developmental dysplasia of hip slipped capital femoral epiphysis

1. Lukman Salim
88946

2. objectives

 Developmental dysplasia of the hip..(DDH)
 Transient synovitis
 Septic arthritis
 Slipped capital femoral epiphysis (SCFE)

3. Developmental dysplasia of

 The abnormal formation of the hip joint in which the
the femoral head is not stable within the acetabulum.
 Epidemiology:
 The incidence ranges from as low as 1 per 1,000 to
as high as 34 per 1,000.
 Common among girls (1:600) compared to boys
(1:4,000)
the hip (DDH)

4. Spectrum of DDH

Acetabular
dysplasia:
• Mildest form
• Femoral
head
remains in
acetabulum
Subluxation:
• Most
common
form
• Femoral
head
partially
displaced
Dislocation:
• Femoral
head not in
contact with
acetabulum
• Displaced
posteriorly
and
superiorly

5. Clinical features of DDH

 Birth to 3 months of age
 Hip instability (demonstrated by positive Ortolani or Barlow
tests
 Asymmetric leg creases (inguinal, gluteal, thigh, or
popliteal)
 Apparent shortening of femur (Galeazzi, )
 3 to 12 months of age
 Limitation of hip abduction
 Apparent shortening of the femur (Galeazzi)
 Laterally rotated posture in prone position
 Marked asymmetry of leg creases (inguinal, gluteal, thigh,
or popliteal)
 Klisic test

6. leg creases


7. Apparent shortening of
the femur


8. Physical examination

 Ortolani test: From an
adducted position the
hip is gently abducted
while lifting the
trochanter anteriorly
 Barlow’s test: The thigh
is grasped loosely with
the examiner's index
and middle finger along
the greater trochanter
and the thumb on the
inner thigh.
 The hip is gently
adducted and a
posteriorly directed
pressure applied.

9. Trendelenburg sign


10. Klisic test


11. investigation

 Ultrasound
 Gold standard in first
2 wks. of age
 Radiography
 Gold standard

12. X ray


13. X ray


14. X ray


15. apply


16. Managments

Method depends on Age
Birth to 6 months :
 Double napkins , Pavlik harness or hip spica cast
6 months – 12 months :
 Closed reduction and hip spica casts
12 months – 18 months :
 Possible closed / possible open reduction
Above 18 months :
 Open reduction and Acetabuloplasty
Above 2 years :
 Open reduction, acetabulplasty, and femoral
osteotomy.

17. Pavlik harness Spica cast


18. Transient Synovitis

 Transient synovitis (TS) is the most common cause
of acute hip pain in children aged 3-10 years
 affects boys twice as often as girls.
 Clinical features
 Limping
 Pain on thigh or knee
 Low grade fever
 Refusing to walk if pain severe
 Night crying in younger children
 Infant: unusual crawling
 Examination:
 mild restriction of motion,
especially to abduction
and internal rotation
 Tender hip with
movement.
 tender to palpation.
 Log roll!!

19. 
 investigation
 CBC: WBC may be slightly elevated.
 Elevated ESR, CRP
 Treatments:
 Bed rest 7-10 days
 Heat and message
 If severe pain.. Admission…. Skin traction of the hip to
reduce intracapsular pressure
 ibuprofen may shorten the duration of symptoms

20. Slipped capital femoral
epiphysis (SCFE)

 Displacement of the capital femoral epiphysis from
the femoral neck through the physeal plate
 Boys affected more than girls
 Occur during puberty usually 14-15 years old
 Risk factors:
 Obesity
 Very tall
 Endocrine problems :hypothyroidism,
panhypopituitarism, hypogonadism,, growth hormone
abnormalities

21. 

22. X-ray


23. Stable vs unstable

 Stable" SCFEs allow the patient to ambulate with or
without crutches.
 "Unstable" SCFEs do not allow the patient to
ambulate at all; these cases

24. Clinical presentation

 Sudden, severe pain, limping.
 Pain in groin and in anterior thigh or knee
 Leg is externally rotated
 Leg 1-2cm short
 Limitation of abduction and internal rotation

25. complications

 Avascular necrosis
 Coxa vara: if not reduced>>>> abnormal fusion>>>
limping
 another SCFE on the other leg

26. Treatment

 treatment of slipped capital femoral epiphysis
(SCFE) is emergent; therefore, early and accurate
diagnosis is a must
 Surgical Intervention
 immediate internal fixation with screws
 Prophylactic fixation of the unaffected hip in unilateral
SCFE… in high risk people

27. Legg-calve- Perthes
disease

 Coxa plana
 is avascular necrosis of the proximal femoral head
resulting from compromised blood supply to this
area.
 Occurs in children between the ages of 4 and 10
years.
 The male-to-female ratio is 4:1
 Pathogenesis: blood supply mostly from lateral
epiphyseal vessels which are susceptible to
stretching or any pressure from an effusion

28. Clinical presentation

 Painless onset of limping.
 Pain in groin, thigh & knee.
 Pain in movements
 Decreased ROM, especially abduction and internal
rotation
 Trendelenburg test often positive

29. Treatments

 Mild cases
 Skin traction
 minimal weight bearing
 Severe cases:
 Containment: keeping the femoral head well seated
within the acetabulum to retain its normal shape
 How: by holding hips widely abducted with a splint
 Surgical : osteotomy

30. thanks

 Reference
 http://emedicine.medscape.com/article/1007186-
overview#showall
 www.uptodate .com
 Apley’s system of orthopedics