Pediatric hip

Question 1

Legg-Calve-Perthes Disease mechanism

Answer 1

blood supply is cut off and femoral head starts to die

Question 2

History of Legg-Calve-Perthes Disease ( onset)

Answer 2

insidious onset
gradual progression over several years

Question 3

Pain described by patient with Legg-Calve-Perthes Disease ( type of pain and location)

Answer 3

Vague ache in groin, medial thigh, and medial knee

Question 4

On the physical exam child with Legg-Calve-Perthes Disease will present with these gait deviations

Answer 4

1. limp ( antalgic gait)
2. trendelenburg giat
3. out towing w/ involved LE

Question 5

ROM limitations for Legg-Calve-Perthes Disease

Answer 5

1. IR and ABD
2. HIP flexion/ ADD contracture

Question 6

muscle changes in Legg-Calve-Perthes Disease

Answer 6

1. thigh muscle atrophy
2. child may be small for age

Question 7

What positions does the Atlanta Scottish-Rite Orthosis promote

Answer 7

hip ABD and IR

Question 8

Mechanism in SCFE ( slipped capital femoral epiphysis)

Answer 8

= femoral neck is displaced from femoral epiphysis
= femoral head remains in acetabulum

Question 9

2 Complications in SCFE

Answer 9

1. AVN
2. Chondrolysis ( articular cartilage dies)

Question 10

SCFE is failure of what secondary to what

Answer 10

failure of growth plates
2* to shear forces

Question 11

Prevalence of SCFE

Answer 11

disorder of the hip among adolescents
1. Boys: 14.4
2. Girls: 12.1

Question 12

Onset of SCFE

Answer 12

traumatic or gradual/ chronic

Question 13

SCFE - initial symptom
pain description and location

Answer 13

1st symptom = knee or lower thigh pain
pain = dull / aching in medial thigh

Question 14

Physical exam in SCFE will reveal these 3 things

Answer 14

1. limping ( often ER of involved side)
2. mild weakness
3. diminished ROM

Question 15

If SCFE is unstable physical exam will reveal

Answer 15

1. more consistent with fracture presentation
2. May be unable to bear weight through involved LE

Question 16

What is the surgical procedure for SCFE ? 4 of them

Answer 16

1. situ surgical fixation ( symptom relief, keep spherical femoral head, restore ROM)
2. Epiphysiodesis ( pictured)
3. Osteotomy
4. Salvage procedure

Question 17

precautions for SCFE

Answer 17

1. Typically NWB or TTWB
2. Full WB within 3-4 months (once growth plate has fused)

Question 18

2 other treatment options for SCFE other than surgery

Answer 18

1. Spika cast
2. traction

Question 19

Developmental Dysplasia of the Hip (DDH) what is the typical orientation in utero?

Answer 19

flexion and ABD
tight hip flexors and anteriolateral orientation

Question 20

What effect may kicking in utero have?

Answer 20

posterior dislocation
everted and flattened labrum

Question 21

The femoral head and acetabulum are displaced. This presents in 4 ways:

Answer 21

1. Flattened head on posteriomedial surface
2. Shallow acetabulum
3. Gradually increasing anteversion
4. Shortening of surrounding hip musculature

Question 22

Ligamentous laxity typically DOESNT present after

Answer 22

10 to 12 weeks

Question 23

Ortolani maneuver positive test

Answer 23

“clunk” palpated as femoral head slides ANTERIORLY over posterior acetabular rim (“sign of entry”)

Question 24

Barlow maneuver positive test

Answer 24

Positive test: ”clunk” palpated as femoral head slides posteriorly over POSTERIOR acetabular rim (“sign of exit”)

Question 25

What two components are involved in the physical exam ages 3 to 13 month (DDH)?

Answer 25

1. Gluteal fold and knee height asymmetry
2. Hip Abduction ROM

Question 26

Positive findings in physical exam DDH

Answer 26

less than 75 degrees ABD
30 degrees ADD ( past midline)

Question 27

Older children physical exam findings

Answer 27

limping,
Trendelenburg gait,
in-toeing,
out-toeing

Question 28

Conservative approach is advised when DDH is ID for how long?

Answer 28

within first 6 months

Question 29

Diapering - how many and in what position?

Answer 29

2 to 3 diapers in flexed and ABD position

Question 30

When is Pavlik harness ineffective?

Answer 30

Ineffective after 3 weeks

Question 31

Hip abduction orthosis for what population

Answer 31

= more than 9 months old
= Beginning to walk independently

Question 32

Hip ABD wearing schedule

Answer 32

Worn 24 hr/day x 6-12 weeks, then 12 hr/day x 3-6 months