Pediatric Orthopaedics Flashcards
This deck covers
Developmental Dysplasia of the Hip (DDH)
Perthes Disease
SUFE
Who gets DDH?
6x more in women
Mostly european races
What can predispose you to DDH?
Being first born FH Breech birth Oligohydramnios Having another lower limb deformity
Does DDH affect one hip more than another?
Yes 3x more likely in the left hip. Something to do with how you pass down the birth canal
What signs can be used to screen for DDH on a newborn exam?
Ortolani’s Sign
Barlow’s Sign
Piston Motion Sign
How do we confirm DDH?
Focussed Examination and US
How do we manage DDH?
Spica Casts (specific type of plaster cast designed to realign the joint)
Who gets perthes disease?
5M:1F
Around primary school age
How does perthes present?
Knee pain on exercise Limp Stiff hip Systemically well Shortening of hip
(15% are bilateral)
What is Legg-Calve-Perthes disease (LCP)?
Avascular necrosis of the head of the femur due to inadequate blood supply to the epiphysis
What are the phases of LCP?
Avascular necrosis
Fragmentation - revascularisation (painful)
Reossification - bone healing
Residual deformity
DDX for LCP?
Unilaterally it could be a septic hip, JIA, SUFE or a lymphoma
If its bilateral it’s more likely a systemic problem e.g. hypothyroid, sickle cell or epiphyseal dysplasia
What can we do to treat LCP?
Maintain the hip motion but restrict painful activities
Analgesia
Consider osteotomy
What is SCFE/SUFE?
Slipped capital/upper femoral epiphysis (same thing)
Who gets SCFE/SUFE?
9-14yrs
Mostly boys
What are the classes of SUFE?
Acute or chronic
Stable vs unstable
What does SUFE look like?
hip or Knee pain
Ext rotated & reduced internal rotation (notable in posture & gait)
How do we spot SUFE?
Do an x-ray
How do we classifying sufe based on the x-ray?
By how far off its slipped:
- 1/3rd = mild
- 1/3rd -> 1/2th = moderate
- > 1/2th = severe
How to treat Sufe?
Pinning in situ
What complications can arise from sufe?
AVN (mostly unstable slips)
Chondrolysis
Deformity
Early OA
Patient is 0-3yrs old, what conditions are you most likely to see?
SA (very common at any childhood stage) Osteomyelitis DDH (only in young'uns) Toddler's fracture NAI
3-10 yr old patient, what conditions are you likely to see?
Trauma (bone & ST) - most common
SA (common at every age)
Transient synovitis
Perthes
What’s most likely to affect a patient 11-15?
Trauma SA Osteomyelitis SUFE (young teenagers) Perthes
