Paediatric Orthopaedics

Question 1

Who gets DDH?

Answer 1

G > B 6:1

Question 2

What does DDH stand for?

Answer 2

Developmental dysplasia of the hip

Question 3

Which side of the hip is more commonly affected by?

Answer 3

Left hip 3:1

Question 4

Increased incidence of DDH in….

Answer 4

Oligohydramnios
First born
Breech presentation (legs pushed together)
FH
other lower limb deformities
**ALL DUE TO BEING SQUISHED INTO A SMALL SPACE ****

Question 5

What is oligohydramnios?

Answer 5

Lack of amniotic fluid

Question 6

Clinical features of DDH

Answer 6

Ortolanis sign 
Barlows sign 
Piston motion sign 
***Only 40% 
Unequal skin folds / leg length

Question 7

What is ortolani’s sign?

Answer 7

Hip can be dislocated

Question 8

What is barlow’s sign?

Answer 8

The hip can be put back into place

Question 9

What is the piston motion sign?

Answer 9

If the hip isn’t in the joint, it can move anywhere without anything stopping

Question 10

Diagnosis of DDH

Answer 10

USS up to 1 y/o

Examination (only 40% picked up)

Question 11

Treatment of DDH

Answer 11

Abduction brace

Surgical treatment if hip completely out

Question 12

What does an abduction brace do?

Answer 12

Reduces the chance of progression

Question 13

Who gets LCP?

Answer 13

M > F 5:1

Primary school age

Question 14

What does LCP mean?

Answer 14

Legg-Calve Perthes Disease

Question 15

Presentation of LCP

Answer 15

15% Bilateral 
short stature
limp 
knee pain on exercise 
stiff hip joint
systemically well

Question 16

Phases of LCP

Answer 16

Avascular necrosis
Fragmentation (revascularisation -> pain)
reossification (bony healing)
Residual deformity

Question 17

Differential diagnosis of LCP

Answer 17

Unilateral 
- septic hip 
- JIA
- SCFE
- lymphoma
Bilateral 
- hypothyroid
- sickle
- epiphyseal disease

Question 18

Treatment of LCP

Answer 18

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

Question 19

Prognosis of DDH

Answer 19

Good if onset < 9 y/o

Question 20

What does SCFE stand for?

Answer 20

Slipped capital femoral epiphysis

Question 21

Who gets SCFE/SUFE?

Answer 21

Boys > girls

9-14 y/o

Question 22

How many cases of SCFE become bilateral?

Answer 22

20%

Question 23

Classification of SCFE/SUFE

Answer 23

acute vs chronic (3 weeks)
stable vs unstable
- unstable needs fixed (serendipitus reduction)
- stable = possibly fix in situ

Question 24

Diagnosis of SCFE

Answer 24

Examination
X ray
- relative to width femoral neck on AP film

Question 25

Presentation of SCFE

Answer 25

Pain in hip and knee
Externally rotated posture and gait
Foot externally rotates and shortens
Reduced internal rotation, especially in flexion

Question 26

Pathology of SCFE

Answer 26

Displacement through hypertrophic zone

metaphysis moves anterior and proximal

Question 27

Treatment of SCFE

Answer 27

Surgery

Question 28

Complications of SCFE

Answer 28

Avascular necrosis (AVN)
Chondrolysis (death of cartilage)
Deformity
Early OA

Question 29

Features of myopathies

Answer 29

Symmetrical muscle weakness (proximal > distal)
Common problems arise when rising out of chair / bath
Sensation and reflexes normal
No fasiculations

Question 30

Causes of myopathies

Answer 30

Polymyositis
Duchennes/Beckers muscular dystrophy 
Myotonic dystrophy 
Cushings
Thyrotoxicosis
Alcohol