#82 - Vascular/Mechanical Dysfunction of bones - Hip disorders. Flashcards
(33 cards)
What is DDH?
Developmental Dysplasia of the hip. It is an abnormal formation of one or both hips during the gestational period (in utero).
What are the 5 risk factors (5F’s) for DDH?
Which is the most important
- Female (joint laxity)
- First born (small uterus)
- Family history - (maternal pelvis shape)
- Frank Breech
- Foot deformities and other packaging issues (torticollis, etc.)
What is the barlow test?
- Test for DDH.
- Sublux the hip –> hip gets popped out of the acetabulum with this maneuver
Pneumonic - BAR = We are going out tonight! = hip gets popped out.
What is the ortolani test?
Test for DDH, done after the barlow test dislocates the hip.
-Reduces the hip back into it’s position after the barlow test.
B before O, after going out, time to go home.
What is the galeazzi test?
test for knee height difference in newborns - will detect possible DDH. Affected hip will be shorter. It is useful from 3 to 12 months.
Which two newborn tests are only useful in the first 3 months of life?
Barlow and ortolani.
Which tests for DDH are useful after 12 months?
Tredelenburg sign is seen (gluteus medius lurch)
- short leg limp.
- stiff legs.
Positive Barlow/ Ortolani. How do you confirm DDH?
Ultrasound used to confirm in newborns.
Positive galeazzi on a newborn 9 months old
X ray. X ray needed to confirm if older than 6 months (Structures no longer cartilaginous, ultrasound no good)
Treatment for DDH in young vs. older children vs. adult
Young: Pavlik harness (presses hip into acetabulum)
Older: open/closed reduction in the OR
Adult: hip replacement.
10 month female walks with her toes on the left. She has dislocated hip on x ray and DDH. What is her prognosis?
With open reduction, very good. There is excellent remodeling potential at this age.
What is the natural history of DDH, left untreated?
-Eventually, the person will develop pseudoacetabulum in a different part of the hip. This will cause severe degenerative changes, and they will need an early joint replacement.
What is Legg-Calve-Perthes disease, aka Perthes?
It is an idiopathic avascular necrosis of the femoral head.
Who gets Perthes?
males, age 4-10
What will an x-ray look like of a boy with Perthes?
The hip may be in one of 3 stages. If both hips are affected (10-15%) of cases, The two hips will ALWAYS be in different stages. If they are in the same stage think something different.
3 stages of disease in Perthes.
Avascular necrosis –> Fragmentation/resorption –> re-ossification
Goal of treatment in Perthes.
They cannot stop the stages from happening. The goal is to maintain a round head and joint during remodeling.
What is the treatment for Perthes?
no agreed upon treatment - Huge variability. (traction beds, etc have been used in the past.
If a child is in this age range at the time of presentation with Perthes,, they may receive intervention (surgery)
6-8 years old.
Under 6 do really well, above 8 do very poorly w/ or w/o treatment.
If younger than 6 at presentation with Perthes, prognosis is (good/bad)
good - nearly all make it to 50 without treatment
If older than 8 at presentation with Perthes, prognosis is (good/bad)
bad - nearly all get degenerative joint disease before age 40
What is SCFE?
Slipped Capital Femoral Epiphysis. “Ice cream slipped off the cone” It is a displacement of the proximal femoral metaphysis through the growth plate. Common in obese males nearing the end of skeletal maturity.
What is the cause of a SCFE?
it is due to an abnormally wide zone of hypertrophy?
Which moves in SCFE: the femoral head, or the metaphysis (long bone)
the metaphysis moves, while the head stays put.hence the name (Slipped Capital Femoral Epiphysis.) is a misnomer
