Children's Orthopaedics

Question 1

Which kind of growth occurs in long bones?

Answer 1

Endochondral ossification

Question 2

Which kind of growth increases the diameter of long bones?

Answer 2

Appositional growth

Question 3

In a basic description, how does endochondral ossification occur?

Answer 3

Occurs at the epiphyseal plate, where there a multiple layers. Chondrocytes multiply in one layer, then the eventually die in lower layers as the surrounding matrix is calcified, when they then are ossified at the diaphyses.

Question 4

By what age should babies normally be walking?

Answer 4

14-17 months

Question 5

Genu varum

Answer 5

bow legged

Question 6

Genu valgum

Answer 6

knock kneed

Question 7

When is genu varum normal and abnormal?

Answer 7

Normal: <2y
Abnormal: unilateral, severe, short stature or painful

Question 8

When is genu valgum normal and abnormal?

Answer 8

Usually normal (peak around 3.5y)
Abnormal: Painful, asymmetric or severe

Question 9

What is Blounts Disease, typical appearance and treatment?

Answer 9

Growth arrest of medial tibial physis of unknown aetiology (?weight overload).
Typical Beak-like protrusion on x-ray.
Hemiepihysiodesis is the surgical treatment

Question 10

What are some of the possible causes of intoeing?

Answer 10

Femoral neck anteversion (increases internal rotation of hip), Internal Tibial Torsion,
metatarsus adductus or combination

Question 11

Why are we all born with flat feet but normally don’t have it in adulthood?

Answer 11

We develop a medial arch once walking when tibialis posterior strengthens

Question 12

What are the 2 types of flat feet?

Answer 12

Flexible or fixed (rigid). Rigid is much more serious

Question 13

What are the possible causes of flexible flat feet?

Answer 13

Generalised ligamentous laxity (hypermobility) or tightness gastrocsoleus complex

Question 14

What are the possible causes of fixed flat feet?

Answer 14

Tarsal coalition

Question 15

Which score is used to measure hpermobility?

Answer 15

Beughtin score (out of 9)

Question 16

What must you check in anterior knee pain?

Answer 16

Hips

Question 17

Talipes

Answer 17

A deformity in which the foot is twisted out of normal position

Question 18

What causes positional talipes?

Answer 18

Intrauterine position

Question 19

What is the difference between physiological and pathological talipes?

Answer 19

Physiological is correctible

Question 20

What is the difference between equinus and calcaneus talipes?

Answer 20

Equines is plantar-flexed, while calcaneus is dorsiflexed

Question 21

What is Congenital Talipes Equinovarus more commonly known as?

Answer 21

Club foot

Question 22

What are the 3 main types of spina bifida?

Answer 22

1) Occulta (spine is still closed)
2) Meningocele (meninges have pushed out of spine)
3) Myelomeningocoele (meninges and spinal cord has pushed out of spine)

Question 23

What are the 5 main causes of limp?

Answer 23

1) Antalgic (pain in the limb so minimise stance phase)
2) Trendelenberg (pelvis tilts so need to tilt body for foot clearance)
3) Short leg
4) Tip toe
5) Neurologic

Question 24

What are the 3 subtypes of causes of tip toe gait?

Answer 24

1) Habitual
2) Structural (tight achilles)
3) Neurological eg. spasticity, spina bifida, cerebral palsy etc

Question 25

Cerebral Palsy

Answer 25

a group of non progressive disorders in which disease of the brain causes an impairment of motor function.

Question 26

Spina Bifida

Answer 26

a condition where the spine does not develop properly, leaving a gap in the spine.

Question 27

What causes cerebral palsy?

Answer 27

Neurological problems that can either occur prenatal (prematurity), perinatal (birth trauma e.g., asphyxia) or postnatal (eg. infection or cereal haemorrhage)

Question 28

What are the topographical classifications of cerebral palsy?

Answer 28

Hemiplegia (unilateral0 walkers), diplegia (bilateral- standers) or totally body involvement (sitters)

Question 29

What is the management of cerebral palsy?

Answer 29

Can either use drugs/surgery acting at the dorsal horn or surges such as hamstring/gastroc lengthening to optimise walking/sitting

Question 30

Which score is used in cerebral palsy?

Answer 30

Gross motor function score

Question 31

What are the main risk factors for DDH?

Answer 31

Breech position and family history

Question 32

What are the 3 instability tests to screen for DDH?

Answer 32

Barlow (sublux the hip), Ortolani (relocate the hip) and Galeazzi (lie the baby feet to bum and if knees aren't level it is +ve)

Question 33

True or False: instability tests can be used for the first year of life

Answer 33

False, they are unreliable after 6 weeks

Question 34

What is the investigation of choice for DDH in >3 months and < 3months?

Answer 34

<3 months = US | 3-6 months = x-ray (calcified epiphysis)

Question 35

What is the treatment of DDH with early diagnosis?

Answer 35

Pavlov harness

Question 36

What is the treatment of DDH with late diagnosis?

Answer 36

Closed or open reduction followed by hip spica

Question 37

What is Perthes?

Answer 37

Idiopathic avascular necrosis in children, where the blood supply to the epiphysis becomes inadequate. As a result the bone softens and breaks down

Question 38

Who is more likely to get Perthes, boys or girls?

Answer 38

Boys (4:1)

Question 39

What is SUFE?

Answer 39

Slipped Upper Femoral Epiphysis - A fracture through the growth plate, which results in slippage of the overlying end of the femur (epiphysis).

Question 40

True or False: An adolescent with hip/groin thigh or knee pain has a SUFE until proven otherwise

Answer 40

True

Question 41

Which type of x-ray is imperative in SUFE?

Answer 41

Lateral view

Question 42

What are you thinking of in 1) Newborn 2) pre-school and 3) adolescent with hip problems?

Answer 42

1) DDH 2) Perthes 3) SUFE