The Big Three- DDH, Perthes Disease, SUFE

Question 1

DDH?

Answer 1

Developmental dysplasia of hip

Question 2

SUFE?

Answer 2

Slipped Upper Femoral Epiphysis

Question 3

Which age group usually gets DDH?

Answer 3

Newborns

Question 4

Which age group tends to get Perthes Disease?

Answer 4

Primary school aged children

Question 5

Which age group tends to get SUFE?

Answer 5

Late primary school, early secondary school

Question 6

Do girls or boys more commonly get DDH/dislocated hips at birth?

Answer 6

Girls

Question 7

Which hip tends to be more commonly affected by DDH/dislocation at birth?

Answer 7

Left hip

Question 8

Risk factors of DDH?

Answer 8

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)

Question 9

What four signs are used clinically to diagnose DDH?

Answer 9

Ortoloani’s sign
Barlow’s sign
Piston Motion sign
Hamstring sign

Question 10

Why is DDH rarer now?

Answer 10

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

Question 11

Issue with x-raying newborns to check for DDH?

Answer 11

Femoral head does not appear until 3 months old

Question 12

Prognosis of DDH?

Answer 12

If diagnosed within first few weeks of life, 90% respond to simple splintage
Older the child, poorer the prognosis

Question 13

Treatment of DDH if < 3 months?

Answer 13

Simple splintage

Question 14

Treatment of DDH if 3mnths-1yr?

Answer 14

Closed reduction surgery and cast

Question 15

Treatment of DDH if over a year old?

Answer 15

Open reduction and capsule reefing

Question 16

Treatment of DDH if over 18mths?

Answer 16

Open reduction with femoral shortening +/- peri-acetabular osteotomy

Question 17

Treatment of DDH if over age of six and bilateral?

Answer 17

Leave alone

Question 18

Treatment of DDH if over age of ten and unilateral?

Answer 18

Leave along

Question 19

Screening for DDH?

Answer 19

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

Question 20

Typical presentation of Perthes disease?

Answer 20

Short stature
Limp
Knee pain on exercise
Stiff hip joint
Systemically well

Question 21

Who is more likely to get Perthes?

Answer 21

Male>female
Primary school age

Question 22

Aetiology of Perthes disease?

Answer 22

Avascular necrosis of hip causing bone to deteriorate

Question 23

Some potential causes of Perthes?

Answer 23

Possible relationship to coagulation tendency
Possible relationship to repeated minor trauma
Familial
Classically low social class typically

Question 24

Four Walderstom stages of radiographic appearance of Perthes?

Answer 24

1. Initial stage
2. Fragmentation stage
3. Reossification stage
4. Healed stage

Question 25

Prognosis of Perthes?

Answer 25

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

Question 26

Treatment of Perthes?

Answer 26

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

Question 27

Examination findings of a leg in someone with SUFE?

Answer 27

Leg slightly shorter and externally rotated

Question 28

Who more commonly gets SUFE?

Answer 28

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

Question 29

Does SUFE tend to be bilateral?

Answer 29

About 20% chance of it being bilateral

Question 30

Stable vs unstable SUFE?

Answer 30

Stable- able to weight bear
Unstable- unable to weight bear

Question 31

When is SUFE acute?

Answer 31

If less than 3 weeks

Question 32

If you have a child complaining of knee pain and cannot find an obvious problem with the knee, what must you examine?

Answer 32

The hip- important

Question 33

Diagnosis of SUFE?

Answer 33

Clinical diagnosis- foot is always externally rotated

Plain x-ray good for confirmation

Question 34

Treatment of SUFE?

Answer 34

Majority operated on- stops bone slip getting any worse

Question 35

Risks of surgical treatment for SUFE?

Answer 35

Avascular necrosis
Chondrolysis
Deformity
Early osteoarthritis
Possibility of slip on the other side
Impingement
Limb length discrepancy