Pediatrics: leg and hip

1. When does genu varus resolve in infants?
*2. What is Blount's disease? What group is it most common in? What is the treatment?
3. What is developmental dysplasia of the hip? How common is it and what factors increase risk?
4. What is Galeazzi's test?
5. What are the Barlow and Ortolani tests?
6. What is the treatment of DDH?

Answers:
1. 12-18 months.
2. Abnormal function of medial portion of proximal tibial growth plate, causing bowing in proximal tibia, most common in obese African-Americans who walk early. Treatment is usually osteotomy of the proximal tibia and fibula.
3. DDH includes hip subluxation, hip dislocation, and acetabular dysplasia. It occurs in 1/1000 births, more common in breech and females.
4. Flexion of hip and knees bilaterally and look at level of knees. If one knee is lower than the other, this implies DDH.
5. Barlow involves pushing laterally on the hip with the leg in a flexed and adducted position, resulting in hip dislocation. Ortolani test reduces the hip back in place by pushing anteriorly with the long finger over the greater trochanter to left the femoral head over the posterior lip of the acetabulum, which should result in a palpable clunk if positive.
6. In the first few months of life, infant can be treated with closed reduction and Pavlik harness or hip spica cast. Surgery may be needed if diagnosed at walking age.