Pediatric Hip

Question 1

Kocher criteria
What’s it used for?
4 Criteria
Probabilities

Answer 1

Used to detect septic arthritis
Criteria: WBC count >12k, ESR >40, non-weight bearing, fever
Probabilities: 1 = 3%, 2 = 40%, 3 = 93%, 4 = 99%

Question 2

Which ROM movements are decreased w/ septic arthritis of the hip?

Answer 2

Abduction and IR

Question 3

3 risk factors for DDH

Answer 3

3 F’s: female, family hx, and feet first (breech)

Question 4

What 2 maneuvers tests for hip dislocation?

Answer 4

Ortolani maneuver and Marlow maneuver

Question 5

What test should all breech girls get?

Answer 5

US of hips at 3-6 weeks

Question 6

Treating DDH

Answer 6

• 1st line is a Pavlik harness to stabilize hips to keep head in acetabulum so remodeling can occur.
• Surgery followed by casting may be required if ligaments are too tight, often later in childhood.

Question 7

Treating Legg-Calve-Perthes Disease

Answer 7

NSAIDs, rest, bracing, casting, surgery

Question 8

Histology of slipped capital femoral epiphysis

Answer 8

Disorganized clusters and absence of columns of chondrocytes in physis

Question 9

Treating slipped capital femoral epiphysis

Answer 9

Requires emergency surgery to avoid bloodflow disruption → avascular necrosis. Slip is not reduced, but is pinned to avoid iatrogenic AVN.