Pediatric Orthopaedics

Question 1

This deck covers

Answer 1

Developmental Dysplasia of the Hip (DDH)
Perthes Disease
SUFE

Question 2

Who gets DDH?

Answer 2

6x more in women

Mostly european races

Question 3

What can predispose you to DDH?

Answer 3

Being first born
FH
Breech birth
Oligohydramnios: less amniotic fluid than expected for given gestational age.
Having another lower limb deformity

Question 4

Does DDH affect one hip more than another?

Answer 4

Yes 3x more likely in the left hip. Something to do with how you pass down the birth canal

Question 5

What signs can be used to screen for DDH on a newborn exam?

Answer 5

Ortolani’s Sign
Barlow’s Sign
Piston Motion Sign

Question 6

How do we confirm DDH?

Answer 6

Focussed Examination and US- look for broken SHENTON line

Question 7

How do we manage DDH?

Answer 7

Spica Casts (specific type of plaster cast designed to realign the joint)

Question 8

Who gets perthes disease?

Answer 8

5M:1F

Around primary school age

Question 9

How does perthes present?

Answer 9

Knee pain on exercise
Limp
Stiff hip
Systemically well
Shortening of hip

(15% are bilateral)

Question 10

What is Legg-Calve-Perthes disease (LCP)?

Answer 10

Avascular necrosis of the head of the femur due to inadequate blood supply to the epiphysis

Question 11

What are the phases of LCP?

Answer 11

1- Avascular necrosis
2- Fragmentation- revascularization : the ischaemia is self-healing
3- Reossification – Bony healing
4- Residual deformity : as a result of reossification leads to distortion of epiphysis

Question 12

DDX for LCP?

Answer 12

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

Question 13

What can we do to treat LCP?

Answer 13

Maintain the hip motion but restrict painful activities
Analgesia
Consider osteotomy

Question 14

What is SCFE/SUFE?

Answer 14

Slipped capital/upper femoral epiphysis (same thing)

Question 15

Who gets SCFE/SUFE?

Answer 15

9-14yrs

Mostly boys

Question 16

What are the classes of SUFE?

Answer 16

Acute or chronic

Stable vs unstable

Question 17

What does SUFE look like?

Answer 17

hip or Knee pain

Ext rotated & reduced internal rotation (notable in posture & gait)

Question 18

How do we spot SUFE?

Answer 18

Do an x-ray

Question 19

How do we classifying sufe based on the x-ray?

Answer 19

By how far off its slipped:

• 1/3rd = mild
• 1/3rd -> 1/2th = moderate
• > 1/2th = severe

Question 20

How to treat Sufe?

Answer 20

Pinning in situ

Question 21

What complications can arise from sufe?

Answer 21

AVN (mostly unstable slips)
Chondrolysis
Deformity
Early OA

Question 22

Patient is 0-3yrs old, what conditions are you most likely to see?

Answer 22

SA (very common at any childhood stage)
Osteomyelitis
DDH (only in young'uns)
Toddler's fracture
NAI

Question 23

3-10 yr old patient, what conditions are you likely to see?

Answer 23

Trauma (bone & ST) - most common
SA (common at every age)

Transient synovitis
Perthes

Question 24

What’s most likely to affect a patient 11-15?

Answer 24

Trauma
SA
Osteomyelitis
SUFE (young teenagers)
Perthes

Question 25

On what movement is hip most stiff in Perthes?

Answer 25

• Internal rotation

- Abduction