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MSK Cramming > Pediatric Disorders, Pediatric Hip, Adult Hip > Flashcards

Pediatric Disorders, Pediatric Hip, Adult Hip Flashcards

1
Q

Clinical presentation of hip osteoarthritis

A

Pain in GROIN, positive trendelenburg, difficulty with stairs, clipping toenails, tying shoes
Limping

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2
Q

Motions that are weak in most patients with hip OA

A

Internal rotation and abduction

Pain on flexion most often

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3
Q

Treatment options for patients with hip OA

A

Non-operative pain management or steroid injections

Surgery can be used to correct and can be joint sparing or reconstructive

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4
Q

Risk factors for hip fracture

A 
Steroid use
Osteoporosis
Female age
Chronic medical conditions
Smoking
Alcohol
post-menopause
Sednetary lifestyle
caucasians
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5
Q

Treatment of choice in intratrochanteric hip fractures

A

Fixation since femoral head blood supply is typically preserved

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6
Q

Treatment of choice in femoral neck hip fractures

A

Joint replacement

Femoral head blood supply has been disrupted and is at risk for necrosis

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7
Q

Options for hip joint replacement

A

THA: total hip arthroplasty. Replaces head, neck, AND acetabulum
SRA: Surface replacement arthroplasty. Replaces only the head surface and acetabulum

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8
Q

Limitations of THA

A

Increases chance of dislocation
Limited ability to revise afterwards (compared to SHA)
Can trigger osteolysis
Can loosen over time

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9
Q

Most common reason for THA failure

A

Accumulation of prosthetic debris and resulting inflammation leading to osteolysis and fracture

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10
Q

Complications associated with THA

A 
Limb length disparity
Dislocation
Osteolysis/Fracture
DVT/PE
Infection
Pneumonia
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11
Q

Three major causes of in-toeing in infants

A

Metatarsus adductus
Tibial torsion
Fermoral anteversion

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12
Q

Indications for using surgery to correct metatarsus adductus

A

ONLY if foot is too rigid to fit in shoes

Deformity will not delay walking and typically resolves by 1yo

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13
Q

Typical age of self-resolution of tibial torsion, femoral anteversion and metatarsus adductus

A

Tibial torsion by age 5
Femoral anteversion by age 10
Metatarsus adductus by age 1

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14
Q

Blount disease etiology

A

Impaired growth of the medial tibial plate –> VARUS

All children with bowing beyond 2 years should be evaluated

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15
Q

Risk factors for the development of Blount disease in children

A

Obesity
Early walking
Knee thrusting when walking
Excessive tibial torsion deformity (varus is reinforced)

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16
Q

Typical treatment for blount disease

A

Bracing

Surgery if not tolerated (common, guided growth)

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17
Q

Blount disease that carries poor prognosis

A

Late onset after puberty, as bones cannot be reformed

18
Q

Adams Forward bending test

A

for scoliosis

One side of hip is higher

19
Q

Cobb angle

A

For scoliosis
Measures angle between the two maximally twisted vertebrae
>10 degrees = scoliosis

20
Q

Cobb angle cutoffs for scoliosis treatment

A 
20-40 = Bracing
>40 = surgical correction and spinal fusion (risk of respiratory compromise, should also get MRI of spinal cord))
21
Q

Constellation of deformities seen in clubfoot

A

Metatarsus adductus
Hindfoot varus
Cavus (high arch)
Equinus (inability to dorsiflex ankle)

22
Q

Treatment of club foot

A

Serial casting

23
Q

Drugs that can induce AVN of the pediatric hip

A

glucocorticoids in immunosupression of children with cancer or autoimmune diseases

24
Q

Common presentation of children with septic arthritis of hip (most common joint)

A

Use Kocher Criteria (WBC, Fever, not weight bearing, elevated ESR)

25
Q

Transient synovitis

A

Mimic of symptoms of juvenile septic arthritis, without permanent joint destruction.

26
Q

Differentiating transient synovitis from septic arthritis

A

Joint aspirate with bacteria in it

Kocher criteria useful (WBC, ESR, Fever, not weight bearing)

27
Q

Developmental dysplasia of the hip

A

Malformation of the hip joint due to the head of the femur not remaining in contact with the acetabulum

28
Q

Manuvers used to diagnose DDH in infants

A

Ortolani and Barlow

29
Q

Ortolani manuver

A

DDH femoral head is felt to dislocate and relocate

30
Q

Barlow manuver

A

DDH femoral head can be subluxed or dislocated under stress

31
Q

Screening for DDH

A

All infants with risk factors should be screened for DDH using US or XR

32
Q

Risk factors for DDH

A 
Females
Family history
Breech
In-utero deformities/positioning
Post-natal positioning
33
Q

Treatment of DDH

A

Bracing (Pavik harness)
Later presentation requires surgical correction
Must be careful not to strain the femoral head and cause AVN

34
Q

Legg Calve Perth Disease

A

Idiopathic avascular necrosis of the hip in children

LCP = Leg Cannot Perfuse

35
Q

Describe the development of LCP in childeren

A
  1. Avascularity causes femoral head to necrose
  2. Overlying cartilage survives and begins to form new bone while underlying bone begins to collapse
  3. Collapse of underlying bone flattens the femoral head
  4. Bone revascularized and remodels, as bone collapses or is remodeled groin pain is common
36
Q

Radiographic findings of LCP

A

Flat, dense, white femoral head

37
Q

Treatment of LCP

A

Patients must be braced, casted, or surgically corrected to reduce pressures on the collapsing femoral head

Poorer prognosis in patients >6yo as they have less time to remodel the head (and thus are more likely to develop osteoarthritis)

38
Q

Risk factors for slipped capital femoral epiphysis

A

Endocrine disorders

Over weight children

39
Q

Treatment for slipped capital femoral epiphysis

A

Immediate immobilization of physis to avoid potential AVN
Slips are not reduced, but are pinned in place
Predisposes to OA

40
Q

Risk factors for developing DDH

A 
Females
Family history
Breech
In-utero deformities/positioning
Post-natal positioning

MSK Cramming (9 decks)

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