Week 3 - E - Paediatric hip prbolems - Development dysplasia, Transient synovitis, Perthe's disease, S.U.F.E Flashcards
What is developmental dysplasia of the hip?
Developmental dysplasia of the hip is a condition where there is dislocation or subluxation of the femoral head during the perinatal period which affects the subsequent development of the hip joint
Which hip is DDH more common in? Which sex is DDH more common in? And can it occur in both hips?
DDH is more common in the left hip DDH is more common in female babies and in 20% of cases is bilateral
What are the different risk factors for developmental dysplasia of the hip?
Risk factors include Positive family history of DDH Breech presentation First born babies DOwn’s syndrome Other congenital disorders eg talipes
If left untreated, what can the developmental dysplasia of the hip cause to the hip joint? What is therefore more likely to occur at a young age?
If left untreated, the acetabulum is very shallow and in more severe cases a false acetabulum occurs proximal to the original one with a shortened limb Severe arthritis due to a reduced contact area can occur at a young age and gait / mobility may be severely affected
What are the presenting signs of a DDH? What are the examinations procedures carried out to test for DDH after birth?
Signs of DDH include Shortening of the limb Asymmetric groin / thigh skin creases Click or clunk on the Ortalani and Barlow test
How are the Ortalani and Barlow tests carried out?
Ortlani test is where you attempt to reduce an already dislocated hip with abduction and anterior dispacement (Ortalni for already Out) Barlow test - dislocataBle hip - attempt to disclocate the hip with flexion and posterior displacement
If the patient has an unstable hip with a positive Ortalani test or Barlow test, what mode of investigation is carried out? When does the choice of investigation change and why?
Ultrasound scan is the imaging of choice in babies up to the age of 4-6 months After this xrays are the investigation of choice - have to wait this long as the femoral head epiphyses is unossified until around 4-6 months
What is used as the treatment of developmental dysplasia of the hip?
A special harness known as a pavlik harness is used which keeps the hips in comfortable flexion and abduction thus maintaining reduction
What can over-flexing and abduction of the hip result in DDH? - this is the worst possible outcome of treatment
Over-flexion and abduction of the hip in the Pavlik Harness can result in avascular necrosis of the hip
How long is the pavlik harness used for?
Pavlik harness is used full time for around 6 weeks, then part-time for another 6 weeks once the hip is confirmed to be stable It can be used for up to 4-6 months
For children with persistent dislocation over 18 months old, what is likely to be required as treatment?
For children with persistent dislocation over 18 months old open reduction is much more likely to be required and the acetabulum is likely to be very shallow by this stage They may also need femoral / pelvic osteotomies to maintain joint stability
What is transient synovitis of the hip?
Transient synovitis of the hip as its name suggest is self-limiting inflammation of the synovium of the hip joint - it is the commonest cause of hip pain in childhood
What age group / sex does transient synovitis of the hip tend to affect and what does it typically occur after?
Transient synovitis of the hip tends to affect boys aged between 2 and 10 years old It typically occurs after an upper respiratory tract infection (usually viral) although sometimes no cause is found
What is the most important pathology that you must rule out when considering transient synovitis of the hip?
YOU MUST RULE OUT SEPTIC ARTHRITIS Take bloods - WBC, ESR/CRP should all be within normal range in transient synovitis of the hip
What other conditions should be considered for causing hip pain?
Also consider * Perthe’s diseasee * SUFE (slipped upper femoral epiphyses) * Juvenile idiopathic arthritis * Rheumatoid arthritis Xray may be useful
How is Perthe’s disease diagnosed and how is it treated?
Perthe’s disease is diagnosed typically by carrying out bilateral hip xrays- may see femoral head collapse and fragmentation No specific treatment - avoid exercise and rest (50% of cases do well)
What is SUFE? What is the typical patient that is affected?
SUFE stands for slipped upper femoral epiphyses It is a condition mainly affected overweight pre-pubertal adolescent boys where the femoral head epiphyses slips inferiorly in relation to the femoral neck
What is the predominant clinical sign of SUFE? What xray view is important to obtain for this condition?
Loss of internal rotation of the hip is the predominant clinical sign. Xray changes may be subtle and a lateral view must be obtained to detect mild degrees of slip.
