Children's Orthapaedics Flashcards
when is a deformity significant
only if its likely to persist and cause physical or mental problems later in life
how do bones grow
longitudinal from the growth plate by echondral ossification
circumferential from the periosteum by appositional growth
what factors affect the growth plate
diet/nutrition sunlight vitamins (D&A) injury illness hormones
do girls or boys grow more quickly
girls
what should a child be doing at 6-9 months
sits alone, crawls
what should a child be doing at 8-12 months
stands
what should a child be doing at 14-17 months
walks
what should a child be doing at 24 months
jumps
what should a child be doing at 3 years
manages stairs alone
when should a child have head control
2 months
what are some variations of normal
genu varum or valgum
intoeing
flat feet
curly toes
what is varum
bow legged
what is valgum
knock kneed
when is genu varum normal
age <2
persisting varum can run in families
what suggests underlying pathology in genu varum
unilateral (asymmetry >5 degrees)
severe
short stature
painful
what can cause pathological genu varum
skeletal dysplasia rickets tumour blunts disease trauma
what is blounts disease
growth arrest of medial tibial physis
unknown aetiology
what can cause genu valgum
tumours
rickets
neurofibromatosis
idiopathic
when is genu valgum normal
peak age 3 1/2
when to refer genu valgum
if asymmetric
painful
>8cm intermalleorla distance consider surgery
what is intoening
child walks with toes pointing in
accentuated when running
may be related to femoral neck ante version,
internal tibial torsion, metatarsus adducts or combination
what is femoral neck anteversion
femoral neck normally points anteriorly
child tends to Sid in W position
XS anterversion - increased IR hip
what is internal tibial torsion
usually seen in toddlers
majority resolve by 6 years
what is metatarsus adducts
common benign condition
food sort of squint?
if not passively correctable casting may help aged 6-12 months
how to determine if flat feet are flexible or fixed
get child to stand on tip toes
what can flexible flat feet be related to
generalised ligamentous laxity or tightness
what is rigid flat foot
uncommon but may have tarsal coalition
bones dont differentiate and bars from
may benefit from surgery is painful
when are curly toes more common
in younger children
most 3rd or 4th toes
vast majority resolve by 6 years
who gets anterior knee pain
females>males
adolescents
ALWAYS check their hips
what causes anterior knee pain
localised patellar tenderness
