Paediatric Hip Disorders Flashcards Preview

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Flashcards in Paediatric Hip Disorders Deck (23)
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1

What is DDH?

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

2

Risk factors for DDH (5)

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

3

Screening methods used for DDH

Ortolani test, Barlow test, USS

4

How does the ortolani test work?

reducing the dislocated hip with abduction and anterior displacement

5

How does the barlow test work?

dislocatable hip with flexion and posterior displacement

6

Signs of DDH

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

7

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

the joints are mostly cartilage

8

How do you treat mildly dislocatable DDH?

watchful waiting and regular screening

9

How do you treat more persistenly dislocatable DDH?

Pavlik harness

10

How is a Pavlik harness used?

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

11

What age can the Pavlik harness be used?

up to 4-6months

12

How is late/persistent DDH treated?

open reduction +/- osteotomy of the femur or pelvis

13

What is transient synovitis of the hip?

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

14

Common features of transient synovitis of the hip

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

15

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

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

16

Treatment of transient synovitis of the hip

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

17

What is Perthes disease?

idiopathic avascular necrosis of the femoral head with subsequent abnormal growth

18

Common features of perthes disease (4)

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

19

Prognosis in perthes disease is determined by...

age of onset with older children faring worse

20

Presentation of perthes disease...

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

21

4 stages of perthes disease

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

22

Treatment in perthes disease focusses on...

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

23

Treatment principles in perthes disease

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