Childrens Orthopaedics - The Big 3

Question 1

Developmental dysplasia of the hip

Answer 1

represents a spectrum of conditions affecting the proximal femur and acetabulum, ranging from acetabular immaturity to subluxation to frank hip dislocation

Question 2

True developmental dysplasia of the hip

Answer 2

true DDH, the femoral head has a persistently abnormal relationship with the pelvic acetabulum, which leads to abnormal bony development that can ultimately result in premature arthritis and significant disability

Question 3

Increased incidence of DDH in:

Answer 3

• First Born
• Oligohydramnios
• Breech Presentation
• Family History
• Other lower limb deformities

Question 4

Clinical features of DDH

Answer 4

• Ortolani’s Sign
• Barlow’s Sign
• Piston Motion Sign

Question 5

DDH investigations

Answer 5

• ultrasound of hip
• hip X-ray

Question 6

DDH management

Answer 6

• most cases treated non-surgically with an abduction harness
• surgery required for children with:
  
  • severe DDH
  • failed treatment with an abduction harness
  • older children

Question 7

Legg Calve Perthes Disease

Answer 7

• a self limiting disease of the femoral head comprising of necrosis, collapse, repair, and remodelling that presents in the first decade of life
• cause hypothesised to be single or multiple vascular events followed be revascularisation
• in later life, can lead to painful and poorly functioning hips

Question 8

Legg Calve Perthes Disease Symtoms

Answer 8

• limp
• limited range of motion at the hip joint
• short stature
• knee pain
• Trendelenburg’s sign
• typically unilateral, bilateral involvement in 10%

Question 9

Legg Calve Perthes Disease Investigations

Answer 9

bilateral hip X-rays

Question 10

Legg Calve Perthes Disease Treatment

Answer 10

• Maintain hip motion
• Analgesia
• Restrict painful activities
• ‘Supervised neglect’ in most cases
• ‘Containment’ - Consider osteotomy in selected groups of older children (>7)
• Prognosis good onset <9y

Question 11

Slipped capital femoral epiphysis (SCFE)

Answer 11

• most common disorder in the adolescent age group
• occurs when weakness in the proximal femoral growth plate allows displacement of the capital femoral epiphysis

Question 12

SCFE diagnostic factors

Answer 12

• gait with affected leg externally rotated
• weight >90 percentile
• groin or knee pain
• restricted range of motion

Question 13

SCFE - detection

Answer 13

• Reduced internal rotation, especially in flexion
• Plain x-rays - best seen on lateral view

Question 14

Treatment of unstable SCFE

Answer 14

• urgent surgical repair
• prophylactic fixation of contralateral hip

Question 15

Treatment of stable SCFE

Answer 15

• in situ screw fixation
• prophylactic fixation of contralateral hip

Question 16

SCFE - stable v unstable

Answer 16

• Stable slips (able to bear weight) have a low risk of AVN (avascular necrosis)
• Unstable slips (unable to bear weight) have a high risk of AVN