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MSK lectures > Pediatric Hip conditions - 22/10/18 > Flashcards

Pediatric Hip conditions - 22/10/18 Flashcards

1
Q

When does Developmental dysplasia of the hip present?

A

Birth to 2 years

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2
Q

When does Perthes present?

A

4-8 years

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3
Q

When does SUFE present?

A

10-16 years

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4
Q

What 3 things contribute to the formation of the acetabulum?

A

Ilium
Ischium
Pubis

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5
Q

When does the greater trochanter form?

A

6+?

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6
Q

What is the normal angle of the head of the femur?

A

135

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7
Q

Hilgenreiners line?

A

Horizontal line through tricartilagenous

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8
Q

Perkens lines?

A

Perpendicular lines through ilium and ischiuum

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9
Q

What are the three layers of the femoral head?

A

Hyaline cartilage
Subchondral bone
Cancellous bone

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10
Q

What does DDH stand for?

A

Developmental dysplasia of the hip

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11
Q

What is DDH?

A

Disorder of abnormal development resulting in dysplasia and possible subluxation or dislocation of the hip secondary to capsular laxity and mechanical factors

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12
Q

What does DDH incluse?

A

Dysplasia
Subluxation
Dislocation

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13
Q

Who is DDH most common in?

A

Females

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14
Q

Why is DDH more common in females?

A

Ligamentum laxity

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15
Q

Which hip is DDH most common?

A

Left hip

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16
Q

Why is DDH rarely seen in african patients?

A

Baby wrap

-the way babies are carried

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17
Q

What is the pathophysiology of DDH?

A

Initial instability thought to be caused by maternal and fetal laxity, genetic laxity and intrauterine and postnatal malpositioning

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18
Q

What is the pathoanatomy of DDH?

A

Initial instability leads to dysplasia

Leads to gradual dislocation

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19
Q

What are risk factors for DDH?

A 
Firstborns
6x commoner in females
Breech presentations
family history
Oligohydramnios
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20
Q

What are patient presentations of DDH?

A

Abnormality on screening
Limping child
Pain in later life

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21
Q

How is DDH diagnosed?

A

Clinical examination
Ultrasound
Radiographs

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22
Q

Why do DDH patients have a trendelenburg gait?

A

shorter lever arm distance

Increased workload on abductors

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23
Q

What may be seen on clinical examination of DDH?

A 
leg lengths
Restricted abduction
Skin crease asymmetry
Ortolani
Barlows
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24
Q

What is the barlow test?

A

Pushing backwards to try and dislocate hip

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25
Q

What is the ortolani test?

A

Abducting the hips to try relocate hip

Fingers push femur forwards into acetabulum

26
Q

What is the treatment of early presenting DDH?

A

Pavlik harness

27
Q

How long should the pavlik harness be worn?

A

23hrs a day
Up to 12 weeks
Night time splinting for a few more weeks

28
Q

How should DDH be monitored?

A

Serial USS

29
Q

What is the position of the legs in the pavlik harness?

A

Abducted

Flexed

30
Q

What is the treatment of late DDH?

A

Surgery
Closed reduction +/- tenotomies + spica
Open reduction + osteotomies + spica

31
Q

What is reactive synovitis and what causes it?

A

Inflammation of the synovium

Often due to viral illness

32
Q

What is the presentation of reactive synovitis?

A 
History of viral illness
Limp and hip/groin pain
Referred pain to knee
Hip lying flexed/externally rotated
Pain at end range of hip movements
Systemically well
Apyrexal
33
Q

How is reactive synovitis diagnosed?

A

Kochers critea

Ultrasounds +/- Aspiration

34
Q

What is the Kochers criteria?

A

Fever over 385
Refusal to bear weight
CRP>20
Serum WBC>12000/mm3

35
Q

What are the chances of septic arthritis with kochers?

A 
0 - 0.2%
1 - 3%
2 - 40%
3 - 93%
4 - 99.6%
36
Q

What is the treatment of reactive synovitis/

A

Self limiting
Analgesia
NSAIDS
Repeat review

37
Q

What is septic arthritis of the hip?

A

Intra-articular infection of the hip joint

38
Q

Why is septic arthritis an emergency?

A

High bacterial load
Destruction of joint
Potential for osteonecrosis

39
Q

How does septic arthritis present?

A 
Short duration of symptoms
Unable to bear weight
Hip lying felxed
Severe hip pain
Usually pyrexial
40
Q

What is the pathophysiology of septic arthritis of the hip?

A

Direct inoculation
Haematogenous seeding
Extension from adjacent bone
Contigous spread of osteomyelitis

41
Q

What is the most common organism causing septic arthritis in 1-5year olds?

A

Staph aureus

42
Q

How is septic arthritis of the hip diagnosed?

A 
Blood tests
Blood cultures
Kochers criteria
Radiographs
Ultrasounds
43
Q

What is the treatment of septic arthritis?

A

Open surgical washout

Antibiotics for 6 weeks

44
Q

What is Perthes disease?

A

Avascular necrosis of the hip

45
Q

What causes perthes?

A

Idiopathic

46
Q

What are risk factors for perthes?

A

Family history
Low birth weight
Second hand smoke
Asian, inuit and central european decent

47
Q

What is the pathophysiology of perthes?

A

Osteonecrosis
Disruption of blood supply
Revasularization
Collapse

48
Q

What are the stages of perthes?

A

Initial
Fragmentation
Reossification
Remodelling

49
Q

What factors affect prognosis?

A

Age
-Younger = better prognosis
Preserving round femoral head

50
Q

How does perthes present?

A 
Gradual onset of painless limp
Intermittent groin pain
Hip stiffness
Limp
-Trendelenburg
-Antalgic
51
Q

How is perthes diagnosed?

A

Radiographs

MRI

52
Q

How is perthes treatment?

A

KEEP FEMORAL HEaD ROUND
Restrict weight bearing
Maintain ROM

53
Q

How is surgery used for perthes?

A

Osteotomy in severe

54
Q

What is SUFE?

A

Slipped upper femoral epiphysis

A condition affecting the proximal femoral physis that leads to slippage of the metaphysis relative to the epiphysis

55
Q

What are the risk factors for SUFE?

A 
Males
Obesity
Endocrine disorders:
-GH deficiency
-Panhypopituitrism
-Hypothyroidism
56
Q

What is SUFE associated with/

A

Period of rapid growth

57
Q

How does SUFE present?

A

Variable
Groin pain
Limp

58
Q

How is SUFE diagnosed?

A

Radiographs

MRI

59
Q

What is seen on X-ray of SUFE?

A

Ice-cream cone appearance?

60
Q

How is SUFE treated?

A

Percutaneous pinning of the hip
+/- pinning of the other side
+/- open reduction if a very sever slip

MSK lectures (50 decks)

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