Paediatric_Orthopaedics_Flashcards
What is Developmental Dysplasia of the Hip (DDH) and how is it diagnosed?
DDH is usually diagnosed in infancy by screening tests. It may be bilateral, and unilateral disease may cause leg length inequality. Early diagnosis is crucial to prevent complications like limping and early onset arthritis.
What are the treatment options for Developmental Dysplasia of the Hip?
Treatment options include splints and harnesses or traction. In later years, osteotomy, hip realignment, and possibly joint replacement may be needed, though replacements are typically deferred due to the likelihood of requiring revision.
How is Perthes Disease characterized and treated?
Perthes Disease is characterized by hip pain that may be referred to the knee, occurring typically between ages 5 and 12. Treatment involves relieving pressure from the joint and physiotherapy; it is usually self-limiting with prompt diagnosis and treatment.
What imaging findings are associated with Perthes Disease?
X-rays in Perthes Disease will show a flattened femoral head, and in untreated cases, the head may fragment.
What is Slipped Upper Femoral Epiphysis and how is it treated?
This condition is typically seen in obese male adolescents, presenting with knee pain referred from the hip and limitation in internal rotation. Treatment includes bed rest, non-weight bearing to avoid avascular necrosis, and possibly percutaneous pinning of the hip in severe cases.
What do X-rays show in cases of Slipped Upper Femoral Epiphysis?
X-rays will show the femoral head displaced and falling inferolaterally, resembling a ‘melting ice cream cone.’ The Southwick angle on X-rays indicates disease severity.
Theme: Disorders of the hip
A. Perthes disease
B. Developmental dysplasia of the hip
C. Osteoarthritis
D. Slipped upper femoral epiphysis
E. Septic arthritis
F. Rheumatoid arthritis
G. Intra capsular fracture of the femoral neck
H. Extra capsular fracture of the femoral neck
Please select the most likely diagnosis for the scenario given. Each option may be used once, more than once or not at all.
- An obese 14-year-old boy presents with difficulty running and mild knee and hip pain. There is no antecedent history of trauma. On examination internal rotation is restricted but the knee is normal with full range of passive movement possible and no evidence of effusions. Both the C-reactive protein and white cell count are normal.
- A 6-year-old boy presents with pain in the hip it is present on activity and has been worsening over the past few weeks. There is no history of trauma. He was born by normal vaginal delivery at 38 weeks gestation On examination he has an antalgic gait and limitation of active and passive movement of the hip joint in all directions. C-reactive protein is mildly elevated at 10 but the white cell count is normal.
- A 30-year-old man presents with severe pain in the left hip it has been present on and off for many years. He was born at 39 weeks gestation by emergency caesarean section after a long obstructed breech delivery. He was slow to walk and as a child was noted to have an antalgic gait. He was a frequent attender at the primary care centre and the pains dismissed as growing pains. X-rays show almost complete destruction of the femoral head and a narrow acetabulum.
- An obese 14-year-old boy presents with difficulty running and mild knee and hip pain. There is no antecedent history of trauma. On examination internal rotation is restricted but the knee is normal with full range of passive movement possible and no evidence of effusions. Both the C-reactive protein and white cell count are normal.
Perthes disease
The correct answer is: Slipped upper femoral epiphysis89%
Slipped upper femoral epiphysis is the commonest adolescent hip disorder. It occurs most commonly in obese males. It may often present as knee pain which is usually referred from the ipsilateral hip. The knee itself is normal. The hip often limits internal rotation. The diagnosis is easily missed. X-rays will show displacement of the femoral epiphysis and the degree of its displacement may be calculated using the Southwick angle. Treatment is directed at preventing further slippage which may result in avascular necrosis of the femoral head.
- A 6-year-old boy presents with pain in the hip it is present on activity and has been worsening over the past few weeks. There is no history of trauma. He was born by normal vaginal delivery at 38 weeks gestation On examination he has an antalgic gait and limitation of active and passive movement of the hip joint in all directions. C-reactive protein is mildly elevated at 10 but the white cell count is normal.
Septic arthritis
The correct answer is: Perthes disease74%
This is a typical presentation for Perthes disease. X-ray may show flattening of the femoral head or fragmentation in more advanced cases.
- A 30-year-old man presents with severe pain in the left hip it has been present on and off for many years. He was born at 39 weeks gestation by emergency caesarean section after a long obstructed breech delivery. He was slow to walk and as a child was noted to have an antalgic gait. He was a frequent attender at the primary care centre and the pains dismissed as growing pains. X-rays show almost complete destruction of the femoral head and a narrow acetabulum.
Slipped upper femoral epiphysis
The correct answer is: Developmental dysplasia of the hip63%
Developmental dysplasia of the hip. Usually diagnosed by Barlow and Ortolani tests in early childhood. Most Breech deliveries are also routinely subjected to USS of the hip joint. At this young age an arthrodesis may be preferable to hip replacement.
summarise
Paediatric orthopaedics
Developmental dysplasia of the hip
Usually diagnosed in infancy by screening tests. May be bilateral, when disease is unilateral there may be leg length inequality. As disease progresses child may limp and then early onset arthritis. More common in extended breech babies.
Splints and harnesses or traction. In later years osteotomy and hip realignment procedures may be needed. In arthritis a joint replacement may be needed. However, this is best deferred if possible as it will almost certainly require revision
Initially no obvious change on plain films and USS gives best resolution until 3 months of age. On plain films Shentons line should form a smooth arc
Perthes Disease
Hip pain (may be referred to the knee) usually occurring between 5 and 12 years of age. Bilateral disease in 20%.
Remove pressure from joint to allow normal development. Physiotherapy. Usually self-limiting if diagnosed and treated promptly.
X-rays will show flattened femoral head. Eventually in untreated cases the femoral head will fragment.
Slipped upper femoral epiphysis
Typically seen in obese male adolescents. Pain is often referred to the knee. Limitation to internal rotation is usually seen. Knee pain is usually present 2 months prior to hip slipping. Bilateral in 20%.
Bed rest and non-weight bearing. Aim to avoid avascular necrosis. If severe slippage or risk of it occurring then percutaneous pinning of the hip may be required.
X-rays will show the femoral head displaced and falling inferolaterally (like a melting ice cream cone) The Southwick angle gives indication of disease severity
