521068
Descripción
Mapa Mental por v.djabatey, actualizado hace más de 1 año
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Creado por v.djabatey
hace casi 11 años
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Limp
- transient synovitis (irritable hip)
- commonest
cause of
acute hip
pain in kids
- 2-12
year
olds
- often follows
or comes w/
viral infection
- presentation
- sudden
onset
of pain
in hip
- no pain @ rest
- pain may
be referred
to knee
- no pain @ rest
- limp
- mild
fever
- child
appears
well
- sudden
onset
of pain
in hip
- needs
differentiating from
early septic
arthritis of hip joint
- if SA suspected, must
- joint aspiration
- blood culture
- joint aspiration
- if SA suspected, must
- can precede
development of
Perthes disease
- Mx
- bed rest
- analgesia
- skin traction
- rarely
- rarely
- bed rest
- improves
within a few
days
- commonest
cause of
acute hip
pain in kids
- Perthes disease
- = avascular necrosis of
capital femoral epiphysis of
femoral head
- due to
interruption of
blood supply fb
revascn &
reossificatn
over 18-36
months
- due to
interruption of
blood supply fb
revascn &
reossificatn
over 18-36
months
- mainly affects boys
- M:F= 5:1
- M:F= 5:1
- insidious
presentation
- onset of limp
- hip or knee pain
- onset of limp
- can be
mistaken for
transient
synovitis
- bilateral in 10-20%
- Ix if ?Perthes disease
- X-ray both hips (incl frog views)
- early signs
- increased density in femoral head
- becoming fragmented & irreg
- becoming fragmented & irreg
- increased density in femoral head
- if initial X-ray normal, repeat if sx continue
- early signs
- bone scan & MRI
- may help diag
- may help diag
- X-ray both hips (incl frog views)
- prognosis
- dependent on early
diag
- if IDed early
- <1/2 femoral head is affected
- only bed rest &
traction needed
- only bed rest &
traction needed
- <1/2 femoral head is affected
- if IDed early
- severe or late px
- femoral head must be covered by acetabulum
- to act as mould for reossifying epiphysis
- achieve by
- kip hip abducted
- plaster
- talipes
- plaster
- femoral or pelvic osteotomy
- kip hip abducted
- to act as mould for reossifying epiphysis
- femoral head must be covered by acetabulum
- good in most kids
- esp < 6 years
old & <1/2
epiphysis
involved
- but older kids or more extensive involvement
- deformity of femoral head & metaphyseal damage more likely
- potential for subseq degenerative arthritis as adult
- potential for subseq degenerative arthritis as adult
- deformity of femoral head & metaphyseal damage more likely
- esp < 6 years
old & <1/2
epiphysis
involved
- dependent on early
diag
- = avascular necrosis of
capital femoral epiphysis of
femoral head
- slipped capital femoral epiphysis (SCFE)
- -> displacement of epiphysis of
femoral head postero-inferiorly
- needs prompt Rx to prevent avascular necrosis
- needs prompt Rx to prevent avascular necrosis
- commonest @
10-15 years old
- during adolescent growth spurt
- esp obese boys
- esp obese boys
- during adolescent growth spurt
- bilateral in 20%
- assoc w/ metabolic
endocrine abnormalities
- hypothyroidism
- hypogonadism
- hypothyroidism
- presentation
- limp
- hip pain +/-
referral to
knee
- onset
- acute
- ff trauma
- insidious
- acute
- limp
- O/E
- restricted abduction
- internal rotation of hip
- restricted abduction
- Ix
- X-ray
- to
confirm
diag
- get a
frog
lateral
view
- to
confirm
diag
- X-ray
- Mx
- surgical
- pin fixation in situ
- pin fixation in situ
- surgical
- -> displacement of epiphysis of
femoral head postero-inferiorly
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