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Flashcards in FN: The Limping Child Deck (21):
1

Aetiology

1. DDH
2. Transient synovitis
3. Septic synovitis
4. Perthes
5. Slipped Capital Femoral Epiphyses
6 JIA/Still's disease

2

DDH

Congenital hip joint deformity in which the femoral head is or can be completely/partially displaced

3

DDH epi

Incidence: 1/1000
Sex: F>M

4

DDH predisposing factors

- FH
- Breach presentation
- Oligohydramnios

5

DDH presentation

- Screening
- Asymmetric skin folds
- Limp/abnormal gait

6

DDH Ix

US is v. specific

7

DDH Mx

Maintain abduction
- double nappeis
- Pavlik harness
- Plaster hip spica
- Open reduction: derotation varus osteotomy

8

Transient Synovitis: Irritable Hip Presentation

Commonest cause of hip pain in children
- 2-12 yrs
- Sudden onset hip pain/limp
- Often following or with viral infection
- Not systemically unwell

9

Transient Synovitis: Irritable Hip Ix

- PMN and ESR/CRP are normal
- -ve blood cultures
- May need joint aspiration and culture

10

Transient Synovitis: Irritable Hip Mx

- Rest and analgesia
- Settles over 2-3d

11

Perthes Disease description

Osteochondritis of the femoral head

12

Perthes Disease epi

4-10 yrs
M>F = 5:1

13

Perthes Disease Presentation

- Insidious onset
- Hip pain initially, then painless
- 10-20% bilateral

14

Perthes Disease Ix

- X-rays normally initially
- raised density of femoral head
- Bone scan is useful

15

Perthes Disease Femoral head changes

Becomes fragmented and irregular
Flattening and sclerosis

16

Perthes Disease Mx

1. Detected early and

17

SUFE description

- Postero-inferior displacement of femoral head epiphysis
- 10-15 yrs
- two main groups
1. fat and sexually underdeveloped
- Tall and thin

18

SUFE Presentation

- Slip may be acute, chronic or acute-on chronic
Acute:
1. Groin pain
2. Shortened, externally rotated leg
3. All movements painful

20% bilateral

19

SUFE Ix

Confirm Dx by x-ray

20

SUFE Mx

Acute: reduce and pin epiphysis
Chronic: in situ pinning: epiphyseal reduction risks AVN

21

SUFE complications

Chondrolysis: breakdown of articular cartilage: increase risk with surgery

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