(3) HIP ADOLFO PEDIA

What condition is this>

1. Abnormality in the size, shape, orientation, or organization of the femoral head, acetabulum, or both.

2. Can predispose a child to premature degenerative changes and painful arthritis

Risk Factors

1. First-born babies

2. Family history of DDH

3. Position of the baby in the uterus

Clinical Manifestations:

1. Affected leg:

• Shorter

• Externally rotated

• Folds in the skin of the thigh or buttock may appear uneven

• Space between the legs may look wider

2. Partially or completely dislocated Asymmetric Gluteal, Thigh, Labial Folds

• Dx - X-ray - Ultrasound - CT Scan - MRI

A. Developmental Dysplasia of Hip (DDH)

What is this?

• From femoral diaphysis to the inferior margin of the superior pubic ramus.

• Break in the this suggests displacement of the femoral head from the acetabulum

Shenton’s Line

This is a treatment for congenital hip dysplasia

• Stretch the soft tissues around the hip

• Allow the femoral head to move back into the hip socket.

• 10 to 14days

• Can either be set up at home or in the hospital.

1. Traction and casting

This is a treatment for congenital hip dysplasia

• Up to 6 months of age

• Hold the hip in place, while allowing the legs to move a little.

• Full time for at least six weeks → part- time for six weeks.

2. Pavlik Harness

This is a treatment for congenital hip dysplasia

Ilfeld Brace (search meaning na lang)

This is a treatment for congenital hip dysplasia that is the most common; for severe cases

Von Rosen Splint

This is a treatment for congenital hip dysplasia that is the least common; for severe cases

Frejka Pillow Splint

In congenital hip dysplasia, what surgical approach will be used for <18mos?

medial adductor approach, tenotomy of iliopsoas

In congenital hip dysplasia, what surgical approach will be used for 18mos-2y/o?

anterior iliofemoral approach

What condition is this?

• Coxa plana

• Idiopathic form of osteonecrosis of femoral head in children

• Self-limiting, can heal by its own

• Usually affects boys between 3 and 13

• Feature:

  • Psoatic limp

  • LE moves in ER, flexion and adduction

  • Gradual onset of aching pain at hip, thigh & knee

  • Atrophy of hip, thigh and leg muscles

  • AROM limited abduction, internal and external rotation Dx:

  • MRI: (+) bony crescent sign

B. Legg-Calve-Perthes Disease (LCPD)

Radiographic finding in Legg-Calve-Perthes Disease (LCPD)?

bony crescent sign

What stage is this in Legg-Calve-Perthes Disease (LCPD)?

• Characterized by vascular damage

• Small capital epiphysis

• Increased radiodensity of the femoral head

• Appearance of osteopathic area in the medial aspect of the proximal femoral neck

Necrosis

What stage is this in Legg-Calve-Perthes Disease (LCPD)?

• Fibrous tissue invades the involved region & gradually resorbs the necrotic bone

• Enlargement of the femoral neck

• Severe deformity of the femoral head

Fragmentation

What stage is this in Legg-Calve-Perthes Disease (LCPD)?

• Begins after all necrotic tissue has been resorbed

• This gradual process is complete when the entire region has become re-ossified

Revascularization

What stage is this in Legg-Calve-Perthes Disease (LCPD)?

• Some resultant deformity may resolve as the joint is subjected to weight bearing & normal joint forces

Remodeling

What stage is this in Legg-Calve-Perthes Disease (LCPD)?

• Bony tissue is once again viable & further resolution of the deformity is minimal

• Enlarged/small femoral head

Healed

This is a cast used in Legg-Calve-Perthes Disease (LCPD) (1)

Scottish Rite Orthosis (search meaning na lang)

This is a cast used in Legg-Calve-Perthes Disease (LCPD) (2)

Toronto Braces (search meaning na lang)

This is a cast used in Legg-Calve-Perthes Disease (LCPD) (3)

Canadian Hip Orthosis (search meaning na lang)

This is a cast used in Legg-Calve-Perthes Disease (LCPD) (4)

Petrie Cast (search meaning na lang)

What condition is this?

• Separation of the head from the femur at the growth plate of the bone.

• Boys (10-17 years) > girls (8-15 years)

• The individual tends to hold the affected limb in flexion and external rotation

• Etiology

  • Unknown

• Pathology

  • Head slips downward and backward on femoral neck

• Painful hip

  • Most frequent presenting complaint
    

• Symptoms of SCFE

  • Vague pain

    • Knee

    • Thigh

    • Hip

• AROM restricted: flexion and internal rotation

• (+) leg length discrepancy

• As hip flexes, it ER and abduct

• Trendelenberg gait (chronic)

Dx: Plain film imaging show a (+) displacement of femoral

epiphysis

Degrees of Severity

MILD

• approximately 1/3 of the femoral head slips off of the  femur

MODERATE

• approximately 1/3 to 1/2 of the femoral head slips off of the femur

SEVERE

• more than 1/2 of the femoral head slips off of the femur

Medication:

• Acetaminophen/ paracetamol

• NSAIDs

Tx: as to degree of slipping

• Traction, gentle manipulation under anesthesia

• Pins, surgery

C. Slipped Capital Femoral Epiphysis (SCFE)