Childrens' Orthopaedics Flashcards
What makes a deformity significant?
if it is likely to persist and cause physical or mental health problems later in life
What are the two ways that bones grow?
longitudinal
Circumferential
What is longitudinal growth?
from the growth plate (physis) by enchondral ossification
What is circumferential growth?
From the periosteum by appositional growth
All physics contribute to the same amount of growth T/F
F- some phases contribute to growth more than others
What factors affect the growth plate?
Diet/nutrition Sunshine, vitamins (Vit D and A) Injury Illness Hormones (GH)
When should a child be able to sit alone and crawl
6-9 months
When should a child be able to stand
8-12 months
When should a child be able to walk
14-17 months
When should a child be able to jump?
24 months
AT what age should a child be able to manage stairs alone?
3 years
At what age does a child have head control
2 months
At what age can a child speak a few words
9-12 months
What causes rickets?
A deficiency of vit d
aT WHAT AGE SHOULD A CHLD BE POTTY TRAINED
3 YEARS
What are the common variations of normal?
Genuinely Varum or Valgum
Intoeing
Flat feet
Curly toes
Knee alignment- what is Varum and Valgum?
varum- bow legged
Valgum- knock legged
Genuinely Varum
normally in age <2
Persisting mild gene varum can run in families
What would indicate that there may be abnormal or underlying pathology in gene varum?
Unilateral (asymmetry >5 degrees)
Severe > 2SD/16 degreee from mean
Short stature >2 SD
painful
What is pathological gene varum?
Skeletal dysplasia rickets tumour e.g. enchondroma blouts disease trauma--> physical injury
What is blunts disease?
Growth arrest of medial tibial physics of unknown aetiology
typical beak-like protrusion on x-ray
What are the potential causes of gene valgum?
Tumours- enchondroma, osteochondroma
Rickets
Neurofibromatosis
Idiopathic
Should you always be alarmed with gene valgum?
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
What is intoeing
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
Femoral neck anteversion?
usually points anteriorly
XS anterversion –> increased IR hip
Tends to sit in W position
Intoeing management
Define cause reassure chart/photograh review discharge unless persisting or severe
Femoral neck anteversion
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
Internal tibial torsion
Usually seeing toddlers
vast majority resolve by 6 yrs
surgery rare, bracing and orthotics ineffective
Metatarsus adductus
common benign
resolves
Flat feet
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
What is flexible flat feet related to? What are consequences?
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
What score is used to measure hyper mobility?
Beighton score - out of 9
rigid flat foot has no benefit from surgery T/F
F- rigid flat foot may have underlying bony connection known as tarsal coalition
May benefit from surgery if painful
Who and where is curly toes most common in?
younger children
most 3rd or 4th toes
Treatment for curly toes?
Vast majority resolve by 6 years
splinting or taping ineffective
rarely persisting cases can consider flexor tenotomy
Who is anterior knee pain most common in?
females>males
adolescent
localised patellar tenderness
stairs/squats
(it is important to check the hips, most resolve by physiology)
