Lukman Salim

88946

Developmental dysplasia of the hip..(DDH)

Transient synovitis

Septic arthritis

Slipped capital femoral epiphysis (SCFE)

objectives

The abnormal formation of the hip joint in which the

the femoral head is not stable within the acetabulum.

Epidemiology:

The incidence ranges from as low as 1 per 1,000 to

as high as 34 per 1,000.

Common among girls (1:600) compared to boys

(1:4,000)

Developmental dysplasia of

the hip (DDH)

Spectrum of DDH

Acetabular dysplasia:

• Mildest form

• Femoral head remains in acetabulum

Subluxation:

• Most common form

• Femoral head partially displaced

Dislocation:

• Femoral head not in contact with acetabulum

• Displaced posteriorly and superiorly

Birth to 3 months of age

Hip instability (demonstrated by positive Ortolani or Barlow tests

Asymmetric leg creases (inguinal, gluteal, thigh, or popliteal)

Apparent shortening of femur (Galeazzi, )

3 to 12 months of age

Limitation of hip abduction

Apparent shortening of the femur (Galeazzi)

Laterally rotated posture in prone position

Marked asymmetry of leg creases (inguinal, gluteal, thigh, or popliteal)

Klisic test

Clinical features of DDH

leg creases

Apparent shortening of

the femur

Physical examination

Ortolani test: From an

adducted position the

hip is gently abducted

while lifting the

trochanter anteriorly

Barlow’s test: The thigh is grasped loosely with the examiner's index and middle finger along the greater trochanter and the thumb on the inner thigh.

The hip is gently adducted and a posteriorly directed pressure applied.

Trendelenburg sign

Klisic test

investigation

Ultrasound

Gold standard in first

2 wks. of age

Radiography

Gold standard

X ray

X ray

X ray

apply

Method depends on AgeBirth to 6 months :

Double napkins , Pavlik harness or hip spica cast

6 months – 12 months : Closed reduction and hip spica casts

12 months – 18 months : Possible closed / possible open reduction

Above 18 months : Open reduction and Acetabuloplasty

Above 2 years : Open reduction, acetabulplasty, and femoral

osteotomy.

Managments

Pavlik harness Spica cast

Transient synovitis (TS) is the most common cause

of acute hip pain in children aged 3-10 years

affects boys twice as often as girls.

Clinical features

Limping

Pain on thigh or knee

Low grade fever

Refusing to walk if pain severe

Night crying in younger children

Infant: unusual crawling

Transient Synovitis

Examination:

mild restriction of motion,

especially to abduction

and internal rotation

Tender hip with

movement.

tender to palpation.

Log roll!!

investigation

CBC: WBC may be slightly elevated.

Elevated ESR, CRP

Treatments:

Bed rest 7-10 days

Heat and message

If severe pain.. Admission…. Skin traction of the hip to

reduce intracapsular pressure

ibuprofen may shorten the duration of symptoms

Displacement of the capital femoral epiphysis from

the femoral neck through the physeal plate

Boys affected more than girls

Occur during puberty usually 14-15 years old

Risk factors:

Obesity

Very tall

Endocrine problems :hypothyroidism, panhypopituitarism, hypogonadism,, growth hormone abnormalities

Slipped capital femoral

epiphysis (SCFE)

X-ray

Stable" SCFEs allow the patient to ambulate with or

without crutches.

"Unstable" SCFEs do not allow the patient to

ambulate at all; these cases

Stable vs unstable

Sudden, severe pain, limping.

Pain in groin and in anterior thigh or knee

Leg is externally rotated

Leg 1-2cm short

Limitation of abduction and internal rotation

Clinical presentation

Avascular necrosis

Coxa vara: if not reduced>>>> abnormal fusion>>>

limping

another SCFE on the other leg

complications

treatment of slipped capital femoral epiphysis

(SCFE) is emergent; therefore, early and accurate

diagnosis is a must

Surgical Intervention

immediate internal fixation with screws

Prophylactic fixation of the unaffected hip in unilateral

SCFE… in high risk people

Treatment

Coxa plana

is avascular necrosis of the proximal femoral head

resulting from compromised blood supply to this

area.

Occurs in children between the ages of 4 and 10

years.

The male-to-female ratio is 4:1

Pathogenesis: blood supply mostly from lateral

epiphyseal vessels which are susceptible to

stretching or any pressure from an effusion

Legg-calve- Perthes

disease

Painless onset of limping.

Pain in groin, thigh & knee.

Pain in movements

Decreased ROM, especially abduction and internal

rotation

Trendelenburg test often positive

Clinical presentation

Mild cases

Skin traction

minimal weight bearing

Severe cases:

Containment: keeping the femoral head well seated

within the acetabulum to retain its normal shape

How: by holding hips widely abducted with a splint

Surgical : osteotomy

Treatments

Reference

http://emedicine.medscape.com/article/1007186-

overview#showall

www.uptodate .com

Apley’s system of orthopedics

thanks