Paediatric hip disorders
Developmental dysplasia fo the hip
Screening at birth, 6 months, 8 months.
- first born
Ortolani & Barlow's tests.
Ultrasound is diagnostic.
- 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.
Unwell, fever, unable to move joint.
US, aspiration, hip XR, blood cultures.
70% staphylococcus aureus. ΔΔx tumour if subacute.
Hip pain. 4–8 aet. M:F 4:1
Rest, traction. Containment of femoral head: abduction bracing or
Good. 1/3 OA at 50 aet.
Slipped upper femoral epiphysis
Very fat or very tall boy. Pain in groin, thigh or knee. Limp.
Leg externally rotated, shortened. Abduction, medial rotation limited.
Frog lateral hip XR. Trethowan's line passes above femoral head.
Pin the head to avoid further slip. (Risk of avascular necrosis!)
Osteotomy if deformity is severe.