Paediatric Orthopaedics Flashcards
Who gets DDH?
G > B 6:1
What does DDH stand for?
Developmental dysplasia of the hip
Which side of the hip is more commonly affected by?
Left hip 3:1
Increased incidence of DDH in….
Oligohydramnios
First born
Breech presentation (legs pushed together)
FH
other lower limb deformities
**ALL DUE TO BEING SQUISHED INTO A SMALL SPACE ****
What is oligohydramnios?
Lack of amniotic fluid
Clinical features of DDH
Ortolanis sign Barlows sign Piston motion sign ***Only 40% Unequal skin folds / leg length
What is ortolani’s sign?
Hip can be dislocated
What is barlow’s sign?
The hip can be put back into place
What is the piston motion sign?
If the hip isn’t in the joint, it can move anywhere without anything stopping
Diagnosis of DDH
USS up to 1 y/o
Examination (only 40% picked up)
Treatment of DDH
Abduction brace
Surgical treatment if hip completely out
What does an abduction brace do?
Reduces the chance of progression
Who gets LCP?
M > F 5:1
Primary school age
What does LCP mean?
Legg-Calve Perthes Disease
Presentation of LCP
15% Bilateral short stature limp knee pain on exercise stiff hip joint systemically well
Phases of LCP
Avascular necrosis
Fragmentation (revascularisation -> pain)
reossification (bony healing)
Residual deformity
Differential diagnosis of LCP
Unilateral - septic hip - JIA - SCFE - lymphoma Bilateral - hypothyroid - sickle - epiphyseal disease
Treatment of LCP
maintain hip motion
Analgesia
Restrict painful activities
‘Supervised neglect’ in most cases - nothing we can do
‘containment’
- consider osteotomy in selected groups > 7 y/o
Prognosis of DDH
Good if onset < 9 y/o
What does SCFE stand for?
Slipped capital femoral epiphysis
Who gets SCFE/SUFE?
Boys > girls
9-14 y/o
How many cases of SCFE become bilateral?
20%
Classification of SCFE/SUFE
acute vs chronic (3 weeks)
stable vs unstable
- unstable needs fixed (serendipitus reduction)
- stable = possibly fix in situ
Diagnosis of SCFE
Examination
X ray
- relative to width femoral neck on AP film
Presentation of SCFE
Pain in hip and knee
Externally rotated posture and gait
Foot externally rotates and shortens
Reduced internal rotation, especially in flexion
Pathology of SCFE
Displacement through hypertrophic zone
metaphysis moves anterior and proximal
Treatment of SCFE
Surgery
Complications of SCFE
Avascular necrosis (AVN)
Chondrolysis (death of cartilage)
Deformity
Early OA
Features of myopathies
Symmetrical muscle weakness (proximal > distal)
Common problems arise when rising out of chair / bath
Sensation and reflexes normal
No fasiculations
Causes of myopathies
Polymyositis Duchennes/Beckers muscular dystrophy Myotonic dystrophy Cushings Thyrotoxicosis Alcohol
