Paediatric Hip Problems Flashcards
What is developmental dysplasia of the hip (DDH)?
Dislocation or subluxation of the femoral head during perinatal period affecting subsequent development of hip joint
What are the risk factors for DDH?
Female Family history of DDH Breech First born Downs syndrome Talipes
What are the consequences of untreated DDH?
Acetabulum becomes very shallow
In severe cases a false acetabulum occurs proximally –> shortened limb
Severe arthritis at a young age
Impaired gait/mobility
How is DDH diagnosed?
Examination after birth
USS of hip
What might been seen on examination of a baby with DDH?
Shortened leg
Asymmetric groin/thigh skin creases
Click/clunk on Barlow/Ortolani manoeuvres
What is Barlow’s manoeuvre?
Dislocatable hip with flexion and posterior displacement
What is Ortolani’s manoeuvre?
Reducing a dislocated hip with abduction and anterior displacement
What would be seen on USS of a hip with DDH?
Dislocated/unstable hip
Shallow acetabulum
What is the first line investigation for DDH in a baby over 4-6 months old?
Xray
Why is xray not used in babies < 4 months old to look for DDH?
Femoral head epiphysis is not ossified so will not show up on xray
What is the management of DDH?
Pavlik harness –> keeps hips flexed and abducted (maintaining reduction)
Full time for 6 weeks, then part time
What is the most common cause of hip pain in children and when does it occur?
Transient synovitis of the hip
After viral URTI
Age 2-10, boys > girls
What are the clinical features of transient synovitis of the hip?
History of recent URTI
Limp or reluctance to weight bare
May have mild fever but not systemically unwell
Which investigations should be done for transient synovitis of the hip?
Xray –> exclude Perthes
CRP –> exclude septic arthritis
What is the treatment and prognosis of transient synovitis of the hip?
NSAIDs and rest
Usually resolves in a few weeks
What is Perthes disease?
Idiopathic osteochondritis of the femoral head
Who gets Perthes disease?
Active boys, age 4-9, of short stature
What is the pathophysiology of Perthes disease?
Transient loss of blood supply –> necrosis –> abnormal growth
Femoral head may collapse or fracture
–> early onset OA +/- hip replacement
What are the clinical features of Perthes disease?
Unilateral pain + limp
Loss of internal rotation
Loss of abduction
–> +ve Trendellenburg (gluteal weakness)
How is Perthes disease managed?
Regular xray observation + avoidance of physical activity
What is SUFE?
Slipped Upper Femoral Epiphysis
- femoral head epiphysis slips inferiorly in relation to femoral neck
Who gets SUFE?
Overweight, pre-pubertal, adolescent boys
What are the clinical features of SUFE?
Pain –> may be in groin but often patients present PURELY WITH KNEE PAIN
Loss of internal rotation of hip is main clinical sign
What is the management of SUFE?
Urgent surgery to pin femoral head + prevent further slippage
If severe, may require hip replacement in adolescence/early adulthood
