Paediatric Hip Problems Flashcards
What are some of the risk factors for developmental dysplasia of the hip (DDH)?
Positive family history
Breech position during birth
Female (4:1)
First born babies
Down Syndrome
How might a child with DDH present?
What clinical examination can be done to test for DDH?
Results in a shallow acetabulum if left untreated. In severe cases, a false acetabulum will form and the limb will be considerably shortened
Risk of severe arthritis developing from a young age
Asymmetric groin/skin creases
The Barlow and Ortolani tests will elicit a “clunk”
If the Barlow and Ortolani tests give a positive result, what must be done next?
USS of hip
(Xrays cannot be used because the femoral head epiphysis is unossified until 4-6 months. After this ossification, Xray would be the investigation of choice)
How is DDH treated?
Early recognition and monitoring is key, usually just need to keep an eye on it.
If persistently dislocating, can treat with a Pavlik harness
Child presents with hip pain after recently having had a cold
What is the most likely diagnosis?
Transient synovitis (although also need to consider septic arthrtiis, Perthes, Juvenile Idiopathic Arthritis etc.)
What is the most common cause of hip pain in childhood?
How does this condition present?
Transient synovitis
2-10 year olds, more commonly boys, usually following URTI
Presentation
- limp/reluctance to weight bear
- possibly reduced range of motion
- may have low grade fever but is not systemically unwell
Transient Synovitis - treatment
After ruling out more serious causes, treatment is rest and a short course of NSAIDs
Who gets Perthes Disease? What is it?
More commonly boys (5:1) between the ages of 4-9, especially very active boys of a short stature
Transient loss of blood supply to the femoral head, resulting in necrosis and abnormal growth, followed by inadequate replacement and remodelling
Poor healing results in early OA and the requirement for a hip replacement in childhood
Perthes Disease - presentation, and what is the first clinical sign?
Pain and a limp in cheeky wee boys…
Most cases are unilateral
Loss of internal rotation is usually the first sign of hip pathology, followed by a loss of abduction and a +ve Trendelenberg test
How is Perthes Disease treated?
Xray monitoring and avoiding making the condition worse, approx half will recover naturally
Can cast the hips using a Petrie cast
What hip pathology most commonly presents in pre-pubertal overweight boys?
What other conditons are associated with this?
SUFE
Hypothyroidism or renal disease may predispose a child to SUFE
SUFE - presentation
Acute, chronic or acute-on-chronic
Pain and a limp (NB - pain may be felt in the knee)
Loss of internal rotation
Why does SUFE sometimes present with referred knee pain?
Because the nerve supplying the knee and the nerve supplying the hip are one in the same (Obturator nerve)
SUFE - treatment
Urgent pinning of femoral head to prevent further slipping
The greater the degree of slippage, the worse the prognosis
