paeds ortho Flashcards
What are the hip problems that can affect children between the ages of 0-5 years?
- “Normal variation” - assume this means that parents think something is wrong but it’s not?
- Trauma
- Transient synovitis
- Osteomyelitis
- Septic Arthritis
- Developmental Dysplasia of the Hip (DDH)
- Juvenile Idiopathic Arthritis
What are the hip problems seen most in children aged 5-10 years?
- Trauma
- Transient synovitis
- Osteomyelitis
- Septic Arthritis
- Legg-Calve-Perthes Disease
What are the hip problems seen most in children aged 10-15 years?
- Trauma
- Osteomyelitis
- Septic Arthritis
- SUFE
- Chondomalacia
- Neoplasm
What is Developmental Dysplasia of the Hip (DDH)?
An abnormality of the hip joint where the socket doesn’t fully cover the ball portion of the joint, resulting in an increased risk of joint dislocation. This may occur at birth or in early life.
- Affects Girls:Boys 6:1
With what children is there in increased risk of DDH?
- First born child
- Oligohydramnios - deficincy of amniotic fluid.
- Breech presentation
- Family history
- Other lower limb deformities
What are the risk factors for DDH?
- Family History
- Breech Birth
- Swaddling - wrapping the baby tightly in blankets.
What are the symptoms and signs of DDH?
Symptoms
- Often none, one leg may appear shorter than the other.
Signs - only 40% of DDH will be picked up on examination.
- Ortolani’s Sign -
- Barlow’s Sign -
- Piston Motion Sign
(tried to find info online but unclear)
What is the treatment of DDH?
- Bracing
- Casting
- Surgery
What is Legg-Calve-Perthes Disease?
Childhood hip disorder initiated by disruption of blood flow to the head of the femur. Due to a lack of blood flow the bone dies (osteonecrosis or avascular necrosis) and stops growing.
- More common in males (5:1)
- Peak age is in Primary School
What are the clinical signs of Legg-Calve-Perthes?
- Short staure
- Limp
- Knee pain on exercise
- Stiff hip joint
- Systemically well.
What are the phases of Legg-Calve-Perthes Disease?
- Avascular Necrosis
- Fragmentation - Revascularisation (pain)
- Reossification - Bone healing
- Residual deformity
What is the treatment of Legg-Calve-Perthes Disease?
Prognosis?
- Maintain hip motion
- Analgesia
- Restrict painful activities
- “supervise neglect” in most cases.
- “containment” - consider osteotomy in selected groups of children
Prognosis is good if the onset is before age 9
What is SUFE/SCFE?
Slipped Upper/Capital Femoral Epiphysis
A fracture through the growth plate (physis), which results in slippage of the overlying end of the femur (epiphysis).
Caused by increased force applied across the epiphysis, or decreases in the resistance within the physis to shearing.
What are the classifications of SUFE?
- Acute v Chronic (3 weeks)
- Stable v Unstable
- Unstable practically defined as when the patient is unable to ambulate even with crutches.
What are some of the common factors that contribute to SCFE?
- Mechanical
- Obesity - Most significant risk factor.
- Coxa Profunda - deep acetabular socket.
- Endocrine
