Children's Orthopaedics - Normal Growth and Development

Question 1

What is appositional growth of bone?

Answer 1

This is outward growth of bone causing increases in bone thickness

Question 2

Which factors can affect bone growth?

Answer 2

• Vitamins D and A
• Diet
• Injury
• Illness
• Hormones (e.g. GH)

Question 3

What is the medical term for bow-leggedness?

Answer 3

Genu varum

Question 4

At what age is genu varum considered normal?

Answer 4

< 2 years

Question 5

When would genu varum be condiered abnormal?

Answer 5

• > 16º from mean
• The patient has short stature
• It is painful

Question 6

What can cause genu varum?

Answer 6

• Skeletal dysplasia
• Rickets
• Tumour
• Blount’s disease
• Trauma

Question 7

What is Blount’s disease?

Answer 7

There is growth arrest of the proximal medial tibial physis

Question 8

What is the characteristic sign of Blount’s disease on X-ray?

Answer 8

Beak-like protrusion

Question 9

What can cause genu valgum?

Answer 9

• Tumours
• Rickets
• Neurofibromatosis
• Idiopathic

Question 10

When is genu valgum considered normal?

Answer 10

The incidence peaks at age 3.5

Question 11

When would you refer a patient with genu valgum?

Answer 11

• It is asymmetrical
• It is painful
• It is severely abnormal (>2SD)

Question 12

Intoeing can be related to what 3 things?

Answer 12

1. Femoral neck anteversion
2. Internal tibial torsion
3. Metatarsus adductus

Question 13

In femoral neck anteversion, where does the femoral neck point?

Answer 13

Anteriorly

Question 14

Does femoral neck anteversion have consequence normally?

Answer 14

No

Question 15

What can femoral neck anteversion predispose to?

Answer 15

Patellofemoral problems

Question 16

Internal tibial torsion normally occurs in which age group of patients?

Answer 16

Toddlers

Question 17

When do most cases of internal tibial torsion resolve by?

Answer 17

6 years

Question 18

What is the treatment for internal tibial torsion?

Answer 18

Surgery

Only when very severe

(braces and orthotics are useless)

Question 19

Describe metatarsus adductus?

Answer 19

The metatarsals are adducted

This is a benign, common and self-limiting condition

Question 20

Metatarsal adductus can be treated by what if necessary?

Answer 20

Serial casting

Question 21

Flat feet are common.

True or false?

Answer 21

True

Question 22

Why do flat feet normally not remain in adulthood?

Answer 22

There is usually medial arch development as the posterior tibialis strengthens

Question 23

What are the two types of flat footedness?

Answer 23

1. Flexible
2. Fixed

Question 24

How can you tell the differnece between flexible and fixed flat footedness?

Answer 24

Flexible flat footedness returns to normal on tip toes

Question 25

What may be the causes of flexible flat footedness?

Answer 25

1. Ligamentous laxity
2. Tightness of the gastrosoleus complex

Question 26

What may be the cause of fixed flat footedness and what is the potential treatment?

Answer 26

Tarsal coalition (bone fusion)

Surgery (when painful)

Question 27

Which toes does curly toes normally affect?

Answer 27

3rd or 4th

Question 28

How may curly toes be treated of they are severe or do not resolve by 6 years?

Answer 28

Flexor tendonotomy

Question 29

Anterior knee pain is common in which age groups?

Answer 29

Adolescents

Question 30

People with anterior knee pain may be predisposed to what?

Answer 30

Arthritis posterior to the patella

Question 31

What must be check in anterior knee pain cases?

Answer 31

The hips

(issues here can be the cause)

Question 32

What is the treatment for anterior knee pain?

Answer 32

Usually physiotherapy

Question 33

When is anterior knee pain exacerbated?

Answer 33

Stairs and squats