Cortex - Paediatric orthopaedics 3

Question 1

What is main cause of genu varum ?

Answer 1

• Blount’s disease is a growth disorder of the tibia (shin bone) that causes the lower leg to angle inward, resembling a bowleg.
• Rarer causes of pathologic genu varum include rickets, tumour (osteochondroma), traumatic physeal injury and skeletal dysplasia

Question 2

What is some of the causes of genu valgum ?

Answer 2

Include rickets, tumours (enchondromatosis), trauma and neurofibromatosis

Question 3

What is the treatment of pathogenic genu valgum and genu valgus ?

Answer 3

Osteotomy - the surgical cutting of a bone, especially to allow realignment.

Question 4

What is in-toeing ? (hint its in the name)

Answer 4

• Basically its when the kids feet point towards the midline and is exaggerated by running.
• Kids are clumsy and wear through shoes at an alarming rate

Question 5

What are some of the causes of in-toeing?

Answer 5

Femoral neck anteversion, internal tibial torsion and forefoot adduction

Question 6

Describe what femoral neck anteversion is and how it causes in-toeing (it is the main cause of in-toeing that i should be concerned about right now)

Answer 6

As part of normal anatomy the femoral neck is slightly anteverted (pointing forwards). Excess femoral neckanteversion can give the appearance of in‐toeing (as well as knock knees).

Question 7

Does in-toeing require intervention ?

Answer 7

Surgery isn’t really indicated

Question 8

What do you need to determine about flat feet ?

Answer 8

If they are mobile or fixed

Mobile/flexible - medial arch forms with dorsiflexion of the great toe (Jack test)

Fixed - arch remains flat regardless of load or great toe dorsiflexion

Question 9

What is mobile/flexible flat feet related to ?

Answer 9

May be related to ligamentous laxity

Think yourself

Question 10

What does fixed flat feet imply ?

Answer 10

Implies an underlying bony abnormality (tarsal coalition)

Question 11

Describe curly toes

Answer 11

Minor overlapping of the toes and curling of toes - only needs surgical correction if causig discomfort

Question 12

What is developmental dysplasia of the hip (DDH) ?

Answer 12

Dislocation or subluxation of the femoral head during the perinatal period which affects the subsequent development of the hip joint.

Question 13

What are some of the risk factors of DDH?

Answer 13

• Positive family history of DDH
• Breech presentation
• First born babies
• Down’s syndrome
• The presence of other congenital disorders (talipes, arthrogryposis).

Question 14

If DDH is left untreated what can happen ?

Answer 14

• Acetabulum becomes shallow and in more severe cases proximal to the original a false acetabulum may develop
• Shortened lower limb
• Severe arthritis due to reduced contact area with the joint
• Gait/mobility affected

Question 15

What are the signs of DDH ?

Answer 15

• Asymmetric groin/thigh skin creases
• Click or clunk on the Ortolani or Barlow manoeuvres

Question 16

How is DDH diagnosed after it is suspected clinically ?

Answer 16

If kid is < 4-6 months:

• 1st line - US

If kid is > 4-6 months:

• 1st line - X-ray

Question 17

What is the treatmeant of DDH where it is mild showing a slightly shallow acetabulum and mildly dislocatable but reduced (in joint) ?

Answer 17

Monitor with examination and US

Question 18

What is the treatment of DDH where the hips are dislocated or persistently unstable ?

Answer 18

Reduced and held with a special harness known as a Pavlik harness

Question 19

What is the treatment of DDH in kids > 18months old who have persistent dislocation

Answer 19

Open reduction and may also need an osteotomy to shorten and rotate the femur and/or pelvic osteotomy to deepen and re‐orientate the acetabulum.

Question 20

What is transient synovitis of the hip ?

Answer 20

• A self‐limiting inflammation of the synovium of a joint, most commonly the hip.
• It is the commonest cause of hip pain in childhood (other pathologies need to be excluded)

Question 21

What does transient synovitis of the hip commonly occur after (doesn’t always have to occur after)?

Answer 21

URTI

Question 22

Describe the presentation of transient synovitis of the hip

Answer 22

• Typical age is 2-10 in boys more commonly
• Limited movement
• Pain
• Limp/ reluctance to weight bear

Question 23

How is transient synovitis of the hip diagnosed ?

Answer 23

I think by ruling out other potential pathologies and the clinical picture combined

• ESR and CRP which will be relatively normal to rule out septic arthritis
• X-ray to exclude perthes disease etc

Question 24

What is the treatment of transient synovitis of the hip ?

Answer 24

1st line: symptomatic - rest and course of NSAID’s