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Developmentaldysplasia of thehip – DDH Perthes disease – image right • New-born babies • Typically, in patients age 4-7 At risk babies = Breach birth, sibling,­birth weight, • Avascular necrosis of the femoral head, older mother, oligohydramnios. resulting remodelling that distorts the epiphysis Diagnosis = Early diagnosis is important as later and generates abnormal ossification. diagnosis requires more complex treatment. Presentation = pain in hip or knee and causes a limp All at risk babies should have hips examined in the Examination= all movements of the hip are limited, st especially internal rotation and abduction. 1 days of life and at 6 weeks, along with ultrasound at 2-4 weeks. Early X rays show joint space wideninglatershows Imaging choice= ultrasound if under 4 ½ months,X- decrease in size of femoral head with patchy density. rays for older infants. Even later can show collapse and deformity of the Hip tests femoral head with new bone formation. Ortalani = positive if palpable clunk as the hip Management = non-weight bearing with crutches and Transient synovitis of the hip – irritable hip relocates. NSAIDS + x-ray surveillance if less severe • Most common cause of hip pain in children Barlow = positive when the femoral head is felt to If more severe surgery may be indicated . (joint dislocate. replacement due to early arthritis) aged 4-10 Galeazzi = looks for shortening of femur, negativeif youngerthe patient = betterprognosis . Prognosis is • Diagnosis of exclusion Presentation = acute onset following a viral illness both hips are dislocated as no discrepancy. governedby risk ofOA inthe hip (URTI, or autoimmune. Other = if over 3 months, limited abduction of the hip while in flexion = most sensitive test. by Gregor ramage and Examination= pain in extremes of movement but Management = allow up until 6 weeks for treatment no limitation and normal X-rays and bloods. as can resolve spontaneously. Dr Shaheer Aslam Joiya Management = rest and analgesia. RED FLAG = must rule out septic arthritis inthe hip If over6weeks require long term splintingin Pavlik The limping child If otherjoints involved could be stills disease. harness. 6-18 months = spica hip bandage under GA. SUFE – slipped upper femoral epiphysis After 18 months = open reduction • Aged 10-16yrs, morecommonin obeseboys • Displacement through the growth plate. Image below showing Pavlik harness Presentation = After a minorinjury withlimping and pain in the groin, thigh or knee. Examination= flexion, abduction and medial rotation are limited. Take anteroposterior and frog -leg lateral X- rays of both hips. Management = surgical withearly internal fixationto stabilizeslippage. Complications = if untreated can result in avascular necrosis and arthritis. Image rightshowing pre and post -surgical fixation