Paediatric Hip Disorders Flashcards
(23 cards)
What is DDH?
developmental dysplasia of the hip where there is dislocation or subluxation of the femoral head in the perinatal period
Risk factors for DDH (5)
Female sex, breech birth, family history, other MSK abnormalities, first born
Screening methods used for DDH
Ortolani test, Barlow test, USS
How does the ortolani test work?
reducing the dislocated hip with abduction and anterior displacement
How does the barlow test work?
dislocatable hip with flexion and posterior displacement
Signs of DDH
shortening of the limb, asymmetric groin/thigh skin creases, +ve ortolani/barlow tests
Why are x-rays not useful in the diagnosis of DDH?
the joints are mostly cartilage
How do you treat mildly dislocatable DDH?
watchful waiting and regular screening
How do you treat more persistenly dislocatable DDH?
Pavlik harness
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
What age can the Pavlik harness be used?
up to 4-6months
How is late/persistent DDH treated?
open reduction +/- osteotomy of the femur or pelvis
What is transient synovitis of the hip?
self-limiting inflammation of the synovium of the joint, most commonly the hip
Common features of transient synovitis of the hip
boys>girls, age 2-10 years, post-URTI (common), generally well with slightly reduced movement
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
Treatment of transient synovitis of the hip
short course of NSAIDs and rest - should resolve in a few weeks
What is Perthes disease?
idiopathic avascular necrosis of the femoral head with subsequent abnormal growth
Common features of perthes disease (4)
boys > girls (4:1); ages 4-8; bilateral in 10%; small, active humans
Prognosis in perthes disease is determined by…
age of onset with older children faring worse
Presentation of perthes disease…
pain, limp, loss of internal rotation, loss of abduction, trendelenberg gait
4 stages of perthes disease
- necrosis/sclerosis (1-14 months) 2. fragmentation (2-35 months) 3. reossification (2-122 months) 4. residual remodelling
Treatment in perthes disease focusses on…
influencing the shape of the recovering head and maintaining the mould of the acetabulum
Treatment principles in perthes disease
Maintain hip abduction, rest and activity modification works for the majority. A small number may need surgery.
