Ch 3 - Rehumatology: Atraumatic arthritis

Question 1

What is congenital hip dislocation?

Answer 1

Dislocated hip at birth

Question 2

What are etiologic factors of congenital hip dislocation?

Answer 2

• 1st born: tight uterine and ABD musculature of mother
• Inhibits fetal movement
• Breech position
• Left hip > right
• Hormonal factors
• MC in whites

Question 3

Desribe Barlow’s test.

Answer 3

Start with hip in flexion and abduction, then the femoral head is dislocated on hip flexion and adduction

Question 4

Desribe Ortolani’s test.

Answer 4

Hip is relocated on hip flexionand abduction

Question 5

When are x-rays useful in congenital hip dislocation?

Answer 5

• Not useful until 6 weeks

* Negative finding on x-ray does not rule out a dislocation

Question 6

What is seen on x-ray in congenital hip dislocation?

Answer 6

• Proximal and lateral migrationof the femoral headfromthe acetabulum
• Acetabular dysplasia
• Delayed ossification

Question 7

What is the goal in treatment of congenital hip dislocation?

Answer 7

Return the hip to its normal position until there is resolution of the pathologic changes

Question 8

What are position devices used in treatment of congenital hip dislocation?

Answer 8

Triple diapers
Frejka pillows
Splints: Craig, Von Rosen-Pavlik harness

Question 9

Describe the Von Rosen-Pavlik harness.

Answer 9

Allows hip motion within the safe zone while maintaining abduction

Question 10

What are complications associated with congenital hip dislocation?

Answer 10

AVN

Question 11

What is slipped capital femoral epiphysis (SCFE)?

Answer 11

Femoral head may slip, displacing it medially and posteriorly in relation to the shaft of the femur at the level of the proximal femoral epiphysis

Question 12

What is the onset of SCFE?

Answer 12

• Males:females 2:1
• 13 to 16 y males
• 11–13 y females
• Bilateral involvement: 30%–40%

Question 13

What are etiologic factors of SCFE?

Answer 13

• Strain on the growth plate
• During its growth spurt 2/2 inc wt •Endocrinopathies
• Growth hormone abnormalities
• Down syndrome

Question 14

What is the most common etiologic factor of SCFE?

Answer 14

Hypothyroidism

Question 15

What is the clinical presentation of SCFE?

Answer 15

• Altered gait

* Pain in the groin, medial thigh, and knee

Question 16

Describe the presentation of chronic slip of SCFE.

Answer 16

Most common
Loss of IR
Hip rolls into ER w/ flexion

Question 17

Describe the presentation of an acute slip of SCFE.

Answer 17

Trauma, sudden onset of pain on weight bearing

Question 18

What is Acute or chronic chondrolysis?

Answer 18

Erosion and degeneration of the cartilage inflaming the synovial membrane on activity

Question 19

What x-ray views are needed to diagnose a SCFE?

Answer 19

AP and frog-leg views of the hip/pelvis

Question 20

How is SCFE graded?

Answer 20

Grading based on degree of displacement of the epiphysis
Grade I: <33%
Grade II: 33% to 50%
Grade III: >50%

Question 21

What are non-surgical treatments for SCFE?

Answer 21

• Bedrest-weight relief
• Prevention of further displacement
• Traction, body casts, hormonal therapy

Question 22

What is the preferred treatment for SCFE?

Answer 22

Surgery: Knowles pinning

Question 23

What are complications of SCFE?

Answer 23

• Chondrolysis
• AVN
• OA

Question 24

What is Legg–Calve–Perthes disease?

Answer 24

Idiopathic AVN of the femoral head

Question 25

What is the onset of Legg–Calve–Perthes disease?

Answer 25

• 2 to 12 yo
• Boys&raquo_space; girls
• Majority—unilateral

Question 26

What happens if the onset of Legg–Calve–Perthes disease is >12 yo?

Answer 26

It is considered AVN not LCPD

Question 27

What are etiologic factors of Legg–Calve–Perthes disease?

Answer 27

• Bone age low for age results in short stature
• Etiology unknown
• Hypothyroid ABN

Question 28

What is the clinical presentation of Legg–Calve–Perthes disease?

Answer 28

• Mild or no pain
• Stiffness
• Painless limp> antalgic gait
• Hip flexion contracture
• ABD and IR restricted
• Disuse atrophy
• Short stature

Question 29

What x-ray views should be used for Legg–Calve–Perthes disease?

Answer 29

Frog-leg views of hip/pelvis

Question 30

What are radiographic findings of Legg–Calve–Perthes disease?

Answer 30

1. Growth arrest: avascular stage
2. Subchondral fracture “crescent sign”
3. Resorption
4. Re-ossification
5. Healed

Question 31

What are goals of treatment for Legg–Calve–Perthes disease?

Answer 31

1. Eliminate hip pain
2. Restoration of motion
3. Prevent femoral head collapse

Question 32

Describe weight bearing restrictions in Legg–Calve–Perthes disease?

Answer 32

Permit weight bearing of the femoral head to assist healing and remodeling

Question 33

What are containment techniques for Legg–Calve–Perthes disease?

Answer 33

Abduction braces
Petrie casts
Toronto brace
Salter stirrup

Question 34

What are surgical techniques for Legg–Calve–Perthes disease?

Answer 34

Epiphysiodesis

Valgus osteotomy

Question 35

What are complications of Legg–Calve–Perthes

Answer 35

AVN

Question 36

What is the most common cause of hip pain in kids (preadolescents)?

Answer 36

Acute transient synovitis

Self-limiting with good outcome

Question 37

What are causes of AVN?

Answer 37

“PLASTIC RAGS”
P—pancreatitis
L—lupus 
A—alcohol 
S—steroids 
T—trauma
I—idiopathic, infection 
C—caisson disease, collagen vascular disease

R—radiation
A—amyloid
G—gaucher’s disease
S—sickle cell