Peadiatic orhtopeadics, the big three Flashcards
What are the big three?
Developmental delay of the hip (DDH)
Perthes Disease
Slipped upper femoral epiphysis (SUFE)
What hip problems typically affect those aged 0-5
Normal varient Trauma Transient synovitis Osteomyelitis Septic arthritis DDH JIA
What hip problems typically affect those aged 5-10
Trauma Transient synovitis Osteomyelitis Septic arthritis Legg-calve-perthes disease
What hip problems typically affect those aged 10-15
Trauma Osteomyelitis Septic arthritis SUFE Chondromalacia Neoplasm
What is DDH
Who gets it?
During fetal development the hip malforms
more common in girls, the left hip,first borns, breech babies, FH, increased weight, other lower limb deformities, oligohydraminos.
What are the clincial signs or DDH?
Ortolani’s sign- from adducted position hip is abducted
Barlow’s sign- flex hip to 90 degrees
Piston motion sign- pistol shape
Hamstring sign-
How is it treated?
Casts in the legs (look very comical)
Surgery, pin it
What screening can be done for DDH
CLinical examination- will inevitably miss some due to inexpericne of examiner, baby distressed etc
Ultrasound screening- time consuing, difficulty with follow up
Selective ultrasound screening
Managable workload, effective, late presenters will still occur
What is the typical presentation of Legg-Calve-perthes disease
Male 5 Primary school age Short stature Limp Knee pain on exercise Stiff hip joint Systemically well
What are the phases of Legg-calv-perthes disease?
Avascular necrosis
Fragmentation (revascularisation-pain)
Re-ossification (bony healing)
Residual deformity
What are some differential diagnoses for Legg-calve-perhtes disease
Unilateral- septic hipm JIA, SUFE, lymphoma
Bilateral-Hypothyroid
Sickle
Epiphyseal dysplasia
What is the prognosis for Perthes disease
Younger do better
Proportion of headinvolved
Herring grade (lateral piillar classification)
Better the head is to the round the better
What is the treatment for perthes disease
Maintain hip motion Analgesia Restrict painful activitie Supervised neglect Containmet (osteotomy in select groups)
What is the typical presntation in SUFE
Pure fat cunt of a child Aged 13 Left groin pain 3 months Short, externally rotated hip Painful to weight bear
Who gets SUFE?
Teenage boys
unilateral typically (although 20% bilateral)
1 in 10 per 100,000
may be endocrine related
