Introduction to Paediatric Orthopaedics and Normal Variation Flashcards
Which part of a bone contains the growth plate?
The metaphysis
Why don’t X-rays tell you much in young children?
Cartilage model in bone is yet to ossify
In Children -
Ligaments stronger than growth plate
easy to produce epiphyseal separation
difficult to produce dislocations or sprains
What is the result of a young persons bone being more porous?
It tolerates more deformation
Fails in compression as well as tension
Buckle freactures and green stick fractures
How does the speed of healing compare in children vs adults
Speed of healing is much faster in children
What is the definition of normal variation?
Lies within 2 standard deviations from the mean) depends on the age and the population)
What parts of normal development may seem concerning?
Femoral anteversion (pigeon toed appearance)
Bow legs
Flat feet
What may fall under the category of self-correcting or non-concerning pathology?
Persistent femoral anteversion
Metatarsus adductus - Metatarsus adductus, also known as metatarsus varus, is a common foot deformity noted at birth that causes the front half of the foot, or forefoot, to turn inward.
Posterior tibial bowing
Curly toes
For what reasons might parents be concerned about in their child?
Out toeing
In toeing
Bow legs
Knock knees
Tiptoe walking
Flat feet
Curved feet
Curly toes
What is the david jones system of the 5 S’s?
Symmetrical – yes
Symptomatic- no
Systemic illness- no
Skeletal dysplasia- no
Stiffness- no
Which planes are associated with the terms rotational alignment and angular alignment?
Rotational alignment- axial
Angular alignment- usually coronal
What is the natural development for in-toeing and out-toeing?
What are the potential origins for intoeing?
Hip
Tibia
Foot - use of foot bisector line
What is a sign that the intoeing is as a result of the hips?
The knee caps will be equally facing inward if intoeing pathology is arising from the hips
If it does not correct then it is ‘persistant femoral anteversion’, this usually grows out by age 12 yrs
Ability to W sit?
How is tibial torsion assessed?
Clinically:
- thigh foot angle technique
- patellae position with feet/ ankles facing forward
Thigh foot angle generally increases with age
How do you tell if the intoeing arises at the feet?
Foot bisector line should emerge between the 2nd and the 3rd toe
What are the issues with angular allignment of the legs?
Knocked knees
Bow legs
Flat feet
Occasional underlying pathology that may require treatment but usually a combination of normal physiology and variation
How do the legs bow in normal variation?
When should bow legs be considered possible for an undderlying pathology?
Bow legs over the age of 8 years
The bowing appears worse in the infant than it truly is becasue the the infants hip is held in external rotation
Knee alignment can change quite notably in the growing child
When does flat footedness remain a normal variant?
If the foot is mobile and it is asymptomatic
What is the clinical assessment for all this?
Walking
Standing:
- Alignment from front
- Patella position
- Heels/arch/toes/leg length from behind
Tip toe (if old enough)
Staheli rotational profile
When might further review or investigation be necessary?
Not age appropriate - can’t walk for example
Assymetry
Rigid flat foot
Bow legs (genu varum)
- Blounts
- Rickets
Which things rarely require treatment
Metatarsus adductus
Tibial torsion (external typically more than internal)
Persistant femoral anteversion
Curly toes
Most of the time it is
Normal variants
Physiological changes
Self correcting/ non-concerning pathologies
