Childhood Hip Disorders

Question 1

Risk factors for DDH

Answer 1

Breech position in utero
Family history
Other MSK anomalies - club foot, torticollis, girls, first born

Question 2

What is DDH

Answer 2

Developmental dysplasia of hip

Question 3

What are you at risk for in DDH?

Answer 3

Severe arthritis at young age

Question 4

What will you find in examination of DDH?

Answer 4

Asymmetry - position of leg, length of leg, thigh creases

Feel a click/clunk

Question 5

What two instability tests are there for DDH?

Answer 5

Barlow test

Ortolani test

Question 6

What is a barlow test?

Answer 6

Attempt to dislocate a hip joint that is in joint by flexion adduction - clunk posteriorly

Question 7

What is an Ortolani test?

Answer 7

Attempt to relocate a dislocated hip by abduction - a clunk anteriorly

Question 8

Investigations for DDH?

Answer 8

X- Ray and USS

Question 9

If patient was 3 months, what investigation for DDH?

Answer 9

USS - because you can’t see unossified bone on X-Ray

Question 10

Treatment for DDH?

Answer 10

Mild disease - monitor with imaging
Moderate/persistent - Pavilk harness
Persistent dislocation with late age diagnosis - hip spica

Question 11

Pavlik harness

Answer 11

Use full time for 6 weeks and part time for further 6 weeks

Question 12

Hip spica

Answer 12

Immobilise for 3 months

Question 13

Surgery for DDH

Answer 13

> 3/12 = closed reduction
9/12 = open reduction likely
2 years = bony surgery required

Question 14

What is transient synovitis?

Answer 14

self limiting inflammation of the synovium of a joint, particularly the hip

Question 15

Does it occur shortly after a URTI (viral)

Answer 15

True, but sometimes no cause found

Question 16

Age of onset for transient synovitis?

Answer 16

2-10 years, with boys more affected

Question 17

Presentation of transient synovitis?

Answer 17

Limp or reluctance to weight bear on affected side
Range of motion restricted
Fever (not systemically unwell)

Question 18

Investigations for transient synovitis

Answer 18

USS - reveals effusion
Radiographs to exclude other diseases
CRP to exclude septic arthritis
Aspirate if any doubt

Question 19

Treatment for transient synovitis

Answer 19

Short course of NSAIDs

Resolves with rest

Question 20

What is Perthes disease?

Answer 20

Idiopathic osteochondritis of the femoral head.

Femoral head loses its blood supply resulting in necrosis

Question 21

Aetiology of Perthes?

Answer 21

Ages 4-8

Question 22

True or False

Males are affected more than females in Perthes?

Answer 22

True, 4:1, especially active, short boys

Question 23

True or False

Perthes is predominantly bilateral?

Answer 23

False - predominantly unilateral with 10% bilateral

Question 24

Presentation of Perthes?

Answer 24

Pain and a limp

Question 25

Clinical signs of Perthes?

Answer 25

Loss of internal rotation Loss of abduction Positive Trendellenburg test Fragmentation of proximal femoral epiphysis on X-Ray

Question 26

Treatment for Perthes?

Answer 26

Regular X-Ray obs Avoid physical activity Bracing, surgery

Question 27

Prognosis of Perthes?

Answer 27

Related to age of onset 7y = early arthritis, aspherical femoral head Severe cases = hip replacement in adolescence or early adulthood

Question 28

What are you at risk of in Perthes?

Answer 28

Early onset OA

Question 29

What is SUFE?

Answer 29

Slipped upper femoral epiphysis

Question 30

Aetiology of SUFE

Answer 30

10-16 years

Question 31

True or False | Are males more commonly affected than females?

Answer 31

True, 2:1 Also black:white = 2:1 1/3rd cases bilateral

Question 32

Presentation of SUFE

Answer 32

Pain and limp

Question 33

Where can pain in SUFE present?

Answer 33

In the knee - due to obturator nerve

Question 34

What is the predominant clinical sign of SUFE?

Answer 34

Loss of internal rotation

Question 35

What investigations would you carry out in SUFE?

Answer 35

X-Ray

Question 36

How many views would you take in the X-Ray for SUFE?

Answer 36

2, particularly a lateral view

Question 37

What is chronic SUFE?

Answer 37

3 weeks or more

Question 38

Treatment plan for SUFE?

Answer 38

Urgent pin of the femoral head | Huge degree of slip may require hip replacement

Question 39

An adolescent who cannot weight bear has what unless proven otherwise?

Answer 39

SUFE

Question 40

Age range for CDH?

Answer 40

0-18 months

Question 41

Age range for Transient synovitis?

Answer 41

2-5 yr

Question 42

Age range for Perthes?

Answer 42

5-10 yr

Question 43

Age range for SUFE?

Answer 43

11-15 yr