Children's Orthopaedics Flashcards
How many standard deviations are considered within normal limits
2
How does angular profile vary between newborns and children aged 4-6 years
Newborns = Genu valgus
1.5 - 2 years = Normal angular profile
2 - 2.5 years = Genu varum
4-6 years = Normal angular profile
Give examples of abnormal features in toddlers which correct themselves with age
Overlapping toes
Internally rotated feet
Flat feet
If a deformity is asymmetrical/unilateral, it is less likely to be pathological. TRUE/FALSE?
FALSE
a deformity is more likely to be pathological if it is only present on one side
e.g. Blouts disease
Describe the two ways in which bones can grow during development
Longitudinal/vertically from the growth plate (epiphysis) by enchondral ossification
Circumferential (bone gets wider)
from the periosteum by appositional growth
When do humans begin to lose bone mass, and do males or females lose it quicker?
Post-menopause OR after age of 50
Men start with a higher bone mass BUT both genders lose it at the same rate
Give an example of a dangerous recreational activity for young children which can damage their epiphyseal growth plate
Trampolining
damages blood vessels and growing bone in this region
How many children have a short stature as a result of a pathological condition?
1 in 5 children
remember to check parents height
What factors can affect the growth plate?
Diet / Nutrition Sunshine, Vitamins (Vit D & A) Injury Illness Hormones (GH)
When a child is growing, they are more likely to fracture the shaft of a bone. TRUE/FALSE
FALSE
more likely to fracture developing growth plates
At what age do children develop each of their integral physical movements (crawling, walking, jumping etc)?
6-9 months - Sits alone, crawls 8-12 months – stands 14-17 months walks 24 months jumps 3 years manages stairs alone
At what age do children develop the ability to move their head, speak, feed themself and become potty trained?
1-6 months Loss of primitive reflexes – grasp , stepping
2 months 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
Why should you be concious to not over-review children with undetermined conditions?
Overtreatment and over-investigation = fear of doctors, feelings of stigmatisation and psychologic distress
both experienced by parent and child
Persisting mild genu varum can run in families. TRUE/FALSE?
TRUE => reassure families that this is normal
When may genu varum be considered abnormal?
- unilateral (asymmetry >5°)
- severe >2SD/16° from mean
- short stature >2SD
- Painful
What pathological conditions can cause genu varum?
Skeletal Dysplasia Rickets – deficiency vitamin D Tumour e.g. enchondroma Blounts disease Trauma => physeal injury
What is Blount’s disease?
The outside of the growth plate continues to grow whilst the inside slows down
=> causing an angular deformity
typical Beak-like protrusion on xray
What surgical intervention can be undertaken on a child with Blount’s disease?
Debridement of growth plate to get rid of dead material and encourage further growth
When does Genu Valgum usually peak?
3½
When should a child with Genu Valgum be referred or considered for surgery?
Refer if asymmetric, painful, severe (>2SD)
> 8cm intermalleolar distance at age 11
=> consider surgery
How is intoeing often tested clinically in children
Often accentuated when running
What 3 deformities can cause intoeing?
femoral neck anteversion
Internal Tibial Torsion
metatarsus adductus
or combination
How do children with femoral neck anteversion usually like to sit?
In the W position
Describe the pathogenesis of femoral neck anteversion
Femoral neck usually sits at 40 degrees anteriorly
when you get older this regresses to 10-15 degrees
some children have a condition where the femoral neck does not regress as quickly
At what age are children usually affected by internal tibial torsion?
Usually seen in toddlers (1-3 yrs)
vast majority resolve by 6 yrs
What treatment is used for internal tibial torsion
Bracing & orthotics = ineffective and not required
Surgery very rare for severe cases!
Is metatarsus adductus usually a serious presentation?
No it is Common and Benign and usually Resolves
If not passively correctable then serial casting may help age 6-12 months
How common is flat feet in adults?
1 in 5 adults have this condition
