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Flashcards in Paediatrics Hips Deck (32):
1

Brief description of DDH

DDH involves dislocation or subluxation of the femoral head during the perinatal period which affects the subsequent development of the hip joint.

2

DDH is more common in?

Girls and the left hip but 20% cases are bilateral

3

Risk factors for DDH

Positive family history of DDH
Breech position
First born babies
Down's syndrome
Presence of other congenital disorders (e.g. talipes)

4

If DDH is left untreated what can happen?

Acetabulum is very shallow and in more severe cases a false acetabulum occurs proximal to the original one with a shortened lower limb. Severe arthritis due to reduced contact area can occur at a young age and gait / mobility may be severely affected.

5

Clinical Signs of DDH

shortening
asymmetric groin/ thigh skin crease
Clink/ clunk on Ortolani or Barlow manoeuvres

6

Positive Ortolani test

Reducing a dislocated hip with abduction and anterior displacement

7

Positive Barlow test

Dislocatable hip with flexion and posterior displacement

8

If Barlow or Ortolani test is positive what further invetsigation is required? What may it show?

Ultrasound
Dislocated hip, unstable hip or a shallow acetabulum

9

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

The femoral head epiphysis is unossified until around 4‐6 months but xrays are the investigation of choice after this age.

10

How are mild cases of DDH treated? Slightly shallow acetabulum and mildly dislocatable but reduced (in joint hip)

Closely observed with serial examination and USS to ensure the hip remains reduced.

11

How are dislocated or persistently unstable hips caused by DDH treated?

Reduced and held with a special harness known as a Pavlik harness which keeps the hips in comfortable flexion and abduction thus maintaining reduction.

12

SE of over-flexing and abducting the hip.

AVN

13

How long should a Pavlik harness be used for?

Full time for around 6 weeks and part time for a further 6 weeks once the hip is confirmed to be stable.

14

Up to what age can a Pavlik harness be used?

Up to around 4-6 months

15

Success rate of Pavlik harness

85-90%

16

If a child has persistent dislocation of the hip over 18 months old, what treatment is required?

Open reduction to clear soft tissues and may also need an osteotomy to shorten and rotate the femur and/ or pelvic osteotomy to deepen and reorientate the acetabulum.

17

What is the most common cause of hip pain in childhood?

Transient synovitis

18

Clinical presentation of Transient synovitis

Limp or reluctance to weight bear on the affected side
ROM may be restricted
May have low grade fever but not systemically unwell

19

Treatment for transient synovitis of the hip.

Short course of NSAIDs and rest.

20

Who does transient synovitis of the hip most commonly affect?

2-10 years
Boys > Girls

21

Describe Perthes Disease

Idiopathic osteochondritis of the femoral head. Femoral head transiently loses if blood supply resulting in necrosis with subsequent abnormal growth.

22

Who does Perthes disease most commonly affect?

4-9 years
Boys > Girls (5:1)
esp. very active boys of short stature

23

Clinical presentation of Perthes disease

Pain
Limp
Unilateral
If bilateral, considerunderlying skeletal dysplasia or thrombophilia

24

Clinical signs of Perthes disease

Loss of internal rotation
Loss of abduction
Later - positive Trendellenburg test from gluteal weakness

25

Treatment of Perthes disease

Regular x-ray observation
Avoidance of physical activity

26

In Perthes disease, if the femoral head subluxes what treatment is required?

Osteotomy of the femur or acetabulum

27

Describe SUFE

Femoral head epiphysis slips inferiorly in relation to the femoral neck.

28

Who does SUFE most commonly affect?

Overweight pre-pubertal adolescent boys

29

Predisposing factors to SUFE

Hypothyroidism or renal disease

30

Clinical presentation of SUFE

Pain - may be in groin but can be just knee pain
Limp

31

Clinical signs of SUFE

Loss of internal rotation is predominant sign

32

Treatment of SUFE

Surgery to pin the femoral head
Severe acute slips - gentle manipulation may be attempted but risks ANV
Chronic severe slips - osteotomy