Childrens' Orthopaedics

Question 1

What makes a deformity significant?

Answer 1

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

Question 2

What are the two ways that bones grow?

Answer 2

longitudinal

Circumferential

Question 3

What is longitudinal growth?

Answer 3

from the growth plate (physis) by enchondral ossification

Question 4

What is circumferential growth?

Answer 4

From the periosteum by appositional growth

Question 5

All physics contribute to the same amount of growth T/F

Answer 5

F- some phases contribute to growth more than others

Question 6

What factors affect the growth plate?

Answer 6

Diet/nutrition
Sunshine, vitamins (Vit D and A)
Injury
Illness
Hormones (GH)

Question 7

When should a child be able to sit alone and crawl

Answer 7

6-9 months

Question 8

When should a child be able to stand

Answer 8

8-12 months

Question 9

When should a child be able to walk

Answer 9

14-17 months

Question 10

When should a child be able to jump?

Answer 10

24 months

Question 11

AT what age should a child be able to manage stairs alone?

Answer 11

3 years

Question 12

At what age does a child have head control

Answer 12

2 months

Question 13

At what age can a child speak a few words

Answer 13

9-12 months

Question 14

What causes rickets?

Answer 14

A deficiency of vit d

Question 15

aT WHAT AGE SHOULD A CHLD BE POTTY TRAINED

Answer 15

3 YEARS

Question 16

What are the common variations of normal?

Answer 16

Genuinely Varum or Valgum
Intoeing
Flat feet
Curly toes

Question 17

Knee alignment- what is Varum and Valgum?

Answer 17

varum- bow legged

Valgum- knock legged

Question 18

Genuinely Varum

Answer 18

normally in age <2

Persisting mild gene varum can run in families

Question 19

What would indicate that there may be abnormal or underlying pathology in gene varum?

Answer 19

Unilateral (asymmetry >5 degrees)
Severe > 2SD/16 degreee from mean
Short stature >2 SD
painful

Question 20

What is pathological gene varum?

Answer 20

Skeletal dysplasia
rickets
tumour e.g. enchondroma
blouts disease
trauma--> physical injury

Question 21

What is blunts disease?

Answer 21

Growth arrest of medial tibial physics of unknown aetiology

typical beak-like protrusion on x-ray

Question 22

What are the potential causes of gene valgum?

Answer 22

Tumours- enchondroma, osteochondroma
Rickets
Neurofibromatosis
Idiopathic

Question 23

Should you always be alarmed with gene valgum?

Answer 23

no
Usually noraml- peaks at age 3 1/2
just chart and monitor
refer is asymmetrical, painful or severe
>8cm intermalleolar distance at age 11 --> consider surgery

Question 24

What is intoeing

Answer 24

child walks with toes pointing in AKA pigeon-toed
often accentuated when running
may be related to femoral neck antersion, internal tibial torsion, metatarsus adducts or combination

Question 25

Femoral neck anteversion?

Answer 25

usually points anteriorly
XS anterversion –> increased IR hip
Tends to sit in W position

Question 26

Intoeing management

Answer 26

Define cause
reassure
chart/photograh
review
discharge unless persisting or severe

Question 27

Femoral neck anteversion

Answer 27

usually no consequence
can predispose to patellofemoral problems
little if any justification for surgery only severe deformity
mean 30-40 degree at brith, slowly unwind and should be around 10-15 degree at maturity

Question 28

Internal tibial torsion

Answer 28

Usually seeing toddlers
vast majority resolve by 6 yrs
surgery rare, bracing and orthotics ineffective

Question 29

Metatarsus adductus

Answer 29

common benign

resolves

Question 30

Flat feet

Answer 30

common ( 1 in 5 adults)
We are brown with flat feet but develop an arch once start walking as tibialis posterior strengthens
usually asymptomatic
need to determine if flexible or fixed

Question 31

What is flexible flat feet related to? What are consequences?

Answer 31

Flexible - may be related to generalised ligaments laxity or tightness gastrocsoleus complex–> stretching
Orthotics unhelpful unless pain, may resolve, no consequences of persisting flat feet

Question 32

What score is used to measure hyper mobility?

Answer 32

Beighton score - out of 9

Question 33

rigid flat foot has no benefit from surgery T/F

Answer 33

F- rigid flat foot may have underlying bony connection known as tarsal coalition
May benefit from surgery if painful

Question 34

Who and where is curly toes most common in?

Answer 34

younger children

most 3rd or 4th toes

Question 35

Treatment for curly toes?

Answer 35

Vast majority resolve by 6 years
splinting or taping ineffective
rarely persisting cases can consider flexor tenotomy

Question 36

Who is anterior knee pain most common in?

Answer 36

females>males
adolescent
localised patellar tenderness
stairs/squats

(it is important to check the hips, most resolve by physiology)