Hip and Pelvis Injuries in Childhood and Adolescence
Disorders of the hip are common in childhood and adolescence. As a child grows older, the most common problems affecting the hip will change. The hip often may be overlooked as a source of pain as disorders may refer pain to the thigh or knee, potentially
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Hip and Pelvis Injuries in Childhood and Adolescence Mark E. Halstead
Clinical Pearls • Universal ultrasound screening of infants for developmental dysplasia of the hip (DDH) is not recommended. • Legg–Calve–Perthes Disease (LCPD) is a common hip disorder affecting children ages 4–8 and is typically felt to be a self-limited condition. • Slipped capital femoral epiphysis (SCFE) is a common condition affecting middle school and early high school aged children and requires urgent orthopedic attention when diagnosed. • Transient synovitis of the hip is the most common source of hip pain in children but needs to be distinguished from the more concerning septic arthritis of the hip. • Snapping hip syndrome is a common source of hip popping that may or may not be painful. It is commonly seen in dancers. • Avulsion fractures of the pelvis should be strongly considered in the adolescent athlete presenting with an acute injury, a painful pop, and difficulty bearing weight or lifting the leg.
7.1
Case Presentation
A 13-year-old male football offensive lineman presents to clinic with his parents following an acute injury he sustained last night at football practice. He was doing several sprints at the end of his practice and during the second sprint he felt a sharp pain and a pop around the anterior hip and groin. He was unable to bear weight. His
M.E. Halstead, MD (*) Departments of Pediatrics and Orthopedics, Washington University in St Louis, St Louis, MO 63130, USA e-mail: [email protected] © Springer International Publishing Switzerland 2017 P.H. Seidenberg et al. (eds.), The Hip and Pelvis in Sports Medicine and Primary Care, DOI 10.1007/978-3-319-42788-1_7
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school had an athletic trainer who evaluated him and felt he may have “pulled his groin.” He was given crutches and iced his hip. In the office he refuses to bear weight. He is overweight. He has mild pain but significant weakness upon resisted hip flexion. Also has pain endorsed with internally and externally rotating his hip. Tender over the anterior hip joint and anterior superior iliac spine. He is then sent for X-rays.
7.2
Introduction
Disorders of the hip are common in childhood and adolescence. As a child grows older, the most common problems affecting the hip will change. The hip often may be overlooked as a source of pain as disorders may refer pain to the thigh or knee, potentially leading the clinician astray as to the source of the problem, potentially resulting in a delayed or incorrect diagnosis. Clinicians should understand the appropriate anatomy, physical exam techniques and imaging studies of the hip and the common pediatric hip disorders and injuries presented in this chapter.
7.3
Developmental Dysplasia of the Hip
Developmental dysplasia of the hip (DDH) is a general term that refers to conditions of the hip present at birth to early infancy that include a wide spectrum of problems typically affecting the development of the hip joint. This may include problems such as abnormal development of the osseous structur
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