Paedeatric Hip Conditions

Question 1

When is DDH likely to present?

Answer 1

Birth to 2 years

Question 2

When is Perthes likely to present?

Answer 2

4-8 years with peak at 6 years

Question 3

When is SUFE likely to present?

Answer 3

10-16 years with peak at 12/13 years

Question 4

What 3 bones does the acetabulum form from?

Answer 4

Ilium
Ischium
Pubis

Question 5

What allingment are all children born with?

Answer 5

Valgus anteroverted femoral heads

Question 6

What is DDH?

Answer 6

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

Question 7

What is included in the spectrum of DDH?

Answer 7

Dysplasia - shallow acetabulum
Subluxation
Dislocation

Question 8

What is the epidemiology of DDH?

Answer 8

Most common ortho disorder in newborns

Most common in left hips in females

Question 9

What is the pathophysiology of DDH?

Answer 9

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

Question 10

What is the pathoanatomy of DDH?

Answer 10

Initial instability leads to dysplasia

Dysplasia lead to gradual dislocation

Question 11

What condition in mothers can lead to DDH?

Answer 11

Elhers danos

Question 12

What are the risk factors for developing DDH?

Answer 12

Firstborns 
MUCH more common in females
Breech presentation 
FMH 
Oligohydraminos

Question 13

What is the presentation of DDH?

Answer 13

Early presentation: abnormality on baby screening test

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

Question 14

How is DDH diagnosed?

Answer 14

Clinical exam
Ultrasound
Radiographs later on

Question 15

What abnormalities are seen on examination of DDH?

Answer 15

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

Question 16

What is barlows test?

Answer 16

Flex hip and push backwards to try to dislocate hip

Question 17

What is ortolanis test?

Answer 17

Abduct the hip to try to relocate the femur

Ortolani - OUT

Question 18

How is DDH treated in an early presentation?

Answer 18

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

Question 19

What is the treatment for a late presentation of DDH?

Answer 19

Closed reduction or open reduction

Question 20

What is reactive synovitis?

Answer 20

Inflammation of the synovium, often secondary to a viral illness

Question 21

What is the presentation of reactive synovitis of the hip?

Answer 21

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

Question 22

How is reactive synovitis diagnosed?

Answer 22

Kochers critera

Ultrasound +/- aspiration

Question 23

What is included in Kochers critera?

Answer 23

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

Question 24

How is reactive synovitis treated?

Answer 24

Self-limiting conditon
Analgesia/ NSAIDs
Repeat review

Question 25

What is septic arthrtis?

Answer 25

Intra-articular infection of the hip joint

Question 26

Why is septic arthrtis a surgical emergency?

Answer 26

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

Question 27

How will septic arthritis present?

Answer 27

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

Question 28

What is kochers critera?

Answer 28

To distinguish between RS and SA | If all are positive then it is SA, if 0/1/2 then likely to be RS

Question 29

What is the pathophysiology of septic arthritis?

Answer 29

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

Question 30

What is the most likely organism to cause SA?

Answer 30

Staph aureus

Question 31

How is SA diganosed?

Answer 31

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

Question 32

How is SA treated?

Answer 32

Open surgical washout with samples prior to antibiotis | Usually anterior approach

Question 33

What is perthes disease?

Answer 33

Idiopathic AVN of the hip

Question 34

What are risk factors for developing perthes disease?

Answer 34

Postive family history Low birth weight Second hand smoke

Question 35

What gender is predisposed to perthes?

Answer 35

Males

Question 36

What is the pathophysiology of perthes?

Answer 36

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

Question 37

What are the different stages of perthes?

Answer 37

Initial Fragmentation Reossification Remodelling

Question 38

What is a good prognostic factor for perthes?

Answer 38

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

Question 39

What is the presentation of perthes?

Answer 39

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

Question 40

How is perthes disease diagnosed?

Answer 40

Radiographs | MRI

Question 41

How is perthes disease diagnosed?

Answer 41

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

Question 42

What is SUFE?

Answer 42

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

Question 43

What are the risk factors for SUFE?

Answer 43

Males Obesity Endocrine disoders: GH deficiency, panhypopitutarism, hypothyrodism

Question 44

How will SUFE present?

Answer 44

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

Question 45

How is SUFE diagnosed?

Answer 45

Radiographs | MRI

Question 46

How is SUFE treated?

Answer 46

Surgery; percutaneous pinning of the hip