Module 32, Pediatric Orthopaedist Level

A two month old child had been treated with a Pavlik Harness for a dislocated hip since age of 10 days. After 2 months, the left hip remained dislocated. Home traction was started. An arthrogram, adductor tenotomy and closed reduction was done at 4 months of age. Single hip spica was applied with the hip in 40 degrees of abduction and 100 degrees of flexion. Four months later, the spica cast was removed and an Atlanta brace was applied. X-rays showed avascular necrosis (AVN) at ten months of age.

Question 32A

Femoral heads which show the head-within-head appearance have a better prognosis.

Question 32B

The damage to the lateral physis may remain dormant until the age of 10 or 12 years.

Question 32C

Trochanteric overgrowth is more of a problem with damage to the central physis.

Question 32D

Severe AVN of the femoral head leads to femoral neck shortness and coxa magna only because the epiphysis has been injured.

Question 32E

Arrest of the medial physis also commonly occurs and leads to coxa vara.