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MSK lectures > Pediatric Hip conditions - 22/10/18 > Flashcards

Pediatric Hip conditions - 22/10/18 Flashcards

(60 cards)

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1
Q

When does Developmental dysplasia of the hip present?

A

Birth to 2 years

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2
Q

When does Perthes present?

A

4-8 years

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3
Q

When does SUFE present?

A

10-16 years

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4
Q

What 3 things contribute to the formation of the acetabulum?

A

Ilium
Ischium
Pubis

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5
Q

When does the greater trochanter form?

A

6+?

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6
Q

What is the normal angle of the head of the femur?

A

135

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7
Q

Hilgenreiners line?

A

Horizontal line through tricartilagenous

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8
Q

Perkens lines?

A

Perpendicular lines through ilium and ischiuum

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9
Q

What are the three layers of the femoral head?

A

Hyaline cartilage
Subchondral bone
Cancellous bone

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10
Q

What does DDH stand for?

A

Developmental dysplasia of the hip

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11
Q

What is DDH?

A

Disorder of abnormal development resulting in dysplasia and possible subluxation or dislocation of the hip secondary to capsular laxity and mechanical factors

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12
Q

What does DDH incluse?

A

Dysplasia
Subluxation
Dislocation

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13
Q

Who is DDH most common in?

A

Females

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14
Q

Why is DDH more common in females?

A

Ligamentum laxity

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15
Q

Which hip is DDH most common?

A

Left hip

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16
Q

Why is DDH rarely seen in african patients?

A

Baby wrap

-the way babies are carried

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17
Q

What is the pathophysiology of DDH?

A

Initial instability thought to be caused by maternal and fetal laxity, genetic laxity and intrauterine and postnatal malpositioning

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18
Q

What is the pathoanatomy of DDH?

A

Initial instability leads to dysplasia

Leads to gradual dislocation

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19
Q

What are risk factors for DDH?

A 
Firstborns
6x commoner in females
Breech presentations
family history
Oligohydramnios
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20
Q

What are patient presentations of DDH?

A

Abnormality on screening
Limping child
Pain in later life

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21
Q

How is DDH diagnosed?

A

Clinical examination
Ultrasound
Radiographs

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22
Q

Why do DDH patients have a trendelenburg gait?

A

shorter lever arm distance

Increased workload on abductors

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23
Q

What may be seen on clinical examination of DDH?

A 
leg lengths
Restricted abduction
Skin crease asymmetry
Ortolani
Barlows
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24
Q

What is the barlow test?

A

Pushing backwards to try and dislocate hip

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25
What is the ortolani test?
Abducting the hips to try relocate hip | Fingers push femur forwards into acetabulum
26
What is the treatment of early presenting DDH?
Pavlik harness
27
How long should the pavlik harness be worn?
23hrs a day Up to 12 weeks Night time splinting for a few more weeks
28
How should DDH be monitored?
Serial USS
29
What is the position of the legs in the pavlik harness?
Abducted | Flexed
30
What is the treatment of late DDH?
Surgery Closed reduction +/- tenotomies + spica Open reduction + osteotomies + spica
31
What is reactive synovitis and what causes it?
Inflammation of the synovium | Often due to viral illness
32
What is the presentation of reactive synovitis?
``` History of viral illness Limp and hip/groin pain Referred pain to knee Hip lying flexed/externally rotated Pain at end range of hip movements Systemically well Apyrexal ```
33
How is reactive synovitis diagnosed?
Kochers critea | Ultrasounds +/- Aspiration
34
What is the Kochers criteria?
Fever over 385 Refusal to bear weight CRP>20 Serum WBC>12000/mm3
35
What are the chances of septic arthritis with kochers?
``` 0 - 0.2% 1 - 3% 2 - 40% 3 - 93% 4 - 99.6% ```
36
What is the treatment of reactive synovitis/
Self limiting Analgesia NSAIDS Repeat review
37
What is septic arthritis of the hip?
Intra-articular infection of the hip joint
38
Why is septic arthritis an emergency?
High bacterial load Destruction of joint Potential for osteonecrosis
39
How does septic arthritis present?
``` Short duration of symptoms Unable to bear weight Hip lying felxed Severe hip pain Usually pyrexial ```
40
What is the pathophysiology of septic arthritis of the hip?
Direct inoculation Haematogenous seeding Extension from adjacent bone Contigous spread of osteomyelitis
41
What is the most common organism causing septic arthritis in 1-5year olds?
Staph aureus
42
How is septic arthritis of the hip diagnosed?
``` Blood tests Blood cultures Kochers criteria Radiographs Ultrasounds ```
43
What is the treatment of septic arthritis?
Open surgical washout | Antibiotics for 6 weeks
44
What is Perthes disease?
Avascular necrosis of the hip
45
What causes perthes?
Idiopathic
46
What are risk factors for perthes?
Family history Low birth weight Second hand smoke Asian, inuit and central european decent
47
What is the pathophysiology of perthes?
Osteonecrosis Disruption of blood supply Revasularization Collapse
48
What are the stages of perthes?
Initial Fragmentation Reossification Remodelling
49
What factors affect prognosis?
Age -Younger = better prognosis Preserving round femoral head
50
How does perthes present?
``` Gradual onset of painless limp Intermittent groin pain Hip stiffness Limp -Trendelenburg -Antalgic ```
51
How is perthes diagnosed?
Radiographs | MRI
52
How is perthes treatment?
KEEP FEMORAL HEaD ROUND Restrict weight bearing Maintain ROM
53
How is surgery used for perthes?
Osteotomy in severe
54
What is SUFE?
Slipped upper femoral epiphysis | A condition affecting the proximal femoral physis that leads to slippage of the metaphysis relative to the epiphysis
55
What are the risk factors for SUFE?
``` Males Obesity Endocrine disorders: -GH deficiency -Panhypopituitrism -Hypothyroidism ```
56
What is SUFE associated with/
Period of rapid growth
57
How does SUFE present?
Variable Groin pain Limp
58
How is SUFE diagnosed?
Radiographs | MRI
59
What is seen on X-ray of SUFE?
Ice-cream cone appearance?
60
How is SUFE treated?
Percutaneous pinning of the hip +/- pinning of the other side +/- open reduction if a very sever slip

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