The Big Three- DDH, Perthes Disease, SUFE Flashcards
DDH?
Developmental dysplasia of hip
SUFE?
Slipped Upper Femoral Epiphysis
Which age group usually gets DDH?
Newborns
Which age group tends to get Perthes Disease?
Primary school aged children
Which age group tends to get SUFE?
Late primary school, early secondary school
Do girls or boys more commonly get DDH/dislocated hips at birth?
Girls
Which hip tends to be more commonly affected by DDH/dislocation at birth?
Left hip
Risk factors of DDH?
First born
Oligohydramnios- reduced amniotic fluid in fluid filled sac (covered more next year)
Breech born
Family history
Other lower limb deformities
Increased birth weight (>10lbs)
What four signs are used clinically to diagnose DDH?
Ortoloani’s sign
Barlow’s sign
Piston Motion sign
Hamstring sign
Why is DDH rarer now?
Part of the newborn examination to ensure hip is not dislocated
->In Sweden they have to examine 500 babies under supervision for DDH. If they then miss it, they go through a public inquiry
Issue with x-raying newborns to check for DDH?
Femoral head does not appear until 3 months old
Prognosis of DDH?
If diagnosed within first few weeks of life, 90% respond to simple splintage
Older the child, poorer the prognosis
Treatment of DDH if < 3 months?
Simple splintage
Treatment of DDH if 3mnths-1yr?
Closed reduction surgery and cast
Treatment of DDH if over a year old?
Open reduction and capsule reefing
Treatment of DDH if over 18mths?
Open reduction with femoral shortening +/- peri-acetabular osteotomy
Treatment of DDH if over age of six and bilateral?
Leave alone
Treatment of DDH if over age of ten and unilateral?
Leave along
Screening for DDH?
Clinical examination in newborn examination but some missed as examiner needs to be experienced
Ultrasound screening very god but too expensive for everyone
So selective screening is done for children who at most at risk using ultrasound
Typical presentation of Perthes disease?
Short stature
Limp
Knee pain on exercise
Stiff hip joint
Systemically well
Who is more likely to get Perthes?
Male>female
Primary school age
Aetiology of Perthes disease?
Avascular necrosis of hip causing bone to deteriorate
Some potential causes of Perthes?
Possible relationship to coagulation tendency
Possible relationship to repeated minor trauma
Familial
Classically low social class typically
Four Walderstom stages of radiographic appearance of Perthes?
- Initial stage
- Fragmentation stage
- Reossification stage
- Healed stage
Prognosis of Perthes?
Younger at presentation do better, a lot end up going completely back to normal, playing sports etc.
Depends on the proportion of the head involved
Treatment of Perthes?
Ummm no one agrees which is fab xx
Maintain hip motion
Analgesia
Restrict painful activites
‘Supervised neglect’ in most cases
Osteotomy in select groups of people if over 7yrs
->splints, physio, etc. not proven to help
Examination findings of a leg in someone with SUFE?
Leg slightly shorter and externally rotated
Who more commonly gets SUFE?
Teenage boys > girls
Many tend to be overweight
Some are taller and skinny
Some has endocrine conditions
->remember the made up example the lecturer used, a boy addicted to chocolate biscuits complaining of a pain for a while but parents thought nothing of it, complained to get out of PE etc. and one day parents were bored and took child to A&E
Note that heavier patients with SUFE do not have endocrine problems
Does SUFE tend to be bilateral?
About 20% chance of it being bilateral
Stable vs unstable SUFE?
Stable- able to weight bear
Unstable- unable to weight bear
When is SUFE acute?
If less than 3 weeks
If you have a child complaining of knee pain and cannot find an obvious problem with the knee, what must you examine?
The hip- important
Diagnosis of SUFE?
Clinical diagnosis- foot is always externally rotated
Plain x-ray good for confirmation
Treatment of SUFE?
Majority operated on- stops bone slip getting any worse
Risks of surgical treatment for SUFE?
Avascular necrosis
Chondrolysis
Deformity
Early osteoarthritis
Possibility of slip on the other side
Impingement
Limb length discrepancy
