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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
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.
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
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)
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