Pediatric hip

Question 1

The ______ is the common physis around which the acetabulum grows

Answer 1

triradiate cartilage- confluence of ilium, ischium, pubis

Question 2

Describe femoral head blood supply in children

Answer 2

• 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

Question 3

Hip infections in infants can occur via:

Answer 3

direct hematogenous seeding of femoral head via metaphyseal vessels

Question 4

Describe presentation of septic arthritis of the hip in young children

Answer 4

fussy, fever, limited range of motion due to pressure and pain

Question 5

What is transient synovitis?

Answer 5

occurs exclusively in pre-pubetal children, viral etiology possible- occurs after respiratory tract infections
resolves without complications

Question 6

Definitive diagnosis of septic arthritis vs transient synovitis is made via:

Answer 6

• ultrasound showing effusion

- guided aspiration and analysis of joint fluid

Question 7

What factors may be predictors of the likelihood of septic arthritis in a child?

Answer 7

WBCs > 12k
ESR> 40
fever
not weightbearing

Question 8

Describe the spectrum of developmental dysplasia of the hip

Answer 8

dislocated, dislocatable, subluxed, subluxable, radiographic abnormalities

Question 9

In developmental dysplasia of the hip, the femoral head fails to remain stably located within the ___________

Answer 9

acetabular cartilage

Question 10

What factors may predispose children to developmental dysplasia of the hip?

Answer 10

female
first born
breech
family history

post-natal: papoosing

Question 11

What factors may predispose children to developmental dysplasia of the hip?

Answer 11

female
first born
breech
family history

post-natal: papoosing

Question 12

What exam maneuvers can identify a dislocated hip?

Answer 12

Ortolani

Barlow

Question 13

What babies should be screened for hip dislocation?

Answer 13

breech girls, screen by ultrasound at 3-6 weeks old

Question 14

What is the treatment for DDH?

Answer 14

• bracing if presentation was early enough
• reduction and casting if later presentation
• surgery if persistent

Question 15

Children with DDH are followed through skeletal maturity because any residual dysplasia contributes to the development of hip _________

Answer 15

osteoarthritis

Question 16

What is Legg-Calve-Perthes disease?

Answer 16

idiopathic avascular necrosis in children

Question 17

How does LCP disease present?

Answer 17

necrotic femoral head –> pain in groin, hip, thigh, knee

Question 18

Describe the natural history of LCP disease

Answer 18

development of avascularity
femoral head fragmentation and collapse
revascularization eventually occurs, epiphysis re-ossifies, remodeling can begin

Question 19

What treatments are used for LCP disease?

Answer 19

NSAIDs, rest, bracing/ casting

Question 20

The more _____ the hip is after LCP disease, the greater the risk of later osteoarthritis

Answer 20

dysplastic

Question 21

As children approach puberty, the proximal femur can weaken due to rapidly expanding ______ zone during growth spurts

Answer 21

hypertrophied

Question 22

Some children can develop a stress fracture that results in :

Answer 22

slipped capital femoral epiphysis, SCFE

Question 23

What children are at risk for SCFE?

Answer 23

overweight adolescents, endocrine disorders

Question 24

What is the major complication of SCFE?

Answer 24

progressive displacement of the femoral head/ neck to the point of avascular necrosis
later risk of osteoarthritis