PAEDS - Common hip conditions Flashcards
What are THE BIG THREE COMMON HIP CONDITIONS IN CHILDREN
DDH – Developmental Dyplasia of the Hip
Perthes Disease
SUFE – Slipped Upper Femoral Epiphysis
What is Developmental dysplasia of the hip (DDH)
Developmental dysplasia of the hip (DDH) is a condition where the “ball and socket” joint of the hip does not properly form in babies and young children.
What is the epidemiology of Developmental dysplasia of the hip (DDH)
Northern Europe 0.7 to 2.2 per 1000
Eastern Europe 28.7 per 1000
African Neonates 0
Apaches and Navajos 5%
Inuits (Eskimo) 25%
What are risk factors for Developmental dysplasia of the hip (DDH)
First Born
Oligohydramnios
Breech Presentation
Family History
Other lower limb deformities (Not TEV)
Increased weight (>10 lb)
What are clinical features of Developmental dysplasia of the hip (DDH)
Ortolani’s Sign
Barlow’s Sign
Piston Motion Sign
The Hamstring Sign
What is Ortolani’s Sign
The Ortolani test is performed by an examiner first flexing the hips and knees of a supine infant to 90°, then with the examiner’s index fingers placing anterior pressure on the greater trochanters, gently and smoothly abducting the infant’s legs using the examiner’s thumbs.
What is Barlow’s Sign
The Barlow Maneuver is done by guiding the hips into mild adduction and applying a slight forward pressure with the thumb. If the hip is unstable, the femoral head will slip over the posterior rim of the acetabulum, again producing a palpable sensation of subluxation or dislocation.
What is The Hamstring Sign
- If the thigh if flexed u oonto the abdomen and the knee passviey extended in most children with nora hips the knee can not be fully exenteded. In those with diclated hips because the hamstrings are less tight then the knee can be extended
What are investigations for Developmental dysplasia of the hip (DDH)
Use an Ultrasound for early diagnosis
On Average the head of the femur does not ossify until the child is at least 3 months old
What is treatment for Developmental dysplasia of the hip (DDH)
(for different ages)
< 3 months 90% respond to simple splint (pavlec harness)
3 Months to 1 year Closed reduction and spica cast (plaster that goes round abdomen)
> 1 year open reduction and capsule reefing
> 18 months open reduction with femoral shortening ± Peri-acetabular osteotomy
> 6 and bilateral leave alone
> 10 and unilateral leave alone
The older the child the poorer the result
How do you screen for Developmental dysplasia of the hip (DDH)
Clinical examination
Universal Ultrasound screening
Selective Ultrasound screening
How do you screen for Developmental dysplasia of the hip (DDH)
Clinical examination (only picks up 40%)
Universal Ultrasound screening
Selective Ultrasound screening
What is perthes disease
Perthes disease is a rare childhood condition that affects the hip. It occurs when the blood supply to the rounded head of the femur (thighbone) is temporarily disrupted. Without an adequate blood supply, the bone cells die, a process called avascular necrosis
What are typical symptoms of Perthes disease
Boy Primary school age Short stature Limp Knee pain on exercise Stiff hip joint Systemically well
What is aetiology of Perthes disease
Pathologically avascular necrosis of hip
Possible relationship to coagulation tendency
Possible relationship to repeated minor trauma
Familial tendency
Classically low social status
