Paediatric orthopaedics

Question 1

Most common hip condition in the under 5’s

Answer 1

Developmental hip dysplasia

Question 2

Most common hip condition in the 5-10 group

Answer 2

Perthe’s disease

Question 3

Most common hip condition in children older than 10

Answer 3

Slipped upper femoral epiphysis

Question 4

Risk factors for developmental hip dysplasia

Answer 4

Female, Family history, Breech birth, First born, Olighydramnios

Question 5

Symptoms of developmental hip dysplasia

Answer 5

Clicking hip, Limping

Question 6

Signs of developmental hip dysplasia

Answer 6

Leg length discrepancy, Reduced abduction, Asymetrical toe walking, Positive Barlow’s test, Positive Ortolani’s test

Question 7

Describe Barlow’s test

Answer 7

Dislocates hip by adducting and depressing a flexed hip

Question 8

Describe Ortolani’s test

Answer 8

Reduces hip by adducting and elevating a flexed hip

Question 9

Investigations for developmental hip dysplasia

Answer 9

USS, X-ray

Question 10

Management of developmental hip dysplasia

Answer 10

Conservative: Pavlik harness, Spica
Surgical: Pelvic/femoral osteotomy

Question 11

Risk factors for slipped upper femoral epiphysis

Answer 11

Obesity, Femoral retroversion

Question 12

Symptoms of slipped upper femoral epiphysis

Answer 12

Pain (in groin, thigh, or knee - relieved by crossing leg over), Limp

Question 13

Signs of slipped upper femoral epiphysis

Answer 13

Abnormal gait, Externally rotated hip, Reduced internal rotation, Decreased abduction, Quadriceps atrophy

Question 14

Investigations for slipped upper femoral epiphysis

Answer 14

X-ray

Question 15

Management of slipped upper femoral epiphysis

Answer 15

Surgical: Percutaneous pinning, ORIF, Femoral osteotomy

Question 16

Define Perthe’s disease

Answer 16

Avascular nercosis of the femoral head

Question 17

Risk factors for Perthe’s disease

Answer 17

Male, Family history, Low birth weight, Abnormal birth presentation, Exposure to second hand smoke, Thrombophilia

Question 18

Symptoms of Perthe’s disease

Answer 18

Painless limp, Intermittent pain (in hip, knee, thigh)

Question 19

Signs of Perthe’s disease

Answer 19

Decreased internal rotation, Decreased abduction, Antalgic gait, Limb length discrepancy

Question 20

Investigations for Perthe’s disease and findings

Answer 20

X-ray (Irregular ossification, medial joint space widening, Cresent sign)

Question 21

Define cresent sign

Answer 21

Linear subchondral lucency - (Perthe’s disease)

Question 22

Management of Perthe’s disease

Answer 22

Conservative: Reduce impacts
Surgical: Femoral/Pelvic osteotomy