Children's Orthopaedics Flashcards
What is more of a problem, unilateral or bilateral abnormalities?
Unilateral
When is deformity significant?
If it is likely to persist and cause physical or mental health problems later in life
How does bone grow?
Longitudinal from the growth plate by enchondral ossification
Circumferential from the periosteum by appositional growth
What mostly causes damage to the growth plate in childhood?
Trampoline
What factors affect the growth plate?
Diet/Nutrition Sunshine, vitamins (Vit D and A) Injury Illness Hormones (Growth Hormone)
What is the normal development for children?
1-6 months - loss of primitive reflexes 2 months - head control 6-9 months - sits alone, crawls 9-12 months - few words 8-12 months - stands 14-17 months - walks 24 months - jumps 3 years - walks stairs alone
What can overtreatment cause?
Fear of doctors
Feelings of stigmatisation and distress
What are 4 variations of normal alignment?
Genu Varum or valgum
Intoeing
Flat feet
Curly toes
What is varum?
Bow legged
What is Valgum?
Knock kneed
What age in genu varum normal?
<2
When may genu varum be abnormal?
Unilateral
Serve >2SD?
Short stature
Painful
What can cause pathological genu varum?
skeletal dysplasia Rickets Tumour Blounts disease Trauma
What is blounts disease?
Growth arrest of medial tibial physis of unknown aetiology
What is seen on x-ray of blounts disease?
Beak like protrusion
What can cause genu valgum?
Tumours
RIckets
Neurofibromatosis
Idiopathic
When does genu valgum usually occur?
3 and 1/2
When should genu valgum be referred?
If asymmetric
Painful
severs
>8cm intermalleolar distance
Three things for intoeign?
Femoral neck anteversion
Internial tibial torsion
Metatarsus adductus
What position do kids tend to sit on?
W position
What do kids that sit in the W position tend to have?
Femoral anteversion
What can femoral neck anteversion cause?
Usually no consequence
Can predispose to patellofemoral problems
What is metatarsus adductus?
Common benign and resolves
Foot bending inwards
What do you do when a child presents with intoeing?
Define cause Reassure Chart/Photograph Review Discharge
What % of people have flat feet?
1 in 5
Are we born with flat feet?
Yes
What is the test for hypermobility?
Beighton score
What is the treatment for curly toes?
Not needed
Majority resolve by 6 years
Splinting or taping ineffective
Consider flexor tenotomy
What are the characteristics of anterior knee pain?
Females>Males
Adolescent
Localised patellar tenderness
Stairs/squats
What should you check for knee pain?
HIPS
