Paediatric Ortho - The big three Flashcards
Causes of hip problems in 0-5 yrs?
> ‘Normal variant’ > Trauma > Transient synovitis > Osteomyelitis > Septic arthritis > DDH > JIA
Causes of hip problems in 5-10 yrs?
> Trauma > Transient synovitis > Osteomyelitis > Septic arthritis > Legg-Calve (Perthes disease)
Causes of hip problems in 10-15 yrs?
> Trauma > Osteomyelitis > Septic arthritis > SUFE > Chrondromalacia > Neoplasm
Countries (Aetiology) of developmental dysplasia of the hip?
> Northern Europe 0.7 to 2.2 per 1000
> Eastern Europe = 28.7/1000
> African Neonates = 0
> Apaches and Navajos = 5%
Are girls or boys more likely to have developmental dysplasia of the hip?
Girls 6:1
Which hip is more commonly have developmental dysplasia of the hip?
The left hip, 3:1
Aetiology of developmental hip dysplasia?
> Girls > First born > Oligohydramnios > Breech delivery > Family history > Other limb deformities > Baby >10lbs > Apaches and Navajos = 5% > Eastern Europe = 28.7/100
Clinical features of developmental hip dysplasia?
> Ortolani’s Sign
Barlow’s Sign
Piston Motion Sign
The Hamstring Sign
However only 40% DDH are picked up by examination
Management of developmental hip dysplasia - <3 months?
Simple splint = 90% response
How does someone usually present with Legg-Calve-Perthes Disease?
> Male 5:1 > Primary school age > Short stature > Limp > Knee pain on exercise > Stiff hip joint > Family tendency > Low social status
Phases of Legg-Calve Perthes Disease?
> Avascular necrosis
> Fragmentation - Revascularisation (Painful)
> Reossification - Bony healing
> Residual deformity
Takes around 3 years and can be left with a deformed hip
Treatment of Legg-Calve-Perthes Disease?
> Analgesia
> Restrict painful activities
> ‘Supervised neglect’ in most cases
> ‘Containment’ - Consider osteotomy in selected groups of older children (>7)
> Prognosis good onset <9y
Treatment of Legg-Calve-Perthes Disease?
> Analgesia
> Restrict painful activities
> ‘Supervised neglect’ in most cases
> ‘Containment’ - Consider osteotomy in selected groups of older children (>7)
> Prognosis good onset <9y
Aetiology of slipped upper (capital) femoral epiphysis (SCFE)?
US call is Slipper capital femoral epiphysis (SCFE)
> 1-10 per 100,000 > Teenage boys > Girls (9-14 yrs) > 20% become bilateral > Many overweight > Small proportion endocrine abnormalities (If they are short thick about it)
Classification of SUFE?
> Acute Vs Chronic (3 weeks)
> Stable yrs unstable (Lober)
What time scale to indicate chronic SUFE?
> 3 weeks
How is unstable SUFE managed?
> Fix - serendipitous reduction
> Unable to weight-bear, poor prognosis (Higher risk of developing avascular necrosis)
How is stable SUFE managed?
> Fix in situ
> Able to weight-bear, good prognosis
Detection of SUFE?
> Pain in hip or knee
Externally rotated posture and gait
Reduced internal rotation, especially in flexion
Plain X-rays (Best seen on lateral view)
Detection of SUFE - Radiographic features?
> Mild <1/3
Moderate 1/3-1/2
Severe >1/2
Pathology of SUFE?
> Displacement through hypertrophic zone (Growth plate)
> Metaphysis moves anterior and proximal
SUFE - Treatment?
Surgical:
> Stable slips are pinned in situ (Through the femoral head)
> Severe unstable slops consider open reduction but avascular necrosis is high risk
Outcome of SUFE treatment (Surgery)?
> AVN (Avascular necrosis):
- Stable slips (Able to bear weight) have a low risk of AVN
- Unstable slips (Unable to bear weight) have a high risk of AVN.
> Chondrolysis
> Deformity (Short, externally rotated, limited flexion)
> Early osteoarthritis
> Possiblility of loop on the other side (If there is an endocrine issue sometime the other leg is pinned prophylactically)
> Limb length discrepancy - Pinning through the growth plate can reduce growth (The younger at the time the larger the discrepancy)
> Impingement
Why can’t you use Xray to monitor Developmental hip dysplasia, what other imaging modality is used instead?
The hip hasn’t ossified prior to 3 months of age. Ultrasound is used instead
