paeds - ortho Flashcards
developmental dysplasia of hip DDH
- Abnormal development of hip joint
- Spectrum
- Dysplasia, subluxation and possible dislocation (low & high)
developmental dysplasia of hip epidemiology
- Most common orthopaedic disorder in neonates
- Incidence of dislocation 1.4/1000 births
- Clinical instability 2.3/100
- Ultrasound abnormal 8/100
- More common in females 6:1
- Most common in left hip
- Bilateral 20%
Causes of developmental dysplasia of hip
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- First born
- Unstretched uterus & tight abdominal muscles
- Female
Estrogens released by fetus - Footling breech
- Family History
One parent = 12% - Oligohydramnios
- Neonatal hip instability
20-60% spontaneously resolve
features hip dysplasia in neonate
- Relaxed child
- Ortolani’s sign = delicate ‘clunk’ of entry
- Barlow’s sign = adduction ‘clunk’ of exit
- Hip may remain reducible
features hip dysplasia in older child
- Asymmetric groin folds
- Limited abduction
- Galeazzi sign
- Klisic’s sign = GT - ASIS
- Nelaton’s line = ischial tuberosity - ASIS
hip dysplasia screening programs in UK, Europe, SA
- UK
– Clinical assessment and ultrasound for high risk cases
– Concerns re high incidence of late presenting / missed cases dt poorly trained staff - Europe – Universal ultrasound screening
- SA CHB and CMJ – Officially clinical screening
DDH radiographic diagnosis
- X-rays not used in the newborn
* Ossification femoral head @ 4-6months - Ultrasound diagnosis
* Static
* Dynamic
DDH Rx - birth- 6 months
- Pavlik Harness : Hip flexion → docks; hip abduction → locates
- Weekly adjustments
= With treatment, > 75% stabilize
DDH Rx - 7 - 18 months
closed reduction
* Under anaesthesia & intraoperative screening
* Confirm reduction – arthrogram, Xray, MRI, CT
* Hip spica = 12 weeks
* Batchelor cast = 12 weeks
DDH Rx - >18 months
- Open reduction
- Extensive surgical release of contracted soft tissue & clearing of potential hip joint
- Hip spica + Batchelor cast = 12 weeks
- Femoral osteotomies useful if under tension
- Pelvic osteotomies to augment coverage
DDH Rx - open reduction approach
iliofemoral approach
- critically exposes the capsule laterally, anteriorly & medially
DDH Rx - open reduction age limit
- bilateral: </= 6y/o
- unilateral: </= 8y/o
DDH - Rx complications
- Re-dislocation (Reported < 5%, probably higher)
- Avascular necrosis should be < 10%
- Femoral head compression
- Vessel injury to medial femoral circumflex artery
Perthes’ Disease what is it
- Idiopathic avascular necrosis of femoral head in children
- Focal disruption of blood supply
- Generalised disorder (osteochondrosis)
- 1 in 10 000 children
- 5:1 M:F
- 4-8 years old
- Bilateral in 12%
Perthes’ Disease presentation
History
* Insidious onset of pain (knee, hip, groin)
* Limp
Examination
* Antalgic, Trendelenburg gait
* Quads & calf wasting
* Limited hip abduction and internal rotation
