Paediatric orthopaedics - the big three Flashcards

1
Q

What are the big three

A

DDH - Developmental Dysplasia of the Hip

Perthes disease

SUFE - Slipped Upper Femoral E piphysis

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2
Q

What can DDH lead to

A

Developmental dysplasia of the hip can lead to arthritis

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3
Q

What age does DDH usually affect

A

newborns

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4
Q

What age does Perthes disease normally affect

A

primary school age

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5
Q

what age does SUFE usually affect

A

Slipped upper femoral epiphyses - End of primary, beginning of secondary school

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6
Q

Where in the world is DDH - developmental dysplasia of the hip - most common

A

inuits - people who live in the arctic regions

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7
Q

Which gender is DDH more common in

A

Females 6:1 Males

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8
Q

Which hip is more commonly effected by DDH

A

Left hip - babies more commonly lie on their left side

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9
Q

What are the risk factors for DDH

A

first born
oligohydramnious - less fluid in the fluid filled sac the baby is in so the child is more likely to have renal problems and therefore they cannot kick around as much and have more chance of dislocated hip
Breech presentation - born feet first
Family history
other lower limb deformities
Overweight babies

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10
Q

What are the clinical features of DDH

A

Ortolani’s sign - as you abduct the hip, the hip pops into the socket
Barlows sign - apply a downward pressure over the knee with your thumb. If the hip is unstable, the femoral head will slip out of the acetabulum, producing the palpable sensation of the hip dislocating.

Piston motion sign - push on hip and you can feel it moving

Hamstring sign - flex thigh onto stomach and you should not be able to extend the knee unless the hip is dislocated

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11
Q

Why is Xray not done in new borns to look for DDH

A

Head of femur does not ossify until 3 months old at least so ultrasound has to be used

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12
Q

What is the treatment of DDH

A

If the DDH is caught early <3 months old - simple splint will be effective - pavlick harness

Closed reduction and spica cast if between 3 months and a year old

Over 18 months - open reduction with femoral shortening with or without peri-acetabular osteotomy

Over 6 years and bilateral - no treatment

Over 10 years old and unilateral - leave alone

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13
Q

What is the correlation between age of diagnosis of DDH and effectiveness of treatment

A

The younger DDH is diagnosed, the easier and more effective the treatment will be

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14
Q

Who is perthes disease more commonly seen in

A

Male - 10:1
Primary school age - 3,4,5
Short stature
Limp
knee pain on exercise
stiff hip joint
systemically well

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15
Q

How does DDH occur

A

Avascular necrosis of the hip

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16
Q

What happens in perthes disease

A

the blood supply to the head of the femur is interrupted. The femoral head then “necroses,” or loses blood supply, which weakens the bone and can lead to multiple fractures. Next, the bone is taken up by the body, or resorbed, which can lead to a complete collapse of the femoral head - Bone becomes soft and then the head of the femur collapses down and the space between the acetabulum and the femur increase

17
Q

What is the correlation with the shape of the femoral head and prognosis in perthes disease

A

The rounder the head the better - perthes can cause flattening of the femoral head

18
Q

What is the correlation between age and prognosis in perthes disease

A

Younger diagnosis - better outcome

19
Q

What is the Herring grade

A

The more collapsed down, the lateral pillar (lateral part) of the head was, the more severe, the perthes disease was

20
Q

How is perthes disease treated

A

Very young do not need treatment

Mantain hip motion
analgesia
restrict painful activities
Osteotomy in selected older children over 7

21
Q

What happens in an osteotomy

A

The head of the femur is broken and then contained into the acetabulum - points into the socket

22
Q

What is used for diagnosis of perthes disease

A

X-ray

23
Q

Who is SUFE - slipped upper femoral epiphysis more common in

A

Teenage boys - 9-14 years old slightly more than females

Mainly overweight

24
Q

What is acute SUFE

A

symptoms for less than 3 weeks

25
Q

What is chronic SUFE

A

symptoms more than 3 weeks

26
Q

What is an unstable SUFE

A

Unable to weight bear - bad prognosis

27
Q

What is stable SUFE

A

able to weight bear - good prognosis

28
Q

What is the presentation of SUFE

A

pain in hip or knee
externally rotated posture and gait
reduced internal rotation especially if the hip is flexed up

29
Q

How is SUFE investigated

A

X-ray

30
Q

What is the treatment for SUFE

A

Surgical - screw through the centre of bone and through the neck of the femur - bone grows across the growth plate and stops the slip getting worse

In severe unstable slips can do open reduction but avascular necrosis risk is high

31
Q

What are the risk factors of SUFE

A

avascular necrosis
chondrolysis - damage to the cartilage
deformity
osteoarthritis
slip possibility on the other side
limb length discrepancy
impingement

32
Q

What is the correlation between stability of slip and risk of avascular necrosis in SUFE

A

The more stable the slip is, the less risk of A vascular necrosis