Peadiatric hip conditions Flashcards
What is developmental dysplasia of the hip?
a shallow/underdeveloped acetabulum which results in possible subluxation or dislocation of the hip
often secondary to capsular laxity and mechanical factors
When does DDH present?
birth - 2 years
What is the common presentation of DDH?
baby screening
limping child
arthritic pain later in life
Who is at greater risk of DDH - males or females?
females x6
What are the risk factors for DDH?
breech presentation family history oligohydramines first borns females
How is DDH diagnosed?
ultrasound
radiography
Barlows test - push backwards to dislocate the hip
Ortonlani test - abduct the hip to try to relocate it
How is DDH treated?
Pavlik harness - for 3 months then just at night- hips are ABDUCTED AND FLEXED
repeat ultrasound and harness until it is normal
then surgery if not fixed: closed reduction or open
What is Perthes disease?
avascular necrosis of the hip - can affect one or both hips
Who is at highest risk of Perthes disease?
5xmales second hand smoke low birth weight family history Asian, inuit, central european decent lower class
What age group presents with Perthes?
4-8 years
What is the pathophysiology behind Perthes?
distruption of the blood supply to the femoral head leading to revascularisation with subsequent reabsorption and then collapse and remodelling
possibly due to abnormal clotting factors
What is the clinical presentation of Perthes?
painless limp - trandelenburg and antalgic
hip stiffness
How is Perthes diagnosed?
MRI
Xray - loss of femoral head roundness
What is perthes treatment?
restrict weight bearing - can self terminate
physiotherapy
femoral and pelvic osteotomies
total hip arthroplasty - old patients
younger age at presentation = better prognosis
What is a Slipped Upper Femoral Epiphysis? (SUFE)
condition where the femoral head epiphysis slips inferiorly in relation to the femoral neck during a period of rapid growth
