Flashcards in DDH - pediatric Deck (23):
Incidence of dysplasia:
Incidence of dislocation
When does femoral head begin to ossify
- thefeore, get xrays beginning in this age group
When should ultrasound be done?
typically no earlier than 4-6 weeks of age
When should you abandon Pavlik harness?
if no reduction in 3-4 weeks
think similarly for abduction bracing
Age for closed reuction and spica casting?
When should you definitely consider osteotomy of femur/tab?
>2 years with residual deformity do the femur
>4 with acetabular deformity do the pelvis too
Possible blocks to closed reduction?
- iliopsoas contracture
- capsular constriction
- inverted labrum
- hypertrophied ligamentum teres
Who gets a Dega?
neuromuscular hip patients with posterior acetabular deficiency
- needs open triradiate cartilage
- reduced acetabular volume
What is the radiographic acetabular teardrop?
- quadrilateral surface + cotyloid fossa
- should be present in normal hips by 18 mo
When are barlow/ortolani unreliable?
after 6 mo of age
Which acetabular osteotomy does not require a concentrically reduced hip?
Shelf procedure_ salvage procedure that covers a portion of the femoral head with capsule, hoping for capsular metaplasia. the hip may be subluxated.
Congenital muscular torticollis - associated conditions:
- DDH in 5-20%
- metatarsus adductus
DDx of congenital muscular torticollis
- congenital atlantoaxial rotatory instability
- klippel-feil syndrome
atlantoaxial rotatory subluxation following a URI
Differentiating congenital torticollis from congenital atalantoaxial rotatory subluxation?
subluxation is painful
there will not be a nodular SCM
get a CT of the C1-2 junction with the child looking max left, then max right
Indications for surgical correction of torticollis?
failure of 1 year of stretching or rotational limitation is <30 degrees
- do Z-plasty or distal bipolar release of the SCM
when does the basilar synchondrosis fuse?
when does the dense secondary osification center appear?
age 3 it appears
fuses to dense at age 12
treatment of atlantoaxial rotatory subluxation
- <1week, treat with soft collar and NSAIDs for spontaneous recovery
- >1 week, head halter traction, benzos, NSAIDs, hard collar
- >1 month - halo vest x3 months
indication for C1-2 fusion in pediatric atlantoaxial rotatory subluxation?
subluxation present >3 months, neuro deficits present, or failed halo vest
most common location for pseudosubluxation of the c spine