Pediatric hip Flashcards
The ______ is the common physis around which the acetabulum grows
triradiate cartilage- confluence of ilium, ischium, pubis
Describe femoral head blood supply in children
- first few months of life: metaphyseal vessels of femoral neck
- by about 8 months, ossification begins and blood supply is from femoral artery via medial and lateral femoral circumlfex, penetrate directly into femoral head
Hip infections in infants can occur via:
direct hematogenous seeding of femoral head via metaphyseal vessels
Describe presentation of septic arthritis of the hip in young children
fussy, fever, limited range of motion due to pressure and pain
What is transient synovitis?
occurs exclusively in pre-pubetal children, viral etiology possible- occurs after respiratory tract infections
resolves without complications
Definitive diagnosis of septic arthritis vs transient synovitis is made via:
- ultrasound showing effusion
- guided aspiration and analysis of joint fluid
What factors may be predictors of the likelihood of septic arthritis in a child?
WBCs > 12k
ESR> 40
fever
not weightbearing
Describe the spectrum of developmental dysplasia of the hip
dislocated, dislocatable, subluxed, subluxable, radiographic abnormalities
In developmental dysplasia of the hip, the femoral head fails to remain stably located within the ___________
acetabular cartilage
What factors may predispose children to developmental dysplasia of the hip?
female
first born
breech
family history
post-natal: papoosing
What factors may predispose children to developmental dysplasia of the hip?
female
first born
breech
family history
post-natal: papoosing
What exam maneuvers can identify a dislocated hip?
Ortolani
Barlow
What babies should be screened for hip dislocation?
breech girls, screen by ultrasound at 3-6 weeks old
What is the treatment for DDH?
- bracing if presentation was early enough
- reduction and casting if later presentation
- surgery if persistent
Children with DDH are followed through skeletal maturity because any residual dysplasia contributes to the development of hip _________
osteoarthritis
What is Legg-Calve-Perthes disease?
idiopathic avascular necrosis in children
How does LCP disease present?
necrotic femoral head –> pain in groin, hip, thigh, knee
Describe the natural history of LCP disease
development of avascularity
femoral head fragmentation and collapse
revascularization eventually occurs, epiphysis re-ossifies, remodeling can begin
What treatments are used for LCP disease?
NSAIDs, rest, bracing/ casting
The more _____ the hip is after LCP disease, the greater the risk of later osteoarthritis
dysplastic
As children approach puberty, the proximal femur can weaken due to rapidly expanding ______ zone during growth spurts
hypertrophied
Some children can develop a stress fracture that results in :
slipped capital femoral epiphysis, SCFE
What children are at risk for SCFE?
overweight adolescents, endocrine disorders
What is the major complication of SCFE?
progressive displacement of the femoral head/ neck to the point of avascular necrosis
later risk of osteoarthritis
