paediatric orthopaedics big three

Question 1

what are the big three and what age do they occur at ?

Answer 1

developmental dysplasia of the hip (DDH), 0-5
Perthes disease, 5-10
Slipped capital femoral epiphysis, 10-15

Question 2

what factors increase the incidence of DDH ?

Answer 2

female 
left hip
first born
oligohydramnios
breech
FHx

Question 3

what are the clinical features of DDH ?

Answer 3

Ortolani’s sign - sense femoral head slip into acetabulum
Barlow’s sign - see if hip can be dislocated
Piston motion sign -

Question 4

how do you manage DDH ?

Answer 4

splinting

fixation

Question 5

who gets Perthes disease ?

Answer 5

males

15% bilateral 5-10

Question 6

what are features of Perthes disease ?

Answer 6

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

Question 7

what are phases or Perthes disease ?

Answer 7

avascular necrosis
fragmentation - revascularisation, pain
reossification - bony healing
residual deformity

Question 8

what are the differentials for Perthes disease ?

Answer 8

unilateral - septic hip, JIA, SCFE, lymphoma

bilateral - hypothyroid, sickle, epiphyseal dysplasia

Question 9

how do you treat Perthes disease ?

Answer 9

maintain hip motion
analgesia
restrict painful activity
consider osteotomy in >7
prognosis good onset <9

Question 10

when is SCFE chronic ?

Answer 10

3 weeks

Question 11

how does SCFE present ?

Answer 11

pain in hip or knee
externally rotated posture and gait
reduced internal rotation, especially in flexion
plain xray

Question 12

how is SCFE classed on Xray ?

Answer 12

mild <1/3
moderate 1/3-1/2
severe >1/2

Question 13

how is SCFE treated ?

Answer 13

operative fixation

Question 14

what are outcomes of SCFE ?

Answer 14

AVN - unstable slips more common
chondrolysis
deformity
early OA