Childhood Disorders

Question 1

what are possible complications of childhood hip disorders

Answer 1

end stage arthritis at a young age

Question 2

what is developmental dysplasia of the hip (DDH)

Answer 2

dislocation or subluxation of the femoral head during the perinatal period which affects the subsequent development of the hip join

Question 3

what are the risk factors for DDH

Answer 3

FHx of DDH
Breech presentation
First born babies
Down syndrome
Presence of other congenital disorders

Question 4

what is a Breech presentation/birth

Answer 4

baby born bottom first

Question 5

which hip is more commonly affect

Answer 5

left hip

20% bilateral

Question 6

what can happen if DDH is not treated

Answer 6

false acetabulum occurs proximal to the original one
causes shortened lower limb
severe arthritis
gait/mobility affected

Question 7

what are signs of DDH

Answer 7

shortening
asymmetric groin/thigh skin creases
click or clunk on the Ortolani or Barlow manoeuvres

Question 8

what is the Ortolani test

Answer 8

attempt to relocate a dislocated hip by abduction

Question 9

what is the Barlow test

Answer 9

dislocataBle hip with flexion and posterior displacement

Question 10

is ortolani/barlow test positive what is the next investigation

Answer 10

Ultrasound

before 3 months

Question 11

after 4-6 months what is the first line investigation and why not before

Answer 11

x-ray

as the femoral head epiphysis is unossified

Question 12

what is used as treatment of DDH caught early

Answer 12

Pavlik harness

Question 13

what is the treatment cascade of DDH

Answer 13

> 3m closed reduction
9m open reduction
2yr bony surgery required

Question 14

when do the instability tests become unreliable

Answer 14

after 6 weeks

Question 15

what needs to be monitored in DDH

Answer 15

acetabular development

Question 16

what needs to be established in a preschool child with a limp

Answer 16

painful or painless?
history of injury?
generally well or ill?

Question 17

what infectious conditions can affect child’s hip

Answer 17

osteomyolitis

septic arthritis

Question 18

what are features of infectious conditions affecting the hip

Answer 18

very painful - at rest + movement
refuse to weight bear
associated fever + ill health

Question 19

Ix for infection

Answer 19

WBC, CRP/ESR, Blood culture

US for effusion

Question 20

Tx of infection

Answer 20

broad spectrum antibiotics
Aspiration
Surgery

Question 21

what is transient synvotitis

Answer 21

self-limmiting inflammation of the synsosium of a joint, most commonly the hip.

Question 22

what is the common features of a case of TS

Answer 22

occurs after URTI
2-10y/o
M > F

Question 23

signs/symptoms of TS

Answer 23

limp
reluctance to weight bear
restricted ROM - slight pain
Low grade fever

Question 24

IX for TS

Answer 24

CRP/FBC - most normal, slightly elevated CRP
X-ray can rule out other pathologies - 1st lines
US - 2nd line, can reveal effusions

Question 25

Tx for TS

Answer 25

NSAIDs | Bed rest

Question 26

how would a late presenting DDH appear

Answer 26

painless limp short leg asymmetric crease trendeleberg limp

Question 27

what is Perthes disease

Answer 27

idiopathic avascular necrosis idiopathic osteochondritis of the femoral head 4-9 y/o M > F

Question 28

symptoms/signs of Perthes Disease

Answer 28

``` limp limited ROM short stature hyperactivity muscle wasting ```

Question 29

when is it possible to still have a near normal hip with Perthes

Answer 29

if Perthes is diagnoses early

Question 30

Ix for Perthes

Answer 30

Bilateral X-ray of the hip joints

Question 31

Tx for Perthes

Answer 31

Rest and activity modification - most Bracing - some Surgery - very few

Question 32

what is a possible complication of Perthes

Answer 32

early onset OA

Question 33

11 year old, pain in knee for 3 months, no Hx of injury and failed to respond to physiotherapy - DDx?

Answer 33

SUFE

Question 34

if some one presents with knee pain what must also be examined

Answer 34

the hip

Question 35

who gets SUFE

Answer 35

10-16 y/o Obese M > F 1/3 cases bilateral

Question 36

what is SUFE

Answer 36

Slipped Upper Femoral Epiphysis | - femoral head epiphysis slips inferiorly in relation to the femoral neck.

Question 37

what causes the femoral head to slip

Answer 37

growth plate (physis) is not strong enough to support body weight and the femoral epiphysis slips due to the strain

Question 38

what are the 3 classifications of SUFE

Answer 38

Acute Acute on Chronic Chronic

Question 39

symptoms of SUFE

Answer 39

pain - in groin limp pain - in the knee gait - leg externally rotated

Question 40

why can pain in the hip be felt in the knee

Answer 40

due to the obturator nerve

Question 41

what is the predominant clinical sign of SUFE

Answer 41

loss of internal rotation of the hip

Question 42

Ix of SUFE

Answer 42

X-ray - AP, and LATERAL

Question 43

what can be seen on a AP X-ray to diagnose SUFE

Answer 43

Trethowan's Sign - the line of Klein passes above the femoral head.

Question 44

why must a lateral x-ray be done

Answer 44

tells you had bad it is - i.e. prognosis dependant on the degree of the slip

Question 45

Tx of SUFE

Answer 45

Acute Unstable - EMERGENCY - urgent surgical repair Stable SUFE - in situ screw fixation

Question 46

what is the basic principle of SUFE Tx

Answer 46

pin femoral head to prevent further slippage

Question 47

what should an adolescent who can't weight bear be thought to have until proven otherwise

Answer 47

SUFE

Question 48

time line for Childhood hip disorders

Answer 48

``` DDH in pre or peri walker 0 – 18m Transient synovitis 2 – 5yr Perthes 5 – 10 yr SUFE 11- 15 yr Always consider infection ```

Question 49

SUFE surgical treatment

Answer 49

internal fixation in-situ using a single cannulated screw