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MSK > Children's Orthopaedics > Flashcards

Children's Orthopaedics Flashcards

1
Q

Abnormal features in babies/young children usually correct…

A

with age.

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2
Q

When is deformity significant>

A

Only if it is likely to persist and cause physical or mental health problems later in life

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3
Q

Longitudinal growth of bones

A

Growth plate (physics) by ENDOCHONDRAL OSSIFICATION

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4
Q

Echondal ossification

A

Longitudinal growth of bones

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5
Q

Circumferential growth of bones

A

From periosteum by APPOSITIONAL GROWTH

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6
Q

Some physes contribute to growth more than others

A

40% of upper limb growth comes from the shoulder

70% of lower limb from the knee joint

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7
Q

Factors affecting the growth plate

A

Diet/nutrition

Sunshine, vitamins (Vit D & A)

Injury

Illness

Hormones (GH)

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8
Q

Short stature

A

Aged <3 growth much more variable.

Can cross centiles

Nutrition plays a big part

Look at parents’ height

Dysmorphic features –> increase chance underlying genetic or endocrine disorder

Low GH

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9
Q

Normal development landmarks

A

6-9 months - sits alone, crawls

8-12 months – stands

14-17 months walks

24 months jumps

1-6 months Loss of primitive reflexes – Moro, grasp , stepping, fencing

2months head control

9-12 months few words

14 months feeds self, uses spoon

18 months stacks 4 blocks, understands 200 words

3 years potty trained

HIGHLY VARIABLE

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10
Q

Genu varum

A

Born on a horse

Bow legged

Can vary with age.

Normal in age <2

Persisitng mild genu vacuum can run in families –> reassure

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11
Q

Genu valgum

A

Knock kneed

6° knock kneed on average.

Usually normal - peak at age 3 1/2

Chart and monitor

Refer if asymmetric, painful, severe (>2SD)

> 8cm intermalleolar distance at age 11 –> consider surgery

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12
Q

When can genu vacuum be pathological

A

If Unilateral (asymmetry >5°)

Severe >2SD/16° from mean

Short stature >2SD

Painful

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13
Q

Patholigical Genu Varum

A

Skeletal dysplasia

Rickets

Tumour (enchondroma)

Blounts disease

Trauma –> injury to physis

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14
Q

Blount’s disease

  • sign on x ray
A

Growth arrest of medial tibial physis of unknown aetiology

Typical BEAK like protrusion on X ray

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15
Q

Genu valgum - pathological causes

A

Tumours - endochondroma, osteochondroma

Rickets

Neurofibromatosis

Idiopathic

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16
Q

Intoeing

A

Child walks with toes pointing in (pigeon-toed)

Often accentuated when running

May be related to femoral neck ante version, internal tibial torsion, metatarsus adducts or combo

17
Q

Femoral neck anteversion

A

Femoral neck normally points anteriorly

XS anteversion –> increased Internal Rotation of hip

Tend to sit in W position

30-40° at birth, slowly unwinds and should be around 10-15° at maturity

Usually of no consequence.

Can predispose to patellofemoral problems

18
Q

Internal tibial torsion

A

Usually seen in toddlers

Vast majority resolves by 6 yrs

Internal torsion causes the foot to adduct, and the patient tries to compensate by everting the foot, externally rotating at the hip, or both

19
Q

Does bracing/orthotics help in internal tibial torsion?

A

Ineffective and not required

20
Q

Metatarsus adductus

A

Common
Benign
Resolves
If not passively correctable - serial acting may help age 6-12 months.

causes the front half of the foot, or forefoot, to turn inward.

21
Q

Intoeing - what to do

A

Define cause

Reassure - vast majority get better with time

Chart/photograph

Review

Discharge unless persisting and severe

22
Q

Flat feet

A

Common

We are born with flat feet but most develop medial arch once walking as tibias posterior strengthens

Flat feet usually asymptomatic

23
Q

Flat feet - flexible or fixed?

A

Fixed flat feet

On tip toes and form an arch = flexible

on tip toes an NO arch formed = fixed

Fixed feet may indicate an abnormality

???

Flexible may be related to generalised ligamentous laxity or tightness gastrocsoleus complex

Many resolve

Orthotics unhelpful unless there is pain

No proven consequence of persisting flat feet

24
Q

Calf tightness assessment

A

Flat feet

Need to relax gastrocs by flexing knee.

25
Q

Hyper mobility

A

More flexible

Beighton score 9/9.

26
Q

Tarsal coalition can cause

A

Flat feet.

Rigid flat foot

May benefit from surgery if painful.

27
Q

Curly toes

A

Common in younger children

Most 3rd or 4th toes

Vast majority resolve by 6 yrs old

Splinting or taping is INEFFECTIVE.

Rarely persisting cases can consider flexor tenotomy

28
Q

Anterior knee pain

A

more common in females than males

Adolescent

Localised patellar tenderness

Stairs/squats pain

very very common

CHECK THE HIPS

Physiotherapy, most resolve

29
Q

In anterior knee pain, what else should you check?

A

HIPS

Slipped femoral head?

MSK (11 decks)

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