Flashcards in Paediatric - The Big 3 Deck (23):
What is the incidence of developmental dysplasia of the hip?
(northern europe, eastern europe, african neonates, apaches and navajos, inuits)
NE: 0.7-2.2 per 1000
Eastern EU: 28.7 per 1000
African neonates: 0
Apaches and navajos: 5%
What is the incidence of develoopmental dysplasia of the hip?
(M:F, Left: Right hip)
Left hip 3:1
An increased incidence of developmental dysplasia of the hip is seen in who?
Other lower limb deformities
What are the clinical features of developmental dysplasia of the hip?
Piston motion sign
What percentage of DDH cases are picked up by examination?
What is Ortolani's sign?
It relocates the dislocation of the hip joint that has just been elicited by the Barlow maneuver.
It is performed by an examiner first flexing the hips and knees of a supine infant to 90 degrees, then with the examiner's index fingers placing anterior pressure on the greater trochanters, gently and smoothly abducting the infant's legs using the examiner's thumbs. A positive sign is a distinctive 'clunk' which can be heard and felt as the femoral head relocates anteriorly into the acetabulum
Specifically, this tests for posterior dislocation of the hip.
What is Barlow's sign?
The maneuver is easily performed by adducting the hip (bringing the thigh towards the midline) while applying light pressure on the knee, directing the force posteriorly.
If the hip is dislocatable - that is, if the hip can be popped out of socket with this maneuver - the test is considered positive. The Ortolani maneuver is then used, to confirm the positive finding (i.e., that the hip actually dislocated).
At what age on average does the head of the femur ossify?
Not until the child is at least 3 months old
Describe the treatments for DDH at different ages
( 1yr, >1yr, >18 months, >6yrs, >10yrs)
-Open reduction and capsule reefing
-Open reduction with femoral shortening
-Bilateral -> leave alone
-Unilateral -> leave alone
What is the typical presentation of Perthes Disease?
Primary school age
Knee pain on exercise
Stiff hip joint
What is the aetiology of Perthes disease?
Pathologically avascular necrosis of hip
Possible relationship to coagulation tendency
Possible relationship to repeated minor trauma
Classically low social status
What are the 4 waldenstrom stages seen radiographically?
1) Initial stage
2) Fragmentation stage
3) Reossification stage
4) Healed stage
How do you determine prognosis in Perthes disease?
-Younger do better
Proportion of head involved
Radiographic "head at risk signs"
Nearer the head is to round, the better the outlook
What are the treatments for Perthes disease?
Maintain hip motion
Restrict painful activities
Consider osteotomy in selected groups of older children (>7)
What percentage of perthes disease cases are bilateral?
What is the normal presentation of SUFE?
Teenage boys (9-14)
Left groin pain 3 months
Short, hip externally rotated
Painful to weight bear
20% become bilateral
What does SUFE stand for?
Slipped Upper Femoral Epiphysis
What are the 3 ways to classify of SUFE?
Acute v chronic (3 weeks)
Magnitude of slip (angle or proportion
Stable vs unstable
-Unstable = unable to weight bear (poor prognosis)
-Stable = able to weight bear (good prognosis)
How do you detect SUFE/ SCFE?
(signs, symptoms, investigation)
Pain in hip OR KNEE
Externally rotated posture and gait
Reduced internal rotation, especially in flexion
-best seen on lateral view
What is the apthology of SUFE?
SUFE is essentially a type I Salter Harris growth plate injury due to repeated trauma on a background of mechanical and probably hormonal predisposing factors.
Conditions that may predispose to SUFE include:
During growth, there is widening of the physeal plate which is particularly pronounced during a growth spurt. In addition, the axis of the physis alters during growth and moves from being horizontal, to being oblique. As the physis becomes more oblique, shear forces across the growth plate increase resulting in an increased risk of fracture and resultant slippage.
What can the outcomes of SCFE be?
Deformity (short, ext rotated, limited flexion)
Possibility of slip on other side
Limb length discrepancy
What is the risk of AVN in SCFE?
Stable slips have a low risk of AVN
Unstable slips have a high risk of AVN