Module 17, General Orthopaedist Level
A 2 year and 3 month old girl presented for evaluation. The child was
the 3 pound 5 ounce product of a 30 week gestation which was complicated
by a low birth weight and respiratory distress at birth. She was able to
sit alone and just started to crawl at 11 months. Hip abduction was 25
degrees on each side with the hips and knees extended. Popliteal angles
were 10 degrees, bilaterally. In the prone position with her hips extended,
she has 60 degrees of internal rotation bilaterally and 40 degrees of external
rotation on the right and 60 degrees of external rotation on the left.
She had a negative Barlow test.
Question 17A
This
x-ray of her hips is slightly abnormal.
Question 17B
A
varus femoral osteotomy is the best treatment of this child at this time.
Question 17C
Acetabular
dysplasia is a major problem in the hip of this child and should be monitored
carefully.
Question 17D
Abduction
orthotic treatment following surgery is a required part of the treatment
program if the best results are to be obtained.
Question 17E
At
this age almost any surgery on the hip will need to be repeated if the
hips are to be kept located.
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