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Systems: MSK AB > Introduction to Paediatric Orthopaedics > Flashcards

Introduction to Paediatric Orthopaedics Flashcards

1
Q

Name the components of a child’s bone.

A
  • Epiphysis
  • Physis - growth plate
  • Metaphysis
  • Diaphysis - shaft
  • Apophysis
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2
Q

What biochemical differences are there between child and adult bones?

A

Child ligament 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 resulting in buckle and green stick fractures
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3
Q

What physiological differences are there between child and adult bones?

A
  • Remodelling
  • Overgrowth
  • Progressive deformity
  • Speed of healing much faster
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4
Q

What is the commonest normal variant that is referred?

A

Intoeing and flexible flat feet

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5
Q

What is normal variation?

A
  • Spectrum/pattern of normal
  • Within 2 standard deviations from the mean (Gaussian distribution)
  • Age matched
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6
Q

What is physiological development?

A

Change in shape/angle/appearance with growth

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7
Q

What normal development physiological changes take place?

A
  • Femoral anteversion
  • Bow legs
  • Flat feet
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8
Q

Give examples of self correcting or non-concerning pathology.

A
  • Persistent femoral anteversion
  • Metatarsus adductus
  • Posterior tibial bowing
  • Curly toes
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9
Q

Excluding true pathology, what possible presenting parental concerns are there?

A
  • Out toeing
  • In toeing
  • Bow legs
  • Knock knees
  • Tiptoe walking
  • Flat feet
  • Curved feet
  • Curly toes
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10
Q

What is the aim of assessment?

A

What are parental worries?

Is it a normal variant?

  • No: spot the true pathology, is the pathology concerning
  • Yes: future development concerns
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11
Q

What is the David Jones system of the 5Ss?

A
  • Symmetrical – yes
  • Symptomatic- no
  • Systemic illness- no
  • Skeletal dysplasia- no
  • Stiffness- no
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12
Q

What is the usual rotational alignment?

A

Axial

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13
Q

What is the usual angular alignment?

A

Coronal

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14
Q

What is the natural development of feet walking patterns?

A

Tendency to in-toe with age

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15
Q

How is a child examined for inroeing?

A

Identify origin of rotation concern

  • Hip (external and internal totation)
  • Tibia
  • Foot

Degree of femoral version

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16
Q

What is the natural development of the hip?

A
  • At birth the hips have more ER than IR
  • With age version changes
  • If anteversion is excessive it will result in IR of the leg, hence intoeing
17
Q

How can intoeing arise from the tibia?

A

Tibial torsion

  • An element of internal tibial torsion is normal
  • Combination of in utero moulding and tibial shape
  • Clinically assessed: thigh foot angle technique and patellae position with feet/ ankles facing forward
18
Q

How can intoeing arise from the feet?

A

Forefoot adduction: metatarsus adductus

  • Normal is between the 2nd and 3rd toe
  • Normal variant
  • Self-correcting pathology
19
Q

How is metatarsus adductus graded?

A

-Normal: between 2nd and 3rd toe
-Mild: on 3rd toe
Moderate: between 3rd and 4th toes
-Severe: between 4th and 5th toes

20
Q

How can problems with angular alignment present?

A
  • Knocked knees
  • Bow legs
  • Flat feet
21
Q

What is angular alignment normally due to?

A

Occasional underlying pathology that may require treatment but usually a combination of normal physiology and variation

22
Q

What is the natural age related development of the legs?

A
  • 0-18 months: bow legs
  • 18-30 months: straight legs
  • 3-4 years: knock knees
  • 8-10 years: straight legs
23
Q

What is the natural development of the feet?

A
  • Babies have naturally flat feet

- Arches develop but fat footedness through childhood is a normal variant, provided the foot is mobile and asymptomatic

24
Q

What should you do with a concerned parent?

A
  • Take a history find out the main underlying concern
  • Examine the child
  • Usually talk through examination to parents
  • Reassure, show graphs if helpful
25
Q

How should a child be assessed?

A
  • Walking (if old enough)
  • Standing including alignment from front, patella position, heels/ arch/ toes/ leg length from behind
  • Tip toe (if old enough)
  • Staheli rotational profile
26
Q

What is included in a rotational profile examination?

A

Supine

  • Leg lengths
  • Hips (Galeazzi, FFD, ROM)

Prone: Staheli rotational profile

  • Hip rotation/version
  • Thigh foot angle
  • Foot bisector line
27
Q

When do issues require further investigation?

A
  • Not age appropriate
  • Assymetry
  • Rigid flat foot
  • Bow legs (genu varum): could be rickets/blounts
28
Q

What issue may require treatment?

A
  • Metatarsus adductus
  • Tibial torsion (external typically more than internal)
  • Persistant femoral anteversion
  • Curly toes

Systems: MSK AB (43 decks)

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