Pediatric Big Ten - Injuries Flashcards
What is developmental hip dysplasia?
Happens in infants - can range from a totally dislocated hip to slightly subluxable joints or just a slightly abnormal socket
What are some risk factors for developing hip dysplasia?
breech presentation - and thus first borns
torticollis (short neck)
metatarsus adductus (foot deformity)
oligohydramnios
usually the left hip
happens in girls 80% of the time
Why has dysplasia historically been more common in native american populations?
they use swaddling more often, which leads to hip dysplasia
What two maneuvers do you do to diagnose hip dysplasia in an infant?
the Barlow and Ortolani
Barlow is the dislocation (can you feel it pop out)
Ortolani is the reduction (can you feel it click back in)
Late diagnosis of hip dysplasia will eventually be made with what two tests?
look for limited abduction of the leg
Galeazzi sign - apparent leg length discrepancy
THe difficult of reducing a dysplastic hip ____ with age.
increases
they have tighter adductor and liiopsoas muscles and other intraarticular obstacles develop like capsular construction ligamentum teres and labrum
What imaging is best for hip dysplasia?
ultrasound (but its only as good as your technician)
x-ray after 4-8 months
What is the treatment for hip dysplasia in a kiddo less than 6 months?
the Pavlik harness
super successful
full time 6-12 weeks on average
However, if the parents take it off and then put it back on when the hip is unreduced, it will make later treatment more difficult
What is the treatment for hip dysplasis in a kid months to 2 years?
closed reduction of the hip using arthrogram to be sure, followed by Spica casting
only use open reduction if closed fails and you continue to get persistent subluxation
What is the treatment for hi dysplasia in a kid older than 2?
open reduction, usually with femoral shortening and acetabular procedure
When should you refer if you’re concerned about hip dysplasia?
with an abnormal exam, abnormal ultrasound, or abnormal x-ray
What is Perthes Disease?
It’s a temporary vascular insult to the epiphysis- we’re not sure what causes it
the femoral head loses blood supply and it gets soft and can fragment to the point where it gets flat within the acetabulum
Who is at greatest risk for Perthes Disease?
grade school-aged boys with a positive family history
they usually have delayed bone age and are shorter
How do kids with Perthes disease usually present?
present with an insidious limb and mild to moderate pain in the hip, thigh or knee
What is the treatment for Perthes disease?
you can’t really stop it once it starts, but…
rest, NSAIDS for pain, physical therapy, casting
bracing doesn’t work actually
goal is to contain the femoral head within the acetabulum so that it won’t fragment so much and may stay as round as possible.
the petri cast is placed so that the hips are abducted and inwardly rotated so that the head stays in the acetabulum
What hip disorder can develop in adolescence? Usually in overweight males….
slipped capital femoral epiphysis