Paediatric Hip Disorders Flashcards Preview

Y2 Child Health > Paediatric Hip Disorders > Flashcards

Flashcards in Paediatric Hip Disorders Deck (23)
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1
Q

What is DDH?

A

developmental dysplasia of the hip where there is dislocation or subluxation of the femoral head in the perinatal period

2
Q

Risk factors for DDH (5)

A

Female sex, breech birth, family history, other MSK abnormalities, first born

3
Q

Screening methods used for DDH

A

Ortolani test, Barlow test, USS

4
Q

How does the ortolani test work?

A

reducing the dislocated hip with abduction and anterior displacement

5
Q

How does the barlow test work?

A

dislocatable hip with flexion and posterior displacement

6
Q

Signs of DDH

A

shortening of the limb, asymmetric groin/thigh skin creases, +ve ortolani/barlow tests

7
Q

Why are x-rays not useful in the diagnosis of DDH?

A

the joints are mostly cartilage

8
Q

How do you treat mildly dislocatable DDH?

A

watchful waiting and regular screening

9
Q

How do you treat more persistenly dislocatable DDH?

A

Pavlik harness

10
Q

How is a Pavlik harness used?

A

worn full-time for 6 weeks, then part-time for another 6 weeks - used to keep hips in comfortable flexion and abduction

11
Q

What age can the Pavlik harness be used?

A

up to 4-6months

12
Q

How is late/persistent DDH treated?

A

open reduction +/- osteotomy of the femur or pelvis

13
Q

What is transient synovitis of the hip?

A

self-limiting inflammation of the synovium of the joint, most commonly the hip

14
Q

Common features of transient synovitis of the hip

A

boys>girls, age 2-10 years, post-URTI (common), generally well with slightly reduced movement

15
Q

Important DDx to exclude when considering transient synovitis of the hip (6)

A

delayed DDH presentation; perthes disease; septic arthritis; osteomyelitis; juvenile idiopathic arthritis; rheumatoid arthritis

16
Q

Treatment of transient synovitis of the hip

A

short course of NSAIDs and rest - should resolve in a few weeks

17
Q

What is Perthes disease?

A

idiopathic avascular necrosis of the femoral head with subsequent abnormal growth

18
Q

Common features of perthes disease (4)

A

boys > girls (4:1); ages 4-8; bilateral in 10%; small, active humans

19
Q

Prognosis in perthes disease is determined by…

A

age of onset with older children faring worse

20
Q

Presentation of perthes disease…

A

pain, limp, loss of internal rotation, loss of abduction, trendelenberg gait

21
Q

4 stages of perthes disease

A
  1. necrosis/sclerosis (1-14 months) 2. fragmentation (2-35 months) 3. reossification (2-122 months) 4. residual remodelling
22
Q

Treatment in perthes disease focusses on…

A

influencing the shape of the recovering head and maintaining the mould of the acetabulum

23
Q

Treatment principles in perthes disease

A

Maintain hip abduction, rest and activity modification works for the majority. A small number may need surgery.