Neel Mohan Consultant in Paediatric Orthopaedics St George’s Hospital Developmental Dysplasia of Hip Developmental Dysplasia of Hip  Spectrum of disorder, not always a dislocated hip  Instability is best picked up sooner rather than later  Hip examination actually easier in first few weeks  Concept of dysplasia, shallow and stable joint, shallow and unstable joint (Barlow and Ortolani), dislocated joint  Best case scenario is DDH diagnosed and treatment started within the first six months of life (Pavlik Harness)  Next best is six - nine months (Closed Reduction Hip Spica)  After that likely to require Open Reduction Signs of a dislocated hip Limited abduction in DDH Unequal hip creases! Hip examination in DDH Start early Re examine if not sure on first visit or child fractious One or two clinicians within a group to regularly examine babies’ hips Practice improves confidence Importance of wide and equal abduction of hips in addition to provocative (Barlow) and relocation (Ortolani) tests Always test on a firm surface like an examination couch, not on parents’ lap ‘Clicky hip’ could be nothing or everything! Adolescent back pain Curse of tight hamstrings  Rapid growth and increase in height  Poor posture  Increased stress on spine (heavy school bags, competitive      sport like rugby, fast bowling in cricket, athletics, etc) Markedly reduced flexibility of the entire spine Flattened lumbar lordosis with posterior pelvic tilt Most teenagers can’t touch their toes! (Boys worse off) Stress fractures of Pars Interarticularis Anxiety levels through the roof!! Causes of adolescent back pain  Mechanical (by far the most common), less common are  Osteochondritis of growth plates (Scheuermann’s disease)  Disc problems  Stress fractures (Pars or Pedicle area)  Nasty lesions (very rare, watch for red flags)  Physiotherapy main treatment  Stretches and strengthening (core muscles etc.)  Investigate if persistent and/or red flags  MRI more helpful than plain radiography Only pages 1-10 of this presentation are available. If you would like copies of the complete presentation please leave your email address below: Name:…………………………………………………………………………. GP Surgery:………………………………………………………………….. Email address:………………………………………………………………..