Paediatric hip disorders
Developmental dysplasia fo the hip
Screening at birth, 6 months, 8 months.
Risk factors
- FHx
- first born
- girls
- oligohydramnios
Diagnosis
Ortolani & Barlow's tests.
Ultrasound is diagnostic.
Treatment
- 0–6 months: Pavlik harness (holds hip flexed, abducted).
- 6 months–18 months: closed gradual reduction, plaster hip spica.
- 18 months–10 years: open reduction, derotation femoral osteotomy.
Septic arthritis
Features
Unwell, fever, unable to move joint.
Diagnosis
US, aspiration, hip XR, blood cultures.
70% staphylococcus aureus. ΔΔx tumour if subacute.
Treatment
IV antibiotics.
Perthes' disease
Features
Hip pain. 4–8 aet. M:F 4:1
Treatment
Rest, traction. Containment of femoral head: abduction bracing or
femoral osteotomy.
Prognosis
Good. 1/3 OA at 50 aet.
Slipped upper femoral epiphysis
History
Very fat or very tall boy. Pain in groin, thigh or knee. Limp.
Examination
Leg externally rotated, shortened. Abduction, medial rotation limited.
Diagnosis
Frog lateral hip XR. Trethowan's line passes above femoral head.
Treatment
Pin the head to avoid further slip. (Risk of avascular necrosis!)
Osteotomy if deformity is severe.