Paediatric Orthopaedics Flashcards
What is the David Jones’ system of the 5 S’?
Symmetrical Symptomatic Systemic Illness Skeletal Dysplasia Stiffness
What is developmental dysplasia of the hip?
The term developmental dysplasia of the hip (DDH) represents a spectrum of conditions affecting the proximal femur and acetabulum, ranging from acetabular immaturity to hip subluxation and frank hip dislocation. In true DDH, the femoral head has a persistently abnormal anatomical relationship with the pelvic acetabulum, which leads to abnormal bony development that can ultimately result in premature arthritis and significant disability.
What are the risk factors for DDH?
First Born Oligohydramnios Breech Presentation Family History Other lower limb deformities Increased ligamentous laxity Female
What are the two clinical signs seen in DDH?
Positive Ortolani test
Positive Barlow test
What would a positive Ortolani test show?
Used in infants <6 months of age.
The hip is flexed to 90° and abducted, with the examiner’s fingers are placed laterally over the greater trochanter or hip joint. The examiner then uses anterior pressure over the trochanter in an attempt to identify a dislocated hip that is relocatable.
What would a positive Barlow test show?
Used in infants <6 months of age.
The hip is flexed to 90° and adducted, the examiner’s hand is placed on the knee, and posterior pressure is placed through the hip in an attempt to identify dislocatable hips
What other indications are shown in a child that has DDH other than the two clinical signs?
Limited hip abduction in children over 6 months old
Delayed crawling or walking
Abnormal leg positioning
Unilateral Toe walking
What two choices of imaging are preferred in what ages for DDH?
Under six months prefer to use US
Over six months prefer to use X ray
What is the management of DDH in the different age groups?
Under six months need to splint the leg in permanent abduction (hip abduction orthosis)
Closed reduction
Open reduction when closed has failed or the dislocation is teratological
Six to eighteen months is open reduction with spica casting
Over six years old is salvage osteotomies
What is a teratological hip dislocation?
When there is a fixed antenatal dislocation of the hip
What is Legg Calve Perthes Disease?
A self-limiting disease of the femoral head comprising of necrosis, collapse, repair, and re-modelling that presents in the first decade of life and is more commonly seen in boys.
What are the four phases of Legg Calve Perthes Disease?
Avascular necrosis
Fragmentation Revascularisation (pain)
Reossification
Bony healing Residual deformity
What are the symptoms of LCPD?
Limp Limited hip movement Short stature Muscle wasting Hyperactivity Trendelenburg's sign Synovitis Knee pain Thigh pain Groin/buttock pain Asymmetric limb length Minor trauma
What are the risk factors for LCPD?
Male 4-8 years old Passive smoking Trisomy 21 Hypercoagulable states Socio economic deprivation Endocrinopathy Skeletal dysplasias
What is the management of LCPD?
Depends on age of child
Limit movement
Analgesia
Surgical containment usually left for older children
What is a slipped capital femoral epiphysis?
It occurs when weakness in the proximal femoral growth plate allows displacement of the capital femoral epiphysis.
Osteromedial displacement of the proximal femoral epiphysis in relation to the neck through the widened zone of hypertrophy in the physis
What are the risk factors for SCFE?
Obesity Endocrine disorders Hormonal involvement-puberty Male Ancestry Prior radiotherapy
What are the signs and symptoms of SCFE?
High BMI Abnormal gait with externally rotated leg Groin or knee pain Bilateral hip pain Trendelenburg's gait Restricted range of motion Renal Failure Recent Trauma Knee X ray usually normal Widened physis on X ray with Klein's line
What investigations should be SCFE?
X ray
Metabolic panel
TFTs
Serum Growth Hormone
What is the management of SCFE?
If unstable then need urgent surgical repair with prophylactic fixation of contralateral hip
Corrective surgery
What is the normal age for children to start walking?
12 months but can be earlier or later than that
What are three reasons for a child to intoe or trip when they walk?
Femoral anteversion
Int. tibial torsion
Metatarsus adductus
What is internal tibial torsion?
Increased thigh foot angle
What is metatarsus adductus?
Foot twisted in
