Pediatrics common conditions

Question 1

what are the types of pediatric hip dislocations?

Answer 1

• idiopathic: isolated (DDH)
• teratologic
  - neurologic
  - muscular: Arthrogryposis
  - syndromatic: Larsen syndrome
• miscellaneous: traumatic or septic arthritis complications

Question 2

when does DDH usually occur?

Answer 2

3rd trimester

Question 3

when does teratologic usually occur?

Answer 3

1st trimester

Question 4

What is the pattern of DDH?

Answer 4

1- acetabular dysplasia
2- subluxated
3- dislocated

Question 5

What are the causes of DDH?

Answer 5

• hormonal
• familial
  
  • lig laxity diseases
• genetics
• mechanical
  
  • prenatal
  • postnatal

Question 6

What are the signs of DDH?

Answer 6

• shortening
• external rotation
• lateralization contour
• asymmetrical skin folds
• limited abduction

Question 7

What are the special tests that should be done for DDH?

Answer 7

• Galiazzi sign (limb length inequality)
• Ortolani, Barlow test: only until 4 - 6 months (movement)
• Trendelenburg sign: older comprehending child
• Limping
  - unilateral: one sided
  - bilateral: waddling gait (Trendelenburg gait)

Question 8

What is the method of investigation that should be used in a 3 week - 3 month old with suspected DDH?

Answer 8

ultrasound

Question 9

What is the method of investigation used in a child >5-6 months old with suspected DDH?

Answer 9

XR pelvis (AP + abduction)
- its when ossification centers normally appear but they 
  are delayed & small incase of DDH

Question 10

What are the 2 radiological components that we should focus on in DDH?

Answer 10

• femoral head position

- acetabular development

Question 11

How should a baby after birth - 6 months be treated for DDH?

Answer 11

• reduce + maintain with Pavlik harness 6 weeks, then abduction splint
• if uneducable: GA + arthrogram open reduction + Hip spica for 6 weeks, then broom-stick cast for months

Question 12

how should a patient with DDH be treated at 6 - 12 months?

Answer 12

GA + arthrogram closed (or open) reduction + Hip spica for 6 weeks then broom-stick cast for months

Question 13

how should a patient with DDH be treated at 12 - 18 months?

Answer 13

GA + open reduction + hip spica for 6 weeks then broom-stick cast for months

Question 14

how should a patient with DDH be treated at 18 - 24 months?

Answer 14

GA + open reduction + acetabuloplasty + hip spica for 6 weeks + broom-stick for 6 weeks

Question 15

how should a patient with DDH be treated at 2-8 years?

Answer 15

GA + open reduction + acetabuloplasty + femoral shortening + hip spica for 6 weeks then broom-stick for 6 weeks

Question 16

how should a patient with DDH after 8 years?

Answer 16

GA + open reduction + acetabuloplasty (advanced) + femoral shortening

Question 17

what are the late complications if DDH is not treated?

Answer 17

• leg length discrepancy
• tilt
• severe pain
• early hip arthritis
• secondary scoliosis
• early lumbar spine degeneration

Question 18

SCFE occurs at what level?

Answer 18

physis

Question 19

what are the types of SCFE?

Answer 19

radiological

• acute <3weeks can’t walk
• chronic >3weeks start of callus formation can walk with crutches

clinical

• unstable -> can not bear weight on that limb
• stable -> can put some weight (walk)

IF SCUTE OR UNSTABLE URGENT SURGERY

Question 20

What are the causes of SCFE

Answer 20

hormonal 
- hypothyroid 
- abnormal GH
- hypogonadism 
metabolic 
- chronic renal failure 
mechanical 
- obesity 
trauma

Question 21

who does SCFE occur in?

Answer 21

8 - 12 year old

• male
• obese
• dark skinned

Question 22

What is the history for SCFE?

Answer 22

-