Pediatric Orthopedics

Front 1

What radiologic techniques are most suitable to screen for developmental hip dysplasia?
At what ages?

Back 1

Before 6 mos: u/s (with normal exam, can delay to 4-6 weeks old)
After 6 mos: AP radiograph

Front 2

Name 8 clinical conditions associated with markedly increased risk of developmental hip dysplasia, where screening should be advised despite normal PE.

Back 2

1) Torticollis (8-20%)
2) Clubfoot or calcanovalgus feet (25%)
3) Metatarsus adductus (10%)
4) Down syndrome
5) Congenital knee dislocation
6) Arthrogryposis
7) Myelomeningocele
8) Larson's syndrome

Front 3

Name 5 clinical presentations of hip dysplasia in an infant over 2 mos old.

Back 3

1) Asymetric shortening on the affected side (Galeazzi sign)
2) Leg on affected side may turn outward
3) Tight hip abductors/decreased hip abduction
4) Asymmetric thigh or gluteal folds
5) Space between legs may look wider than usual

Front 4

Name 2 clinical presentations of hip dysplasia in the walking child.

Back 4

Pain is not common in kids!
1) Mild hip flexion contractures (bilateral) may produce lumbar hyperlordosis and a waddling gait.
2) Unilateral dislocation may produce a short leg gait or limp

Front 5

Ortelani Test:
1) Where do examiner's digits go (2 points to recall)
2) What is the motion?
3) What is sought?

Back 5

1) Thumbs on the medial thigh, fingers place gentle upward stress on lateral thigh and greater trochanter area.
2) Apply slow abduction while fingers continue gentle upward stress
3) A dislocated and reducable hip will reduce with a palpable "clunk."

Front 6

Barlow Maneuver
1) How is it done? (2 steps)
2) What is sought?

Back 6

1) Procedure
a) Guide hips into mild adduction
b) Slight forward pressure with thumb
2) The unstable femoral head will slip over the posterior edge of the acetabulum producing a palpable "clunk."