Introduction to paediatric orthopaedics Flashcards
3 main differences between the adult and child
anatomical
biochemical
physiological
What is physis also known as
growth plate
What is the metaphysis?
transition between epiphysis and diaphysis
diaphysis
shaft of bone
apophysis
natural protuberance from a bone
2 main biomechanical differences in child compared to adult bones
ligaments are stronger than the growth plate
young bone is more porous
Effects of child stronger ligaments than growth plate
easy to produce epiphyseal separation
difficult to produce dislocation or sprain
Effect of more porous bone
tolerates more deformation
fails in compression and tension - buckle and green stick fractures
4 physiological differences between adult and child bone
remodelling
overgrowth
progressive deformity
speed of healing is faster
normal variant and true pathology % in clinic
normal = 53% eg intoeing
pathology - 16.3%
Normal variant
within 2 standard deviations of the mean
Physiological development
change in shape/angle/appearance
normal development
femoral anteversion
bow legs
flat feet
4 self correcting pathologies
persistent femoral anteversion
metatarsus adductus
posterior tibial bowing
curly toes
possible presenting parental concerns (excluding true pathology)
flat feet out-toeing in-toeing bow legs knock knees tiptoe walking curly toes curved feet
Aim of assessment
parental worries
normal variant?
yes - future developmental concerns
no - spot true pathology and decide if it will self correct
David jones system of 5S’s
symmetrical - yes symptomatic - no systemic illness - no skeletal dysplasia - no stiffness - no
rotational alignment
axial
Angular alignment
usually coronal
Natural development of feet-walking pattern
out toeing - intoeing then progressive out-toeing
Changes in feet-walking pattern related to changes in…
hip
tibia
foot
How to test internal and external hip rotation
child lying on its front
hold foot and with knee bent rotate the leg laterally for internal rotation and medially for external rotation
Normal femoral neck anteversion angle
15-20 degrees
Natural development of anteversion angle of hip
starts at 40 degrees at birth and decreased to normal
both knees internally rotated - where is pathology coming from?
HIP
Ways to assess tibia torsion
thigh foot angle technique witch child on its front
patellae position with feet facing forwards - knees turn in but feet turn in more
Normal values for thigh-foot angle
10 degrees - increases with age
Normal forefoot adductus
between 2nd and 3rd toe
grading metatarsus adductus
mild - midway toe 3
moderate - between toe 3+4
severe - between toe 4+5
3 angular alignment
knocked knees
bow legs
flat feet
knocked knees and bow legs - normal progression with age
0-18months = bow legs
18-30months - normal
3-4years = knock knees
8-10 years normal
Why does bowing appear worse in toddler?
external rotation hip is held in
Why do babies naturally have flat feet?
large medial fat pad in arch
not learnt to walk or weight bear
So long as what is flat feet a normal variant?
foot is mobile and asymptomatic
Clinical assessment
walk
standing - alignment
tip toes
staheli rotational profile
Staheli rotational profile
hip rotation/version
thigh foot angle
foot bisector line
further investigations
asymmetry, rigid flat foot, bow legs eg rickets
Treatment for…
metatarsus adductus
tibial torsion - external
persistent femoral anteversion
curly toes
