Paediatric Hip Disorders Flashcards
How does the hip joint form?
*What is developmental dysplasia of the hip (DDH)? RFs?
Acetabulum shallows out…?
Females
Demographics
L > R hip (left is usually the one sitting next to mother’s spine)
Aetiology of DDH and how to manage the condition?
Aetiology = Multifactorial - ‘Perfect storm’
Female…girls more susceptible to oxytocin & other hormones mom produce during delivery
Breech
FHx
Olgiohydramnios
Moulded baby (Feet/neck/head/spine)
First born
>4kg
Multiple pregnancy
Management:
Pick-up early [currently poor rate] (baby hip examination)
Imaging Ultrasound < 3 mo, X-ray > 3 mo
Treatment:
Pavlik harness - Early DDH
Late DDH (>3m/o) might require surgery
*What is slipped capital femoralepiphysis (SCFE)?
Metaphysis slips forward
More commonly seen in teenagers
What are RFs of SCFE and how does it present?
Adolescence
Racial differences (african-american)
Endocrine/Metabolic conditions
Obesity
Hip/Groin/Thigh or KNEE PAIN
Limp
How to manage SUFE?
Surgery
What is the underlying pathology of Perthes disease and what are the RFs?
Avascular necrosis of the hip in children
- Idiopathic
RF:
positive family history
low birth weight
Passive smoke
Asian, Inuit, and Central European decent
Males
ADHD
How to treat Perthes disease?
*Controversial
Containment
Movement
Seeing through fragmentation
Restrictions
Crutches/wheelchairs
Healing
Minimise degenerative changes
In the end of healing might have different features of the femoral head
What is transient synovitis and how does it present?
Inflammation of the synovium, often secondary to a viral illness
Patient presentation:
Often Hx of viral illness
Limp and hip/groin pain
May present with referred pain to knee (but less common)
Hip lying flexed/externally rotated
Pain at end range of hip movements
Usually systemically well, apyrexial
How to diagnose transient synovitis?
Kochers criteria:
fever higher than 38.5 degrees celsius
ESR > 40 millimeters per hour (mm/hour)
white blood cell (WBC) count > 12,000 cells/mm3.
Ultrasound +/- aspiration
Self-limiting, doesn’t need treatment usually
What is irritable hip?
How does irritable hip differ from septic arthritis?
What is septic arthritis?
Intra-articular infection of the hip joint
What is Kocher’s criteria and common organisms for septic arthritis?
Staph Aureus
