Pediatric hip Flashcards
Legg-Calve-Perthes Disease mechanism
blood supply is cut off and femoral head starts to die
History of Legg-Calve-Perthes Disease ( onset)
insidious onset
gradual progression over several years
Pain described by patient with Legg-Calve-Perthes Disease ( type of pain and location)
Vague ache in groin, medial thigh, and medial knee
On the physical exam child with Legg-Calve-Perthes Disease will present with these gait deviations
- limp ( antalgic gait)
- trendelenburg giat
- out towing w/ involved LE
ROM limitations for Legg-Calve-Perthes Disease
- IR and ABD
- HIP flexion/ ADD contracture
muscle changes in Legg-Calve-Perthes Disease
- thigh muscle atrophy
- child may be small for age
What positions does the Atlanta Scottish-Rite Orthosis promote
hip ABD and IR
Mechanism in SCFE ( slipped capital femoral epiphysis)
= femoral neck is displaced from femoral epiphysis
= femoral head remains in acetabulum
2 Complications in SCFE
- AVN
- Chondrolysis ( articular cartilage dies)
SCFE is failure of what secondary to what
failure of growth plates
2* to shear forces
Prevalence of SCFE
disorder of the hip among adolescents
1. Boys: 14.4
2. Girls: 12.1
Onset of SCFE
traumatic or gradual/ chronic
SCFE - initial symptom
pain description and location
1st symptom = knee or lower thigh pain
pain = dull / aching in medial thigh
Physical exam in SCFE will reveal these 3 things
- limping ( often ER of involved side)
- mild weakness
- diminished ROM
If SCFE is unstable physical exam will reveal
- more consistent with fracture presentation
- May be unable to bear weight through involved LE
What is the surgical procedure for SCFE ? 4 of them
- situ surgical fixation ( symptom relief, keep spherical femoral head, restore ROM)
- Epiphysiodesis ( pictured)
- Osteotomy
- Salvage procedure
precautions for SCFE
- Typically NWB or TTWB
- Full WB within 3-4 months (once growth plate has fused)
2 other treatment options for SCFE other than surgery
- Spika cast
- traction
Developmental Dysplasia of the Hip (DDH) what is the typical orientation in utero?
flexion and ABD
tight hip flexors and anteriolateral orientation
What effect may kicking in utero have?
posterior dislocation
everted and flattened labrum
The femoral head and acetabulum are displaced. This presents in 4 ways:
- Flattened head on posteriomedial surface
- Shallow acetabulum
- Gradually increasing anteversion
- Shortening of surrounding hip musculature
Ligamentous laxity typically DOESNT present after
10 to 12 weeks
Ortolani maneuver positive test
“clunk” palpated as femoral head slides ANTERIORLY over posterior acetabular rim (“sign of entry”)
Barlow maneuver positive test
Positive test: ”clunk” palpated as femoral head slides posteriorly over POSTERIOR acetabular rim (“sign of exit”)
