Children's Orthopaedics

Question 1

What is more of a problem, unilateral or bilateral abnormalities?

Answer 1

Unilateral

Question 2

When is deformity significant?

Answer 2

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

Question 3

How does bone grow?

Answer 3

Longitudinal from the growth plate by enchondral ossification
Circumferential from the periosteum by appositional growth

Question 4

What mostly causes damage to the growth plate in childhood?

Answer 4

Trampoline

Question 5

What factors affect the growth plate?

Answer 5

Diet/Nutrition
Sunshine, vitamins (Vit D and A)
Injury
Illness
Hormones (Growth Hormone)

Question 6

What is the normal development for children?

Answer 6

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

Question 7

What can overtreatment cause?

Answer 7

Fear of doctors

Feelings of stigmatisation and distress

Question 8

What are 4 variations of normal alignment?

Answer 8

Genu Varum or valgum
Intoeing
Flat feet
Curly toes

Question 9

What is varum?

Answer 9

Bow legged

Question 10

What is Valgum?

Answer 10

Knock kneed

Question 11

What age in genu varum normal?

Answer 11

<2

Question 12

When may genu varum be abnormal?

Answer 12

Unilateral
Serve >2SD?
Short stature
Painful

Question 13

What can cause pathological genu varum?

Answer 13

skeletal dysplasia
Rickets
Tumour
Blounts disease
Trauma

Question 14

What is blounts disease?

Answer 14

Growth arrest of medial tibial physis of unknown aetiology

Question 15

What is seen on x-ray of blounts disease?

Answer 15

Beak like protrusion

Question 16

What can cause genu valgum?

Answer 16

Tumours
RIckets
Neurofibromatosis
Idiopathic

Question 17

When does genu valgum usually occur?

Answer 17

3 and 1/2

Question 18

When should genu valgum be referred?

Answer 18

If asymmetric
Painful
severs
>8cm intermalleolar distance

Question 19

Three things for intoeign?

Answer 19

Femoral neck anteversion
Internial tibial torsion
Metatarsus adductus

Question 20

What position do kids tend to sit on?

Answer 20

W position

Question 21

What do kids that sit in the W position tend to have?

Answer 21

Femoral anteversion

Question 22

What can femoral neck anteversion cause?

Answer 22

Usually no consequence

Can predispose to patellofemoral problems

Question 23

What is metatarsus adductus?

Answer 23

Common benign and resolves

Foot bending inwards

Question 24

What do you do when a child presents with intoeing?

Answer 24

Define cause
Reassure
Chart/Photograph
Review
Discharge

Question 25

What % of people have flat feet?

Answer 25

1 in 5

Question 26

Are we born with flat feet?

Answer 26

Yes

Question 27

What is the test for hypermobility?

Answer 27

Beighton score

Question 28

What is the treatment for curly toes?

Answer 28

Not needed
Majority resolve by 6 years
Splinting or taping ineffective
Consider flexor tenotomy

Question 29

What are the characteristics of anterior knee pain?

Answer 29

Females>Males
Adolescent
Localised patellar tenderness
Stairs/squats

Question 30

What should you check for knee pain?

Answer 30

HIPS