Introduction to paediatric orthopaedics

Question 1

3 main differences between the adult and child

Answer 1

anatomical
biochemical
physiological

Question 2

What is physis also known as

Answer 2

growth plate

Question 3

What is the metaphysis?

Answer 3

transition between epiphysis and diaphysis

Question 4

diaphysis

Answer 4

shaft of bone

Question 5

apophysis

Answer 5

natural protuberance from a bone

Question 6

2 main biomechanical differences in child compared to adult bones

Answer 6

ligaments are stronger than the growth plate

young bone is more porous

Question 7

Effects of child stronger ligaments than growth plate

Answer 7

easy to produce epiphyseal separation

difficult to produce dislocation or sprain

Question 8

Effect of more porous bone

Answer 8

tolerates more deformation

fails in compression and tension - buckle and green stick fractures

Question 9

4 physiological differences between adult and child bone

Answer 9

remodelling
overgrowth
progressive deformity
speed of healing is faster

Question 10

normal variant and true pathology % in clinic

Answer 10

normal = 53% eg intoeing

pathology - 16.3%

Question 11

Normal variant

Answer 11

within 2 standard deviations of the mean

Question 12

Physiological development

Answer 12

change in shape/angle/appearance

Question 13

normal development

Answer 13

femoral anteversion
bow legs
flat feet

Question 14

4 self correcting pathologies

Answer 14

persistent femoral anteversion
metatarsus adductus
posterior tibial bowing
curly toes

Question 15

possible presenting parental concerns (excluding true pathology)

Answer 15

flat feet 
out-toeing
in-toeing
bow legs 
knock knees 
tiptoe walking 
curly toes 
curved feet

Question 16

Aim of assessment

Answer 16

parental worries
normal variant?
yes - future developmental concerns
no - spot true pathology and decide if it will self correct

Question 17

David jones system of 5S’s

Answer 17

symmetrical - yes 
symptomatic - no 
systemic illness - no 
skeletal dysplasia - no 
stiffness - no

Question 18

rotational alignment

Answer 18

axial

Question 19

Angular alignment

Answer 19

usually coronal

Question 20

Natural development of feet-walking pattern

Answer 20

out toeing - intoeing then progressive out-toeing

Question 21

Changes in feet-walking pattern related to changes in…

Answer 21

hip
tibia
foot

Question 22

How to test internal and external hip rotation

Answer 22

child lying on its front

hold foot and with knee bent rotate the leg laterally for internal rotation and medially for external rotation

Question 23

Normal femoral neck anteversion angle

Answer 23

15-20 degrees

Question 24

Natural development of anteversion angle of hip

Answer 24

starts at 40 degrees at birth and decreased to normal

Question 25

both knees internally rotated - where is pathology coming from?

Answer 25

HIP

Question 26

Ways to assess tibia torsion

Answer 26

thigh foot angle technique witch child on its front

patellae position with feet facing forwards - knees turn in but feet turn in more

Question 27

Normal values for thigh-foot angle

Answer 27

10 degrees - increases with age

Question 28

Normal forefoot adductus

Answer 28

between 2nd and 3rd toe

Question 29

grading metatarsus adductus

Answer 29

mild - midway toe 3
moderate - between toe 3+4
severe - between toe 4+5

Question 30

3 angular alignment

Answer 30

knocked knees
bow legs
flat feet

Question 31

knocked knees and bow legs - normal progression with age

Answer 31

0-18months = bow legs
18-30months - normal
3-4years = knock knees
8-10 years normal

Question 32

Why does bowing appear worse in toddler?

Answer 32

external rotation hip is held in

Question 33

Why do babies naturally have flat feet?

Answer 33

large medial fat pad in arch

not learnt to walk or weight bear

Question 34

So long as what is flat feet a normal variant?

Answer 34

foot is mobile and asymptomatic

Question 35

Clinical assessment

Answer 35

walk
standing - alignment
tip toes
staheli rotational profile

Question 36

Staheli rotational profile

Answer 36

hip rotation/version
thigh foot angle
foot bisector line

Question 37

further investigations

Answer 37

asymmetry, rigid flat foot, bow legs eg rickets

Question 38

Treatment for…

Answer 38

metatarsus adductus
tibial torsion - external
persistent femoral anteversion
curly toes