Children's Orthapaedics

Question 1

when is a deformity significant

Answer 1

only if its likely to persist and cause physical or mental problems later in life

Question 2

how do bones grow

Answer 2

longitudinal from the growth plate by echondral ossification

circumferential from the periosteum by appositional growth

Question 3

what factors affect the growth plate

Answer 3

diet/nutrition 
sunlight 
vitamins (D&A) 
injury 
illness 
hormones

Question 4

do girls or boys grow more quickly

Answer 4

girls

Question 5

what should a child be doing at 6-9 months

Answer 5

sits alone, crawls

Question 6

what should a child be doing at 8-12 months

Answer 6

stands

Question 7

what should a child be doing at 14-17 months

Answer 7

walks

Question 8

what should a child be doing at 24 months

Answer 8

jumps

Question 9

what should a child be doing at 3 years

Answer 9

manages stairs alone

Question 10

when should a child have head control

Answer 10

2 months

Question 11

what are some variations of normal

Answer 11

genu varum or valgum
intoeing
flat feet
curly toes

Question 12

what is varum

Answer 12

bow legged

Question 13

what is valgum

Answer 13

knock kneed

Question 14

when is genu varum normal

Answer 14

age <2

persisting varum can run in families

Question 15

what suggests underlying pathology in genu varum

Answer 15

unilateral (asymmetry >5 degrees)
severe
short stature
painful

Question 16

what can cause pathological genu varum

Answer 16

skeletal dysplasia 
rickets 
tumour 
blunts disease 
trauma

Question 17

what is blounts disease

Answer 17

growth arrest of medial tibial physis

unknown aetiology

Question 18

what can cause genu valgum

Answer 18

tumours
rickets
neurofibromatosis
idiopathic

Question 19

when is genu valgum normal

Answer 19

peak age 3 1/2

Question 20

when to refer genu valgum

Answer 20

if asymmetric
painful
>8cm intermalleorla distance consider surgery

Question 21

what is intoening

Answer 21

child walks with toes pointing in
accentuated when running
may be related to femoral neck ante version,
internal tibial torsion, metatarsus adducts or combination

Question 22

what is femoral neck anteversion

Answer 22

femoral neck normally points anteriorly
child tends to Sid in W position
XS anterversion - increased IR hip

Question 23

what is internal tibial torsion

Answer 23

usually seen in toddlers

majority resolve by 6 years

Question 24

what is metatarsus adducts

Answer 24

common benign condition
food sort of squint?
if not passively correctable casting may help aged 6-12 months

Question 25

how to determine if flat feet are flexible or fixed

Answer 25

get child to stand on tip toes

Question 26

what can flexible flat feet be related to

Answer 26

generalised ligamentous laxity or tightness

Question 27

what is rigid flat foot

Answer 27

uncommon but may have tarsal coalition
bones dont differentiate and bars from
may benefit from surgery is painful

Question 28

when are curly toes more common

Answer 28

in younger children
most 3rd or 4th toes
vast majority resolve by 6 years

Question 29

who gets anterior knee pain

Answer 29

females>males
adolescents
ALWAYS check their hips

Question 30

what causes anterior knee pain

Answer 30

localised patellar tenderness