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MSK > Introduction to Paedatric Orthopaedics and Normal Variation > Flashcards

Introduction to Paedatric Orthopaedics and Normal Variation Flashcards

1
Q

What are the differences between adult’s and children’s bones?

A

Physiological, biochemical and anatomical differences

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2
Q

What is an apophysis?

A

Normal bony outgrowths arising from separate ossification centres

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3
Q

What are the epiphyses of infants like?

A

Almost completely cartilaginous

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4
Q

Describe bone growth in children

A

Interstitial (growth in length) occurs at epiphysis of long bones

Appositional growth (in width) occurs due to periosteal growth

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5
Q

How do the ligaments differ in children as opposed to adults and why is this clinically relevant?

A

Ligaments are stronger than the growth plate therefore more likely to cause epiphyseal separation as opposed to dislocation or sprain

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6
Q

Young bones are more porous what does this result in?

A

More toleration of deformity and increased ability to deal with compressive forces

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7
Q

What fractures are children more likely to get and why?

A

Buckle fractures and Greenstick fractures as the bone is a lot more pliable

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8
Q

What is a buckle fracture?

A

Break on only one side of a long bone (opposite cortex remains intact)

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9
Q

What is a greenstick fracture?

A

Bending/cracking of the bone as opposed to the bone splitting into separate fragments

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10
Q

How do children’s bones differ in their healing/remodelling?

A

Greater remodelling potential (more efficient) and faster speed of heeling

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11
Q

What are the majority of orthopaedic paediatric referrals for?

A

Normal variants (53%)

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12
Q

Define normal variant

A

Atypical finding that has no clinical significance (within a spectrum of normal findings)

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13
Q

Define physiological development

A

Normal changes in shape, size, appearance, angle with growth

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14
Q

Define self-correcting pathology

A

Pathology that fixes itself

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15
Q

How close is a normal variant to ‘normal’?

A

Within 2 standard deviation of the mean

age and population matched

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16
Q

What are examples of normal physiological development?

A

Femoral anteversion, bow legs and flat feet

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17
Q

What is the appearance of bow legs?

A

Knees turned outwards but ankles touching

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18
Q

What are examples of self-correcting/non-concerning pathologies?

A

Persistent femoral anteversion
Metatarsus adductus
Posterior tibial bowing
Curly toes

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19
Q

What are curly toes?

A

Toes curl under feet as tendons are too tight

20
Q

What is metatarsus adductus?

A

Forefoot is angled inwards too much

21
Q

What are possible presenting patient concerns that are not true pathology?

A 
Curly toes 
intoeing 
Outtoeing 
Bow legs and knock knees
Flat feet
Curved feet
22
Q

What is the david jones system of the 5S’s?

A

To assess for non-concerning pathology/normal variants:

Symmetrical - yes 
Systemic illness - no 
Skeletal dysplasia - no 
Stiffness - no 
Symptomatic - no
23
Q

What is the normal angular alignment?

A

Coronal

24
Q

What is the normal rotational alignment?

A

Axial

25
Q

What is the normal development in walking pattern?

A 
Bowed legs (o-18 months) 
Straightens out (18m-2y)
Knock knees (some 3 year olds) 
Fairly straight legs (5) 
Adult legs (8)
26
Q

Define intoeing

A

When the feet turn inward when the person is walking instead of facing straight ahead

27
Q

What are three causes for intoeing?

A

Metatarsus adductus
Femoral anteversion
Tibial torsion

28
Q

What is the appearance of femoral anteversion?

A

Hips, knees and toes point inward

29
Q

How do children with femoral anteversion tend to sit?

A

In W position - with knees bent and legs flared out behind them

30
Q

What is the best way to assess for femoral anteversion?

A

Get child to lie on their tummy, with their knees flexed and rotate the hip

In femoral anteversion, expect more IR than ER

31
Q

How does the degree of femoral anteversion change throughout a life?

A

Born with 40 degrees of anteversion, decreases to about 10 degrees by teenager

32
Q

How do you treat femoral anteversion?

A

It is self-correcting

Usually fixes by age 12

33
Q

At birth does the hip have more ER than IR or vice versa?

A

Has more ER than IR

34
Q

Is tibial torsion normal?

A

An element of tibial torsion is normal

35
Q

What causes tibial torsion?

A

Intrauterine moulding

Legs rotate to fit in the uterus - should correct after birth

36
Q

How do you assess tibial torsion?

A

Thigh foot angle technique

Assess patellar position with feet/ankles facing forward - knees turned in but feet turn in more

37
Q

What is the normal alignment of the forefoot?

A

2nd and 3rd digit should be in line with the heel

38
Q

Describe the grading of metatarsus adductus

A

Normal - heel line between 2nd and 3rd toe
Mild - in middle of third toe
Moderate - in between 3rd and 4th toe
Severe - in between 4th and 5th toe

39
Q

What are examples of issues with angular alignment?

A

Knocked knees
Bow legs
Flat feet

40
Q

True or false:

Bow legs are never pathologic

A

False - should be investigated if still present over age 8

Could be a sign of rickets or blounts

41
Q

Why do babies naturally have flat feet?

A

They have a large medial fat pad in the arch

42
Q

Is flat footedness a problem is it continues throughout childhood?

A

No so long as it is mobile and asymptomatic it remains a normal variant

43
Q

What tests can you do to assess flat footedness?

A

Heel raise tests, Jacks test, foot rotational alignment, foot progression in gait

44
Q

What is the Staheli rotational profile alignment?

A

Assessment of child in prone position, knee flexes looking at rotation/version, thigh foot angle and foot bisector line

45
Q

What may require further investigation?

A

Not age appropriate
Asymmetry
Rigid flatfoot
Bow legs (genu varum)

46
Q

What might rarely require treatment?

A

Persistent femoral anteversion
Tibial torsion (external usually)
Metatarsus adductus
Curly toes

MSK (27 decks)

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