Pediatric Disorders, Pediatric Hip, Adult Hip Flashcards
Clinical presentation of hip osteoarthritis
Pain in GROIN, positive trendelenburg, difficulty with stairs, clipping toenails, tying shoes
Limping
Motions that are weak in most patients with hip OA
Internal rotation and abduction
Pain on flexion most often
Treatment options for patients with hip OA
Non-operative pain management or steroid injections
Surgery can be used to correct and can be joint sparing or reconstructive
Risk factors for hip fracture
Steroid use Osteoporosis Female age Chronic medical conditions Smoking Alcohol post-menopause Sednetary lifestyle caucasians
Treatment of choice in intratrochanteric hip fractures
Fixation since femoral head blood supply is typically preserved
Treatment of choice in femoral neck hip fractures
Joint replacement
Femoral head blood supply has been disrupted and is at risk for necrosis
Options for hip joint replacement
THA: total hip arthroplasty. Replaces head, neck, AND acetabulum
SRA: Surface replacement arthroplasty. Replaces only the head surface and acetabulum
Limitations of THA
Increases chance of dislocation
Limited ability to revise afterwards (compared to SHA)
Can trigger osteolysis
Can loosen over time
Most common reason for THA failure
Accumulation of prosthetic debris and resulting inflammation leading to osteolysis and fracture
Complications associated with THA
Limb length disparity Dislocation Osteolysis/Fracture DVT/PE Infection Pneumonia
Three major causes of in-toeing in infants
Metatarsus adductus
Tibial torsion
Fermoral anteversion
Indications for using surgery to correct metatarsus adductus
ONLY if foot is too rigid to fit in shoes
Deformity will not delay walking and typically resolves by 1yo
Typical age of self-resolution of tibial torsion, femoral anteversion and metatarsus adductus
Tibial torsion by age 5
Femoral anteversion by age 10
Metatarsus adductus by age 1
Blount disease etiology
Impaired growth of the medial tibial plate –> VARUS
All children with bowing beyond 2 years should be evaluated
Risk factors for the development of Blount disease in children
Obesity
Early walking
Knee thrusting when walking
Excessive tibial torsion deformity (varus is reinforced)
Typical treatment for blount disease
Bracing
Surgery if not tolerated (common, guided growth)
Blount disease that carries poor prognosis
Late onset after puberty, as bones cannot be reformed
Adams Forward bending test
for scoliosis
One side of hip is higher
Cobb angle
For scoliosis
Measures angle between the two maximally twisted vertebrae
>10 degrees = scoliosis
Cobb angle cutoffs for scoliosis treatment
20-40 = Bracing >40 = surgical correction and spinal fusion (risk of respiratory compromise, should also get MRI of spinal cord))
Constellation of deformities seen in clubfoot
Metatarsus adductus
Hindfoot varus
Cavus (high arch)
Equinus (inability to dorsiflex ankle)
Treatment of club foot
Serial casting
Drugs that can induce AVN of the pediatric hip
glucocorticoids in immunosupression of children with cancer or autoimmune diseases
Common presentation of children with septic arthritis of hip (most common joint)
Use Kocher Criteria (WBC, Fever, not weight bearing, elevated ESR)
Transient synovitis
Mimic of symptoms of juvenile septic arthritis, without permanent joint destruction.
Differentiating transient synovitis from septic arthritis
Joint aspirate with bacteria in it
Kocher criteria useful (WBC, ESR, Fever, not weight bearing)
Developmental dysplasia of the hip
Malformation of the hip joint due to the head of the femur not remaining in contact with the acetabulum
Manuvers used to diagnose DDH in infants
Ortolani and Barlow
Ortolani manuver
DDH femoral head is felt to dislocate and relocate
Barlow manuver
DDH femoral head can be subluxed or dislocated under stress
Screening for DDH
All infants with risk factors should be screened for DDH using US or XR
Risk factors for DDH
Females Family history Breech In-utero deformities/positioning Post-natal positioning
Treatment of DDH
Bracing (Pavik harness)
Later presentation requires surgical correction
Must be careful not to strain the femoral head and cause AVN
Legg Calve Perth Disease
Idiopathic avascular necrosis of the hip in children
LCP = Leg Cannot Perfuse
Describe the development of LCP in childeren
- Avascularity causes femoral head to necrose
- Overlying cartilage survives and begins to form new bone while underlying bone begins to collapse
- Collapse of underlying bone flattens the femoral head
- Bone revascularized and remodels, as bone collapses or is remodeled groin pain is common
Radiographic findings of LCP
Flat, dense, white femoral head
Treatment of LCP
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)
Risk factors for slipped capital femoral epiphysis
Endocrine disorders
Over weight children
Treatment for slipped capital femoral epiphysis
Immediate immobilization of physis to avoid potential AVN
Slips are not reduced, but are pinned in place
Predisposes to OA
Risk factors for developing DDH
Females Family history Breech In-utero deformities/positioning Post-natal positioning
