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MSK > Paedeatric Hip Conditions > Flashcards

Paedeatric Hip Conditions Flashcards

1
Q

When is DDH likely to present?

A

Birth to 2 years

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2
Q

When is Perthes likely to present?

A

4-8 years with peak at 6 years

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3
Q

When is SUFE likely to present?

A

10-16 years with peak at 12/13 years

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4
Q

What 3 bones does the acetabulum form from?

A

Ilium
Ischium
Pubis

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5
Q

What allingment are all children born with?

A

Valgus anteroverted femoral heads

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6
Q

What is DDH?

A

A disorder of abnormal development resulting in dysplasia and possible subluxation or dislocation of the hip secondary to capsular laxity and mechanical factors

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7
Q

What is included in the spectrum of DDH?

A

Dysplasia - shallow acetabulum
Subluxation
Dislocation

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8
Q

What is the epidemiology of DDH?

A

Most common ortho disorder in newborns

Most common in left hips in females

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9
Q

What is the pathophysiology of DDH?

A

Intial instability though to be caused by maternal and fetal laxity, genetic laxity and intrauterine and postnatal malpositioning

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10
Q

What is the pathoanatomy of DDH?

A

Initial instability leads to dysplasia

Dysplasia lead to gradual dislocation

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11
Q

What condition in mothers can lead to DDH?

A

Elhers danos

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12
Q

What are the risk factors for developing DDH?

A 
Firstborns 
MUCH more common in females
Breech presentation 
FMH 
Oligohydraminos
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13
Q

What is the presentation of DDH?

A

Early presentation: abnormality on baby screening test

Late presentation: limping child, trendelenberg gait, pain later in life

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14
Q

How is DDH diagnosed?

A

Clinical exam
Ultrasound
Radiographs later on

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15
Q

What abnormalities are seen on examination of DDH?

A

Inspection: leg lengths, restricted abduction, skin crease asymmetry
Ortolani and Barlows test

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16
Q

What is barlows test?

A

Flex hip and push backwards to try to dislocate hip

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17
Q

What is ortolanis test?

A

Abduct the hip to try to relocate the femur

Ortolani - OUT

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18
Q

How is DDH treated in an early presentation?

A

23hrs a day for up to 12 weeks until USS is normal
Then night time splinting for a few more weeks
Hips in an abducted and flexed postion

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19
Q

What is the treatment for a late presentation of DDH?

A

Closed reduction or open reduction

20
Q

What is reactive synovitis?

A

Inflammation of the synovium, often secondary to a viral illness

21
Q

What is the presentation of reactive synovitis of the hip?

A 
Often Hx of viral illness
Limp and hip/groin pain 
May present with referred pain to knee 
Hip lying flexed and externally rotated 
Pain at end range of hip movements 
Usually systemically well
22
Q

How is reactive synovitis diagnosed?

A

Kochers critera

Ultrasound +/- aspiration

23
Q

What is included in Kochers critera?

A

Fever of 38.5 or above
Refusal to weight bear
CRP over 2.0
Serum WBC >12,000

24
Q

How is reactive synovitis treated?

A

Self-limiting conditon
Analgesia/ NSAIDs
Repeat review

25
Q

What is septic arthrtis?

A

Intra-articular infection of the hip joint

26
Q

Why is septic arthrtis a surgical emergency?

A

High bacterial load that causes sepsis
Destruction of the joint to proteolytic enzymes - pus is chondrocytic
Potential for osteonecrosis of the hip

27
Q

How will septic arthritis present?

A 
Short duration of symptoms 
Ubable to weight bear 
Hip lying flexed/ externally rotated 
Severe hip pain on passive movement 
Usually pyrexial
28
Q

What is kochers critera?

A

To distinguish between RS and SA

If all are positive then it is SA, if 0/1/2 then likely to be RS

29
Q

What is the pathophysiology of septic arthritis?

A

Direct inoculation from trauma or surgery
Haematogenous seeding
Extension from osteomyelitic bone

30
Q

What is the most likely organism to cause SA?

A

Staph aureus

31
Q

How is SA diganosed?

A 
Blood tests - FBC, CRP
Blood cultures
Kochers critera
Radiographs 
Ultrasound +/- aspiration in theatre
32
Q

How is SA treated?

A

Open surgical washout with samples prior to antibiotis

Usually anterior approach

33
Q

What is perthes disease?

A

Idiopathic AVN of the hip

34
Q

What are risk factors for developing perthes disease?

A

Postive family history
Low birth weight
Second hand smoke

35
Q

What gender is predisposed to perthes?

A

Males

36
Q

What is the pathophysiology of perthes?

A

Osteonecrosis secondary to disruption of blood supply to femoral head followed by revascularisation with subsequent resorption and later collapse
Creeping substitution provides pathway for remodelling after collapse

37
Q

What are the different stages of perthes?

A

Initial
Fragmentation
Reossification
Remodelling

38
Q

What is a good prognostic factor for perthes?

A

Younger the age the better the prognosis due to the fact the bone still has alot of growth to do

39
Q

What is the presentation of perthes?

A 
Gradual onset of painless limp
Sometimes intermittent groin pain 
Hip stiffness (internal rotation and abduction)
40
Q

How is perthes disease diagnosed?

A

Radiographs

MRI

41
Q

How is perthes disease diagnosed?

A

Restrict weight bearing
Maintain ROM with physiotherapy
Surgery in young patients with severe diseae and deformity

42
Q

What is SUFE?

A

A condition affecting the proximal femoral physis that leads to slippage of the metaphysis relative to the epiphysis

43
Q

What are the risk factors for SUFE?

A

Males
Obesity
Endocrine disoders: GH deficiency, panhypopitutarism, hypothyrodism

44
Q

How will SUFE present?

A

Variable length of symptom development
Groin pain
Antalgic limp
Obligatory external rotation of hip flexion

45
Q

How is SUFE diagnosed?

A

Radiographs

MRI

46
Q

How is SUFE treated?

A

Surgery; percutaneous pinning of the hip

MSK (34 decks)

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