llbgurl's version from 2015-10-02 15:12

Section 1

Question Answer
abnormality in the development of the hip causing femoral head to be partially/completely displaced from acetabulum developmental dysplasia of the hip
increased in females 4-6:1, whites, eskimos and navajosdevelopmental dysplasia of the hip
genetic, maternal hormones, laigamentous laxity, first born/breechdevelopmental dysplasia of the hip
family hx positive especially first degree relativedevelopmental dysplasia of the hip
physical exam is critical in diagnosing DDH x-ray's are not always diagnosticneonatal period
hands placed over child's knees with thumbs on medial thigh and fingers placing gentle upward stress on lateral thigh and greater trochanter. With slow abduction a dislocation/reducible hip will have palpable clunk ortolani sign
guide hips into mild adduction and applying slight forward pressure with thumb. If unstable will slip over posterior rim of acetabulum and production palpable clunkbarlow sign
pops outbarlow = bad
pops back inortolani = good
hip exam conducted at every well check with each hip assessed seperate until up to 12 months of age
above 3 months of age difinitive dxUltrasound
after 3 months of ageOrtolani and barlow become negative
after 3 months of agemuscle contractures develop making signs negative
limitation in ABDuction of affected hip is primary sign of DDH after age3 months
unequal knee HEIGHTsgaleazzi sign
unequal leg lengthsshorter on affected side = DDH
assymetry of gluteal or inguinal foldsDDH
leg length inequality is a sign of hip disolcation
flexing hips and kness while infant is supine placing soles of feet flat on table near the buttocks and look at knee HEIGHTgaleazzi sign
painless limpolder children with DDH
waddling gaitolder children with DDH
short leg with toe-walkingolder children with DDH
marked lordosis older children with DDH
child stands on the affected side, the opposite side of the pelvis drops due to weak and shortened abductor muscles on the affected sideTrendelenburg sign
Less than 3 months of age imaging for DDHultrasound
Greater than 3 months of age imaging for DDHx-ray
>3 months of age x-ray best becausehip joint is mostly cartilaginous and changes may NOT have occured
DDH managementPediatric Ortho - early Tx results = best outcomes
0-4 months of age DDHpavlik harness
pavlik harnesssecure the hip in flexion and ABDuction until stable usually 3-6 months. Allows diapering, cleaning and some movement
6-8 months of age DDHrequires traction, closed reduction, and casting
18-48 months of age DDHavascular necrosis is common complication
18-48 months of age DDHopen reduction with possible pelvic or femoral osteotomy
above 48 months of age DDHusually recquires extensive surgical intervention
Follow up DDHuntil AFTER puberty and skeletal maturity - bc of the potential for acetabular changes despite earlier successful treatment

Section 2

Question Answer
Osteonecrosis of hip found only in childrenLegg Calve' Perthes
usually 4-8 years of age Legg Calve' Perthes
acute or chronic history of KNEE or hip painLegg Calve' Perthes
4 phases of processLegg Calve' Perthes
femoral head becomes more dense with possible fracture of supporting boneLegg Calve' Perthes
fragmentation and reabsorption of boneLegg Calve' Perthes
reossification when new bone has regrownLegg Calve' Perthes
healing when new bone repshapesLegg Calve' Perthes
pain, limp, decreased ABDuction, internal rotation of hipLegg Calve' Perthes
obtain AP, lateral, and frog-legged x-raysLegg Calve' Perthes
disease may not be evident on x-ray in early processesLegg Calve' Perthes
orthopedic referral, bedrest with possible femoral ABDuction traction to reduce hip, physical therapy, surgeryLegg Calve' Perthes

Section 3

Question Answer
displacement of the femoral epiphysis from the metaphysis slipped femoral capital epiphysis
increased in overweight/obese childrenslipped femoral capital epiphysis
prepubescent male, overweight and stands with little weight on internally rotated legslipped femoral capital epiphysis
my c/o knee pain, is a painful process and high incident of reoccuranceslipped femoral capital epiphysis
etiology unknown usually presents with knee painslipped femoral capital epiphysis
looks like scoop of ice cream falling off the coneslipped femoral capital epiphysis
immediate referral to ORTHO, non-weight bearing, surgeryslipped femoral capital epiphysis

Section 4

Question Answer
femoral neck is rotated forward or anteriorly (more than usual) from the femoral shaftFemoral anteversion
pigeon toedfemoral anteversion
most common ages 3-8 yearsfemoral anteversion
usually bi-lateral and W sitting position may exacerbate problemfemoral anteversion
can be viewed as normal variation of lower extremity position in developing childfemoral anteversion
etiology unknownfemoral anteversion
complete muscle and neuro exam is essential of lower extremities is essentialfemoral anteversion
note asymmetry typically this is bilateral femoral anteversion
in-toeing of both feet and kneesfemoral anteversion
internal rotation markedly exceeds external rotationfemoral anteversion
less than 70 degreesnormal
70-80 degreesmild deformity
80-90 degreesmoderate deformity
above 90 degreessevere deformity
99% of all cases resolve by age 8femoral anteversion
discourage W sittingfemoral anteversion
severe deformity or exagegerated gait deformity refer to ORTHOfemoral anteversion
braces have NO effect on femoral anteversionfemoral anteversion