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2A - Musculoskeletal > Paediatric Orthopaedics - The Big 3 > Flashcards

Paediatric Orthopaedics - The Big 3 Flashcards

1
Q

What does DDH stand for?

A

Developmental dysplasia of the hip

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2
Q

Describe the epidemiology of DDH in terms of ethnicity, sex and which hip is more commonly affected?

A
  • Different incidence in different parts of world, most prevalent in Eskimo’s and least in northern Europe
  • Girls:boys 6:1
  • Left hip more commonly affected than right
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3
Q

What are risk factors for DDH?

A
  • First born
  • Oligohydramnios
    • Reduced fluid within the uterus
  • Breech presentation
  • Family history
  • Other lower limb deformity
  • High birth weight
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4
Q

What is oligohydramnios?

A
  • Reduced fluid within the uterus
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5
Q

What are the clinical features of DDH?

A
  • Ortolani’s sign
  • Barlow’s sign
  • Piston motion sign
  • Hamstring sign
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6
Q

What investigations are done for DDH?

A

X-ray is not done due to reducing x-ray exposure, and it would show things too late anyway due to femur not ossifying until 3 months

Investigation:

  • USS
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7
Q

What does the treatment of DDH depend on?

A

Age of patient

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8
Q

What is the treatment for DDH?

A
  • If <3 months
    • 90% respond to splint
  • 3 months to 1 year
    • Closed reduction and spica cast
  • >1 year
    • Open reduction and capsule reefing
  • >18 months
    • Open reduction with femoral shortening with or without periacetabular osteotomy
  • >6 years and bilateral
    • Leave alone
  • >10 years and unilateral
    • Leave alone
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9
Q

How does the prognosis of DDH with treatment change with age?

A

The older the child the poorer the result

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10
Q

Is any screening done for DDH in the UK?

A

Selective US screening is done in UK:

  • Every baby examined at birth
  • US may follow if indicated
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11
Q

What is the aetiology of perthes disease?

A
  • Pathologically avascular necrosis of hip
  • Possible relationships to
    • Coagulation tendency
    • Repeated minor trauma
  • Familial
  • Classically low social status
  • smnall stature - usually boys
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12
Q

Describe the epidemiology of perthes disease in terms of sex and age?

A
  • M>F
  • Primary school age
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13
Q

What are the clinical features of perthes disease?

A
  • Limp
  • Knee pain on exercise
  • Stiff hip joint
  • Systemically well
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14
Q

What investigation is done for perthes disease?

A
  • X-ray
    • Four Waldenstrom stages
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15
Q

How is perthes disease staged on an x-ray?

A

Four Waldenstrom stages:

1) Initial stage
2) Fragmentation stage
3) Reossification stage
4) Healed stage

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16
Q

What impacts the prognosis of perthes disease?

A
  • Younger age at presentation do better
  • The Proportion of head involved
  • Herring grade (lateral Pillar classification)
  • Radiographic “head at risk signs” Caterall
  • The nearer the head is to round, the better the outlook (Stulberg)
17
Q

What is the treatment of perthes disease?

A
  • Maintain hip motion
  • Analgesia
  • Restrict painful activity
  • Consider osteotomy in selected groups of older children (>7 years)
18
Q

What does SUFE stand for?

A

Slipped upper femoral epithysis

19
Q

Describe the epidemiology of SUFE in terms of sex and age?

A
  • M>F
  • Many overweight
  • Age 9-14 years
20
Q

How can SUFE be classed?

A
  • Acute v chronic
  • Magnitude of slip (angle or proportion)
  • Stable v unstable
    • Unstable is unable to weight bear (poor prognosis)
    • Stable is able to bear weight (good prognosis)
21
Q

What is the difference between stable and unstable SUFE?

A
  • Stable v unstable
    • Unstable is unable to weight bear (poor prognosis)
    • Stable is able to bear weight (good prognosis)
22
Q

How is the magnitude of SUFE classified?

A

Magnitude is classified by ratio of width of femur to amount of slip:

  • Mild <1/3
  • Moderate 1/3-1/2
  • Severe >1/2
23
Q

Describe the pathology of SUFE?

A
  • Displacement through hypertrophic zone
  • Metaphysis moves anterior and proximal
24
Q

What are the clinical features of SUFE?

A
  • Pain in hip or knee
  • Externally rotated posture and gait
  • Reduced internal rotation, especially in flexion
  • Plain x-rays
    • Best seen on lateral x-rays
25
Q

What investigations are done for SUFE?

A
  • X-ray
  • Slip can be identified early using Trethowan;s sign on AP film
26
Q

What is the treatment for SUFE?

A
  • Operative
    • Pinned in situ if stable
    • Open reduction if severe unstable slips
      • AVN high risk
27
Q

What are possible complications of SUFE?

A
  • AVN
    • Stable slips have low risk, unstable slips have high risk
  • Chrondolysis
  • Deformity
  • Early OA
  • Limb length discrepancy
  • Impingement

2A - Musculoskeletal (41 decks)

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