امراض مفصل الورك عند الاطفال - Pediatric hip استشاري جراحة العظام - البروفيسور فريح ابوحسان

Pediatric hipPediatric hipFreih Odeh Abu HassanFreih Odeh Abu Hassan

F R C S (Eng ) F R C S (Tr &Orth)F.R.C.S.(Eng.), F.R.C.S.(Tr.&Orth)Professor of Orthopaedicso esso o O t opaed cs

and Pediatric Orthopaedic SurgeryUniversity of Jordany

Professor Freih Abuhassan1





Developmental dysplasia of the hipp y p p(DDH)


10 F(Risk factors for DDH)10 F(Risk factors for DDH)F l 2 F il hi ( 0 f ld )1. Female 2. Family history (10 folds)

3. First born breech. (5‐10 folds)( )

4. Fluid around the fetus.

5. Feet deformity : Met. Add./ C.Valgus.

6 Full term or Premature6. Full term or Premature.

7. Facial asymmetry.

8. Faulty habits 9.Fetal anomalies




Di i f DDHDiagnosis of DDH

* Persistent neonatal instability < 3m.‐ Clunk sign of Ortolani.‐ Barlow’s sign !!!!!‐ Barlow s sign.!!!!!

* 3 ‐12 months.‐ Limited abduction. ‐ Shortening.

* After 12 months. After 12 months.‐ Limping. ‐ Shortening.



O t l i t tOrtolani test Professor Freih Abuhassan12


Galliazzi





Flexion

PAVLIK HARNESS is the bestProfessor Freih Abuhassan18







Bilateral DDHProfessor Freih Abuhassan25







Poor orthosis for DDHPoor orthosis for DDH

Professor Freih Abuhassan32 Double Napkins

Limited abduction in DDHProfessor Freih Abuhassan33


DDH managementDDH management flowchart,

birth to 6 monthsbirth to 6 months



Leg‐Calve‐Perthes‐disease.Leg Calve Perthes disease.(LCP)(LCP)






Imaging Various features are shown based on the stage of the disease in the AP radiograph (yellow

) Th b ft h d d t k arrow). The bone scan often shows decreased uptake over the femoral head (red arrow). Professor Freih Abuhassan42

MRI Marrow necrosis corresponding to the extent of the necrosis (arrow) is evident.



Head at risk signs Extrusion (red arrow)Head‐at‐risk signs Extrusion (red arrow), metaphyseal reaction (yellow arrow), and lateral

( )rarifaction or Gage sign (white arrow)Professor Freih Abuhassan45

Symmetrical involvement suggests anotherSymmetrical involvement suggests another diagnosis This child has epiphyseal dysplasia


Differential diagnosis of LCP


LCP disease in a young child This 3‐year‐y g yold girl was managed without treatment. Th t dThe outcome was good



Late sequale of LCPProfessor Freih Abuhassan50

Slipped Capital Femoral Epiphysis


Slipped capital femoral epiphysis Typical habitus is shown (left). The upper radiograph was made in OPD where diagnosis of SCFE pp g p g(yellow arrow) was made. An acute slip (red arrow) next day










Unstable slip with avascular necrosisThis acute slip (yellow arrow) was reduced and pinned (orange arrow) without drainagepinned (orange arrow) without drainage. The hip developed AVN (red arrows) and eventually required a hip fusion (green arrow





Coxa Vara






Health & Medicine

امراض مفصل الورك عند الاطفال - Pediatric hip استشاري جراحة العظام - البروفيسور فريح ابوحسان