Childhood hip disorders Flashcards Preview

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Flashcards in Childhood hip disorders Deck (29):
1

What are features of a history which make developmental dysplasia of the hip more likely?

Child

2

What might you find on examination of a child with developmental dysplasia of the hip?

Asymmetrical groin creases
Position
Leg length
Clunk/click
Positive barlow and ortolani tests

3

What are the barlow and ortolani instability tests?

Barlow - attempt to dislocate a hip that by flexing and adduction
Ortolani - attempt to relocate a dislocated hip by abduction

4

What imaging modalities can be used to investigate suspected developmental dysplasia of the hip?

X-ray if epiphysis calcified (>3-6m)
Ultrasound (

5

How is developmental dysplasia of the hip treated?

Relocate (closed >3m ; open >9m)
Splint (pavlik harness)
Monitor acetabular development
Surgery if >2y

6

How is surgery carried out for developmental dysplasia of the hip?

Pre-op gallows traction
Arthrogram
Osteotomy
Hip spica immobilisation 3 months post-op

7

Which questions are important to ask in a pre-school child with a limp?

Painful or painless?
History of injury?
Generally well or ill?

8

What features of a limp would point to infection?

Pain at rest
Pain on movement
Resistance to movement
Systemically unwell (fever)
Infection elsewhere
Susceptible

9

How is suspected bone infection in a child investigated?

Bloods (FBC, inflammatory markers, culture)
X-ray unhelpful
USS for effusion
Tech bone scan

10

How should bone infection in children be treated?

Antibiotics
Aspiration
Arthrotomy

11

How does transient synovitis present?

Insidious onset (post viral infection)
Slight pain
Low grade fever/no fever
Generally well
Usually no reduced movement

12

What are the results for investigation of transient synovitis?

Bloods normal
USS effusion

13

How is transient synovitis treated?

Conservative - resolves with rest

14

How does a developmental dysplasia of the hip present late?

Painless limp
Asymmetric hip creases
Short leg
Trendelenberg gait

15

How should a suspected late presenting developmental dysplasia of the hip be investigated?

X-ray

16

What is perthes disease?

Idiopathic avascular necrosis

17

Which age group gets perthes?

4-8

18

Which gender gets perthes more commonly?

Boys

19

How does perthes present?

Small children
Active children
Limp

20

How is perthes treated?

Maintenance of hip abduction -
Rest and activity modification
Bracing
Surgery

21

Can perthes be bilateral?

Rarely yes

22

Perthes is associated with a better prognosis if it occurs below age 7. T/F

True

23

What can perthes cause?

Secondary osteoarthritis

24

How does SUFE present?

Adolescent in rapid growth (10-16)
Obesity
Male
Black
May or may not be bilateral

25

How is a SUFE investigated and what should be seen?

X-ray (AP & lateral)
trethowans/kline sign

26

In which direction does a SUFE slip?

Inferior
Anterior

27

How is a SUFE classified?

Mild - 3 wks, >60, inability to weight bear

28

Is an acute unstable hip an emergency?

Yes - risk of avascular necrosis in SUFE

29

What does an adolescent who is unable to weight bear have?

SUFE until proven otherwise
(refer for immediate x-ray)

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