Answer 15

metaphysis of the femur displaces anteriorly and superiorly

Shaft slides off the head of femur

Question 16

Risk factors for SCFE?

Answer 16

Male
adolescents aged 10-16 yrs
Obesity: increases stress on physis
Puberty/endocrine disorders: hormones weaken physis, making it more prone to displacement
Previous radiotherapy

Question 17

Presentation of SCFE?

Answer 17

Pain
Abnormal leg alignment: external rotation
Abnormal gait/limp: may have Trendelenburg gait
Decreased range of movement
Weakness and muscle atrophy

Question 18

Investigations for SCFE?

Answer 18

bilateral AP pelvic x-rays
frog-leg lateral X-ray

Klein sign - when the lateral corner of epiphysis is not intersected by line from greater trochanter

Question 19

Mangament of SCFE?

Answer 19

surgical

Question 20

Complications of SCFE?

Answer 20

Chondrolysis
Late deformity
SCFE in the contralateral hip
Osteonecrosis
Infection
Chronic pain
Degenerative arthritis
Pin associated fracture

Question 21

What is transient synovitis?

Answer 21

intermittent inflammatory disorder of the synovium of the hip

Question 22

Risk factors of transient synovitis?

Answer 22

cause unknown
sometimes a viral upper respiratory infection precedes it

age 4-10 years

Question 23

Presentation of transient synovitis?

Answer 23

Hip presents in flexion, abduction and external rotation
Limited range of motion: most commonly, hip abduction
Limp
Pain
Muscle spasms

Question 24

Investigations of Transient synoviits?

Answer 24

raised white cell count
CRP ESR raised

Xray

USS to rule out septic arthitis

Question 25

Management of transient synovitis?

Answer 25

self limiting 7-10 days
analgesia