Children's Orthopaedics - Normal Growth and Development Flashcards
What is appositional growth of bone?
This is outward growth of bone causing increases in bone thickness
Which factors can affect bone growth?
- Vitamins D and A
- Diet
- Injury
- Illness
- Hormones (e.g. GH)
What is the medical term for bow-leggedness?
Genu varum
At what age is genu varum considered normal?
< 2 years
When would genu varum be condiered abnormal?
- > 16º from mean
- The patient has short stature
- It is painful
What can cause genu varum?
- Skeletal dysplasia
- Rickets
- Tumour
- Blount’s disease
- Trauma
What is Blount’s disease?
There is growth arrest of the proximal medial tibial physis
What is the characteristic sign of Blount’s disease on X-ray?
Beak-like protrusion
What can cause genu valgum?
- Tumours
- Rickets
- Neurofibromatosis
- Idiopathic
When is genu valgum considered normal?
The incidence peaks at age 3.5
When would you refer a patient with genu valgum?
- It is asymmetrical
- It is painful
- It is severely abnormal (>2SD)
Intoeing can be related to what 3 things?
- Femoral neck anteversion
- Internal tibial torsion
- Metatarsus adductus
In femoral neck anteversion, where does the femoral neck point?
Anteriorly
Does femoral neck anteversion have consequence normally?
No
What can femoral neck anteversion predispose to?
Patellofemoral problems
Internal tibial torsion normally occurs in which age group of patients?
Toddlers
When do most cases of internal tibial torsion resolve by?
6 years
What is the treatment for internal tibial torsion?
Surgery
Only when very severe
(braces and orthotics are useless)
Describe metatarsus adductus?
The metatarsals are adducted
This is a benign, common and self-limiting condition
Metatarsal adductus can be treated by what if necessary?
Serial casting
Flat feet are common.
True or false?
True
Why do flat feet normally not remain in adulthood?
There is usually medial arch development as the posterior tibialis strengthens
What are the two types of flat footedness?
- Flexible
- Fixed
How can you tell the differnece between flexible and fixed flat footedness?
Flexible flat footedness returns to normal on tip toes
What may be the causes of flexible flat footedness?
- Ligamentous laxity
- Tightness of the gastrosoleus complex
What may be the cause of fixed flat footedness and what is the potential treatment?
Tarsal coalition (bone fusion)
Surgery (when painful)
Which toes does curly toes normally affect?
3rd or 4th
How may curly toes be treated of they are severe or do not resolve by 6 years?
Flexor tendonotomy
Anterior knee pain is common in which age groups?
Adolescents
People with anterior knee pain may be predisposed to what?
Arthritis posterior to the patella
What must be check in anterior knee pain cases?
The hips
(issues here can be the cause)
What is the treatment for anterior knee pain?
Usually physiotherapy
When is anterior knee pain exacerbated?
Stairs and squats
