Paediatric hips Flashcards
What is important in the history in diagnosing a hip disorder?
If breech Family history Girl First born Left hip Other MSK abnormalities
What is important in the examination in diagnosing a hip disorder?
Assymmetry - leg length, position and thigh crease
Feeling for a click
how well it abducts
What instability tests can be done during examination?
Barlow’s test
Ortolani test
What is Barlow’s test?
Attempt to dislocate/sublux a hip by flexion
What is Ortolani’s test?
Attempt to relocate a dislocated hip by abduction
What imaging can be useful?
If over 3 months then x-ray
If under then USS
What does DDH stand for?
Developmental dysplasia of the hip
What is DDH?
Dislocation or subluxation of the femoral head during the perinatal period
Why can an x-ray not be used before 3 months?
Ossification has not yet completed so little bone is available for imaging
What might be seen on imaging?
Dislocated hip or
shallow acetabulum
What equipment can be used to realign the hip?
Pavlik harness
“Extra skin fold”
DDH
When is a routine USS done?
If breech or have a family history
Why is it better to diagnose DDH early?
Can lead to dislocation in future
higher risk of arthritis
If diagnosed after two years what is the management?
Femoral and acetabular surgery
Will never have a normal hip
What is important to exclude in history in an older child with a hip issue?
Exclude infection.
Could be septic arthritis
What does transient synovitis present as?
Insidious onset of inflammation of synovium 9/10 years old low grade fever pain on movement Normal bloods
What can Perthes present as?
Pain in knee or groin
Limp
May be painless
Who does perthes present in?
boys
4-8
Small, active children
What is Perthes?
Idiopathic avascular necrosis
What is treatment for perthes?
Rest- no activity
Regular x-ray
some surgery
Who gets SUFE?
10-16 years Males obesity More common in black patients Sometimes bilateral
