Revision - Hip Problems, Rickets & OI Flashcards
Clinical features of DDH?
1) asymmetrical skin folds
2) leg length discrepancy
3) clunking on special tests
4) limited hip abduction
5) significant bilateral restriction in abduction
What 2 special tests are used to check for DDH?
1) Barlow test
2) Ortolani test
What is Barlow vs Ortolani test attempting to do?
Barlow –> Gentle downward pressure is placed on knees through femur to see if the femoral head will dislocate posteriorly.
Ortolani –> Gentle pressure is used to abduct the hips and apply pressure behind the legs with the fingers to see if the hips will dislocate anteriorly
Clicking vs clunking in DDH exam?
Clicking - normal
Clunking - more likely to indicate DDH and requires an US
In DDH, if the baby presents <6 months of age, what does 1st line treatment involve?
Pavlik harness
What is a Pavlik harness?
A soft splint with the aim to hold the femoral head in the correct position to allow the hip socket (acetabulum) to develop a normal shape.
What position does a Pavlik harness keep the baby’s legs in?
Abduction & flexion
How long is a Pavlik harness typically on for?
6-8w
Management of DDH if the harness fails or the diagnosis is made after 6 months of age?
Surgery
What are some red flags for hip pain in children?
- age <3 y/o
- fever
- waking at night due to pain (malignancy)
- weight loss etc
- stiffness in morning (inflammatory)
- swollen or red joint
What are the 2 most common organisms causing septic arthritis in children?
1) Staph. aureus
2) Strep. pyogenes
What age in children is septic arthritis most common?
<4 y/o
What is the most common cause of hip pain in children aged between 3-10 years old?
Transient synovitis
How will children with transient synovitis typically hold their leg?
In a flexed, abducted and externally rotated position.
This position results in the least amount of intracapsular pressure within the joint and is therefore the least painful.
What movement is limited in transient synovitis?
Internal rotation
What special manoeuvre is indicated in transient synovitis?
Log roll test
What is the log roll test?
Ask the patient to lay supine with the hip and knee extended.
The examiner then passively rotates the entire limb internally and then externally.
A positive test is defined as involuntary muscle guarding when the leg is rolled passively
What is a positive result on a log roll test in transient synovitis?
Involuntary muscle guarding when the leg is rolled passively.
When can a working diagnosis of transient synovitis can be managed in primary care?
- afebrile
- mobile but limping
- symptoms have been present for <48 hours
What are the 4 aspects of the Kocher criteria?
1) non-weight bearing
2) fever >38.5
3) raised WCC
4) raised ESR
3 xray results in septic arthritis?
1) joint effusion
2) narrowing of the joint space
3) destruction of the subchondral bone
What is the main complication of Perthes?
Early hip osteoarthritis
There is remodelling of the bone as it heals –> causing a soft and deformed femoral head.