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Systems: MSK AB > Children's Orthopaedics > Flashcards

Flashcards in Children's Orthopaedics Deck (28)
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1

What specific hip problems tend to occur in the 0-5 year olds?

-‘Normal variant’
-Trauma
-Transient synovitis
-Osteomyelitis
-Septic arthritis
-DDH
-JIA

2

What specific hip problems tend to occur in the 5-10 year olds?

-Trauma
-Transient synovitis
-Osteomyelitis
-Septic arthritis
-Legg Calve Perthes disease

3

What specific hip problems tend to occur in the 10-15 year olds?

-Trauma
-Osteomyelitis
-Septic arthritis
-SUFE
-Chrondromalacia
-Neoplasm

4

DDH

Developmental Dysplasia of the Hip

5

What is the incidence of DDH?

-Northern Europe: 0.7 to 2.2 per 1,000
-Eastern Europe: 28.7 per 1,000
-Apaches and Navajos: 5%

6

What is the epidemiology of DDH?

-F:M 6:1
-Left hip 3:1

7

Who is there increased incidence of DDH in?

-First born
-Oligohydramnios
-Breech presentation
-Family history
-Other lower limb deformities

8

What are the clinical features of DDH?

Only 40% are picked up by examination
-Ortolani's sign
-Barlow's sign
-Piston Motion sign

9

Acetabular index

The angle is formed by a horizontal line connecting both triradiate cartilages (Hilgenreiner line) and a second line which extends along the acetabular roofs.

10

Shenton line

Imaginary line drawn along the inferior border of the superior pubic ramus

11

Hilgenreiner line

Imaginary line running horizontally between the inferior aspects of both triradiate cartilages of the acetabulums

12

Perkin line

Imaginary line perpendicular to Hilgenreiner's line at the lateral aspects of the triradiate cartilage of the acetabulum

13

How is DDH managed?

-Spica cast
-Pavlik harness

14

What is the epidemiology of Legg Clave Perthes disease?

-M:F 5:1
-15% bilateral
-Primary school age

15

How does LCP disease present?

-Short stature
-Limp
-Knee pain on exercise
-Stiff hip joint
-Systemically well

16

What are the phases of LCP?

-Avascular necrosis
-Fragmentation: revascularisation (pain)
-Reossification : bony healing
-Residual deformity

17

What is the differential for LCP disease?

Unilateral
-Septic hip
-JIA
-SCFE
-Lymphoma

Bilateral
-Hypothyroid
-Sickle cell anaemia
-Epiphyseal dysplasia

18

What is the treatment for LCP disease?

-Maintain hip motion
-Analgesia
-Restrict painful activities
-‘Supervised neglect’ in most cases
-‘Containment’
-Consider osteotomy in selected groups of older children (>7)

19

What is the prognosis of LCP disease?

Good if onset <9 years

20

SCFE/ SUFE

Slipped capital femoral epiphysis

21

What is the epidemiology of SUFE?

-1-10 per 100,000
-Teenage boys> girls
-9-14 years
-20% become bilateral

22

How can SUFE be classified?

-Acute vs chronic (3 weeks)
-Stable vs unstable (Loder)

23

How is SUFE detected?

-Pain in hip or knee
-Externally rotated posture and gait
-Reduced internal rotation, especially in flexion
-Plain x-rays (best seen on lateral view)

24

What are the radiogrpahical features that separate mild from severe SUFE?

All relative to width of femoral neck on AP film
-Mild <1/3
-Moderate 1/3-2/3
-Severe >1/2

25

What pathological changes occur in SUFE?

-There is displacement through hypertrophic zone
-Metaphysis moves anterior and proximal

26

What is the treatment for SUFE?

Surgery
-Fixation (serendipitous reduction) if unstable
-Fixation in situ if stable

27

What are the possible outcomes of SUFE?

-Avascular necrosis
-Chrondrolysis
-Deformity
-Early osteoarthritis

28

How does the risk of AVN vary in SUFE?

-Stable slips (able to bear weight) have a low risk of AVN.
-Unstable slips (unable to bear weight) have a high risk of AVN