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MSK > Peadiatric Hip Conditions > Flashcards

Peadiatric Hip Conditions Flashcards

1
Q

when does DDH tend to present?

A

birth - 2 years

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2
Q

when does perthes disease tend to present?

A

4-8 years

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3
Q

when does SUFE tend to present?

A

10-16 years

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4
Q

how does the acetabulum develop>

A

triradiate cartilage in the middle ossifies over time

- cartilage composed of ischium, ilium and pubis

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5
Q

why is X ray not that useful in very young children? what is used instead?

A

femoral head has not yet ossified so wont be seen on X ray

US is better

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6
Q

H line on X ray?

A

horizontal line across the 2 triradiate cartilages - shows symmetry

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7
Q

what other lines can show positioning of hip on X ray?

A

2 perpendicular perkin lines - intersect the H line - upper femoral epiphysis should be mainly be in the lower left corner of the intersecting lines

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8
Q

what is DDH?

A

developmental dysplasia of the hip
developmental disorder resulting in dysplasia and possible subluxation/dislocation of the hip secondary to capsular laxity and mechanical factors

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9
Q

describe the spectrum of DDH

A

just dysplasia with shallow/underdeveloped acetabulum
subluxation
dislocation

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10
Q

where does DDH most commonly occur?

A

left hip in females (due to they way the baby lies in utero)

but can be bilateral

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11
Q

what demographics is DDH more/less common in?

A

more common in native americans and Laplanders
less common in African patients
- due to the way baby is carried after birth

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12
Q

describe the pathophysiology of DDH?

A

initial instability caused by maternal and fetal laxity, genetic laxity and intrauterine and postnatal malpositioning

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13
Q

describe the pathoanatomy of DDH

A

initial instability leads to dysplasia,dysplasia leads to gradual dislocation

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14
Q

how does DDH differ to a normally developing hip?

A

normal = correctly positioned femoral head stimulates normal head and acetabular growth
absent in DDH where hip never was or becomes subluxed/dislocated

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15
Q

what are the risk factors for DDH?

A 
first borns
female
breech presentation
family history
oligohydramnios
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16
Q

how does DDH present?

A

abnormality on screening
limping - trandellenberg gait
pain later in life

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17
Q

why do DDH patients get a trandellenberg gait?

A

short lever arm means abductors need to work harder

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18
Q

how is DDH diagnosed?

A

clinical exam - leg lengths, restricted abduction, skin creases
US
radiographs

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19
Q

what 2 clinical tests can indicate DDH?

A

ortolani - can you reduce the dislocated hip back in?

Barlows - can you dislocate the hip?

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20
Q

how is early DDH treated?

A

Pavlik harness - pute femoral head into position of safety (abduction and flexion)
night time splinting for a few weeks afterwards

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21
Q

how is Pavlik harness used?

A

worn 23 hrs a day for up to 12 weeks until US is normal

22
Q

how is late DDH treated?

A

surgery
- closed reduction +/- tendonotomies + spica (cast)
- open reduction + osteotomies + spica (cast)
hip arthrogram to assess congruency during treatment

23
Q

what is reactive synovitis?

A

inflammation of the synovium, often secondary to a viral illness

24
Q

how does reactive arthritis present?

A 
history of viral illness
limp with hip/groin pain
can have only referred pain to the knee
lying with hip flexed/externally rotated
pain at end range of hip movement
usually generally well
25
Q

how is reactive synovitis diagnosed?

A

kochers criteria

US +/- aspiration

26
Q

what is kochers criteria?

A

distinguishes between septic arthritis and reactive arthritis
- higher score = more chance of it being septic arthritis

27
Q

how is reactive synovitis treated?

A

self limiting

analgesia/NSAIDs

28
Q

what is septic arthritis of the hip?

A

intra-articular infection of the hip joint

29
Q

why is septic arthritis a surgical emergency?

A

high bacteria load causing sepsis
destruction of joint due to proteolytic enzymes
potential for osteonecrosis of the hip due to increased pressure

30
Q

how does septic arthritis of the hip present?

A 
sudden onset
unable to weight bear due to pain
hip lying flexed/externally rotated
severe hip pain on passive movement
usually pyrexial but can be haemodynamically stable
31
Q

through what 5 mechanisms can septic arthritis occur?

A

direct inoculation
hematogenous seeding
extension from adjacent bone (osteomyelitis)
continuous spread of osteomyelitis
can often spread from highly vascular metaphysis

32
Q

what are the most common causative organisms in septic arthritis?

A

neonates - strep
infant - adults = staph aureus
IV drug user = suspect pseudomonas and atypical

33
Q

how is septic arthritis treated?

A 
blood tests
blood cultures
kochers criteria
radiographs (to rule out)
US +/- aspiration
34
Q

how is septic arthritis treated?

A

open surgical washout (with samples)

antibiotics for 6 weeks

35
Q

what is perthes disease?

A

avascular necrosis of the hip

36
Q

risk factors for perthes?

A 
male
4-8 year olds
lower socioeconomic class
family history
low birth weight
second hand smoke
Asian, inuit, central europe
37
Q

is perthes unilateral or bilateral?

A

usually unilateral

38
Q

describe the pathophysiology of perthes

A

osteonecrosis occurs secondary to disruption of blood supply to femoral head
followed by revascularisation with subsequent resorption and later collapse
creeping substitution provides pathway for remodelling after collapse

39
Q

what are some proposed mechanisms for perthes development?

A

possible association with abnormal clotting factors

repeated subclinical trauma and mechanical overload lead to bone collapse and repair

40
Q

what are the stages of perthes disease?

A

initial
fragmentation
reossification
remodelling

41
Q

what determines prognosis in perthes?

A

age

- younger = better

42
Q

how does perthes present?

A

gradual painless limp
sometimes intermittent groin/thigh/knee pain
hip stiffness
limp (trendelenberg gait)

43
Q

how is perthes diagnosed?

A

radiograph

MRI

44
Q

how is perthes treated?

A

aim to keep femoral head round whilst the process self terminates
restrict weight bearing
maintain ROM with physio

45
Q

is surgery ever used in perthes?

A

occasionally
young patients with severe disease/deformity
older patients with secondary osteoarthritis

46
Q

what is SUFE?

A

slipped upper femoral epiphysis

condition affecting the proximal femoral physis that leads to slippage of the metaphysis relative to the epiphysis

47
Q

what are the risk factors for SUFE?

A

male
obesity
endocrine disorders
associated with a period of rapid growth

48
Q

how does SUFE present?

A 
variable length of development
groin pain (or knee/thigh)
limp
obligatory external rotation on hip flexion
49
Q

how is SUFE diagnosed?

A

radiographs

MRI

50
Q

how is SUFE treated?

A

surgery

  • pinning of the hip
  • +/- pinning of the other side +/- open reduction if very severe

MSK (66 decks)

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