Paediatric Orthopaedics - The Big Three Flashcards
What is the incidence of DDH?
Aberdeen 2.4 per 100 births
Girls 6:1
Left hip 3:1
What is the risk factors of DDH (developmental dysplasia of the hip)?
First born
Oligohydramnios - baby more cramped as less fluid around them
Breech presentation
Family history
Other lower limb deformities
Increased weight > 10lb
What are the clinical features of DDH?
Ortolani’s sign - abducted hip and clunking sensation when joint moves
Barlow’s sign - flex hip and push backwards
Those tests are fist few days of life
Piston Motion sign
The hamstring sign
What scans are done for DDH?
US for early diagnosis
Head of femur does not ossify until the child is 3 months old - often too late for X-ray
What is the treatment for DDH?
Under 3 months respond to simple splint
3 months to 1 year - closed reduction and spica cast
Over a year - open reduction and capsule reefing
Over 18 months - open reduction with femoral shortening and pre-acetabular osteotomy
Over aged 6 and bilateral leave alone
Over 10 and unilateral leave alone
Why is it important to diagnose DDH early?
The older the child the poorer the result
Worst results are associated with AVN of the head
What is a typical story for Perthes disease?
Male, primary school age, short stature, limp, knee pain on exercise, stiff hip joint and systemically well
What is the aetiology of Perthes disease?
Pathologically avascular necrosis of the hip
Possible relationship to coagulation tendency
Possible relationship to repeated trauma
Familial tendency
Classically low social status
What is seen on x-ray of Perthes disease?
Small sclerotic epiphysis - bone is more dense and flattened
What are the 4 stages of Waldenstrom of Perthes disease on X-ray?
Initial stage - collapsed bone smaller and sclerotic
Fragmentation stage
Re-ossification - new bone
Healed stage - remodelling
Can deform easily over these stages
What impacts the prognosis of Perthes disease?
Age of presentation - younger do better
Proportion of head involved
Herring grade - lateral pillar classification
Radiographic head at risk signs
Nearer the head is to round then the better the outlook
What is the treatment for Perthes disease?
Maintain hip movement, analgesia, restrict painful activity, supervised neglect, and consider osteotomy in selected groups of older children
10% bilateral
What is a typical story of SUFE?
Aged 13, left groin pain 3 months, short, externally rotated and painful to weight bear
What is the incidence of SUFE (slipped upper femoral epiphysis)?
1-10 per 100000/ year
Teenage boys more than girls
20% become bilateral
Many overweight
Small proportion endocrine abnormalities
How is SUFE classified?
Acute vs chronic (3 weeks)
Magnitude of slip (angle or proportion)
Stable vs unstable - unable to weight bear (poor prognosis)
