Ortho
6-30-99
Lower Extremity
- Infant to toddler
- Ortonlani's reduction test
- Hip abducted from a flexed position—clip or clunk—head of femur back into the acetabulum
- Barlow's dislocation test
- Flexion and adduction and posterior LOD—push down on the head of femur and dislocation—congenital dislocation—most cases resolve themselves
- First bone children—confined in a small tight uterus—60%
- Breach birth—30-50% have this
- Left side pushed up against the sacrum
- More common in females 6:1—affected by maternal hormones (relaxin) relaxing the ligaments
- Respond very quickly a few wks to months—part of well baby exam
- Trenelenburg's test—gluteus medius weakness on wt bearing side
- Many reasons why it may be weak
- Gait that goes along w/it—contralateral side drops down (none wt bearing)
- Head of the femur and the acetabulum together influence the develop of each in the joint
- Pulvinar—fibro-fatty tissue that fills the acetabulum if the femur head is not there
- Triple diapering—keeping the hip flexed and abducted, maintained for several months
- Need to make sure that the hip still receives good blood supply to avoid necrosis—Safe Zone of Ramsey
- Decreased ROM—decreased safe zone
Legg-Calve-Perthes Disease
- Ischemic necrosis of the femoral head
- Idiopathic
- Age 2-12 (mean is 7)
- More common in boys 4or5:1
- Obesity may contribute
- Important not to miss the Dx
- May come in w/thigh or knee pain
- Interruption of blood supply to the femur head
- Osteoblast and clasts die—dead chunk of bone
- Revascularization—return of blood supply
- Big job for osteoclasts which remove the dead bone
- Osteoblasts have to produce new bone
- Subchondral fracture may occur b/c weak new bone leading to secondary ischemia
- Tx is minimize the deformity and maximize the