Paediatric Orthopaedics

Question 1

which gender is most likely to get DDH, and what age is it most likely to occur at?

Answer 1

girls more likely

between birth and 5 years old

Question 2

which hip is most commonly affected in DDH?

Answer 2

left hip

Question 3

name a few risk factors of DDH

Answer 3

first pregnancy
oligohydramnios
breech presentation
narrow pelvis

Question 4

how is DDH diagnosed?

Answer 4

clinically: Barlow’s manoeuvre and Ortolani’s manoeuvre
imaging: ultrasound/xray

Question 5

how is DDH managed?

Answer 5

if younger than 1 year: Pavlik harness/splint/closed reduction
if older than 2 year: open reduction/femoral shortening

Question 6

what is Legg-Calve-Perthes disease, and who is most likely to get it and at what age?

Answer 6

avascular necrosis leading to deformity of femoral head

most likely boys between 5-10years old

Question 7

how is Legg-Calve-Perthes disease managed?

Answer 7

• monitor and maintain hip motion (physio, analgesia, avoid painful activities)
• osteotomy if older than 7 and severe disease

Question 8

how does Legg-Calve-Perthes disease present?

Answer 8

child systemically well
stiff hip
knee pain
limp

Question 9

how does slipped upper femoral epiphysis (SUFE) present?

Answer 9

pain in groin/hip or knee on exercise

externally rotated hip (especially on hip flexion)

Question 10

who typically gets SUFE?

Answer 10

teenage boys (10-15yo)
overweight
underlying endocrine disease

Question 11

how is SUFE diagnosed?

Answer 11

x-rays

Question 12

how is SUFE managed?

Answer 12

surgically:
stable slip - fix in situ
unstable slip - open reduction

Question 13

what is the difference between a stable and an unstable SUFE?

Answer 13

stable - able to weight bear

unstable - unable to weight bear

Question 14

name a few complications of SUFE

Answer 14

• reduced hip ROM
• early osteoarthritis
• chrondolysis
• AVN (mostly unstable slips)

Question 15

match the age and gender to the disease:
age (0-5; 5-10; 10-15)
disease (SUFE; DDH; LCP)

Answer 15

DDH: girls, 0-5yo
Legg-Calve-Perthes: boys, 5-10yo
SUFE: boys, 10-15yo

Question 16

what is a characteristic presenting feature of SUFE?

Answer 16

externally rotated hip/foot

pain in joint other than the hip (knee common)

Question 17

what is the classification of stages called in Perthes disease, and what are they?

Answer 17

Walderstrom classification
1 - avascular necrosis
2 - bone destruction/resorption
3 - bone remodellihg
4 - bone healed

Question 18

what does a hip with Perthes disease look like on xray?

Answer 18

flattened femoral head

Question 19

what is a Harris line on an xray?

Answer 19

it’s a horizontal calcification at epiphyseal plate -evidence of temporary growth cessation as a result of steroid use