intro to children's ortho

Question 1

What are the biochemical differences between children and adult bones?

Answer 1

Ligaments stronger than growth plate - easy to produce epiphyseal separation, difficult to produce dislocations or sprains. Young bone more porous - tolerates more deformation (plasticity), fails in compression as well as tension, Buckle fractures, Green stick fractures

Question 2

what are thhe phhysiological differences?

Answer 2

Remodelling
Overgrowth
Progressive deformity
Speed of healing much faster

Question 3

what is a normal variant?

Answer 3

Describes a specific pattern of normality for that population/ age
The range: conventionally lying between 2 Standard deviations. By definition there will be children who fall out with the norm who have no underlying pathology

Question 4

what is physiological development?

Answer 4

Change in shape/ angle/ appearance with growth

Question 5

what is self correcting/ non concerning pathology?

Answer 5

Persistent femoral anteversion
Metatarsus adductus
Posterior tibial bowing
Curly toes

Question 6

Outline the David Jones system of 5 S’s

Answer 6

Symmetrical- yes
Symptomatic- no
Systemic illness- no
Skeletal dysplasia- no
Stiffness-no

Question 7

describe the natural development of the hip

Answer 7

At birth the hips have more ER than IR which is due to the ST contractures of the hip at birth

Question 8

assessing tibial torsion

Answer 8

thigh foot angle technique

patellae position with feet/ ankles facing forward

Question 9

outline angular alignment issues

Answer 9

Knocked knees
Bow legs
Flat feet

Question 10

outline natural development of the feet

Answer 10

Babies naturally have flat feet, they have a large medial fat pat in the arch and have not yet learnt to walk or weight bear
Arch development- If flat footedness continues through childhood it remains a normal variant, provided the foot is mobile and asymptomatic
Heel raise test and Jacks test/ Foot rotational alignment/ Foot progression in gait

Question 11

how is clinical assessment done?

Answer 11

Walking (if old enough), Standing, Alignment from front, Patella position, Heels/ arch/ toes/ leg length from behind, Tip toe (if old enough), Staheli rotational profile

Question 12

outline a rotational profile examination

Answer 12

Supine: Leg lengths, Hips, Galeazzi, FFD, ROM
Prone: Staheli Rotational Profile, Hip rotation/ version, Thigh foot angle, Foot bisector line