Introduction to Paediatric Orthopaedics and Normal Variation

Question 1

What is used to show a normal variation in height based on age?

Answer 1

Childrens growth charts

Question 2

When is intervention required in coronal plane skeletal deformities in children?

Answer 2

Very rarely- most will resolve with age

Treatment sometimes required if very severe or unilateral

Question 3

What is the average walking age and at what point is a lack of walking concerning?

Answer 3

12 months average

Only concerning if approaching two years and no progress being made

Question 4

What are the causes of intoeing?

Answer 4

Femoral aversion
Internal tibial torsion
Metatarsus adductus

Question 5

How is femoral anteversion measured?

Answer 5

Femoral anteversion is measured by having child prone on an examination table and flexing knees to 90 degrees and measuring anteversion. Femoral anteversion if usually 40 degrees at birth and decreases by one or two degrees per year

Question 6

When is intervention in intoeing required?

Answer 6

Not operated on before age of ten

Intervention may be required in patients with cerebral palsy or muscle dystrophies

Question 7

When are flat feet operated on?

Answer 7

Only if they are painful

Question 8

What are the different ways in which gait can be observed?

Answer 8

Observational
Video analysis
3D instrumented gait analysis

Question 9

What is a gait cycle?

Answer 9

The single sequence of functions by one limb, beginning when reference foot contact the ground

Question 10

What is walking base?

Answer 10

The distance between the line of the two feet, giving information on balance and sway

Question 11

What is the difference between cadence and velocity?

Answer 11

Cadence is the number of steps per minute, usually around 100 steps/min. Velocity is the distance covered per time eg ms-1

Question 12

What are the two phases of a gait cycle?

Answer 12

Stance phase- reference limb is in contact with the floor

Swing phase- when reference limb is not in contact with the floor

Question 13

What proportion of normal gait is spent in each phase?

Answer 13

60% in stance phase, 40% in swing phase

Question 14

What is the difference between single support and double support?

Answer 14

Single support is when only one foot is in contact with the ground, double support is when both feet are in contact with the ground

Question 15

What changes occur in gait when walking speed increases?

Answer 15

Stance phase decreases
Swing phase increases
Double support decreases (running defined as no double support)

Question 16

Where is the centre of gravity in the body?

Answer 16

Midway between the hips, usually a few cm in front of S2

Question 17

What are the forces that have the highest influence on gait?

Answer 17

Gravity
Muscular contraction
Inertia
Floor reaction

Question 18

What is an antalgic gait?

Answer 18

Reduced stance phase on affected limb, can be caused by splinter in foot, osteoarthritis or tendonitis

Question 19

What is Trendelenburgs gait?

Answer 19

Trendelenberg is when there is dysfunction in the abductor muscles so the pelvic cannot swing appropriately and throws off the centre of gravity. Trendelenberg sign is when the patient is stood still, lifts one foot and the pelvis sinks. Trendelenbergs gait shows leaning to one side during walking

Question 20

What are the common compensations in leg-length discrepancy?

Answer 20

Circumduction
Hip hiking
Steppage
Vaulting

Question 21

What are the causes of increased walking base?

Answer 21

Deformities- abducted hip, valgus knee

Instability- cerebellar ataxia, proprioception deficits

Question 22

What are the causes of inadequate dorsiflexion control?

Answer 22

Weak tibialis anterior

Spastic plantarflexors

Question 23

What are the causes of excessive knee extension?

Answer 23

Quadriceps weakness
Quadriceps spasticity
Knee flexor weakness

Question 24

What are the features of a concerning MSK pathology in children?

Answer 24

• Symptoms- night pain or non-weight bearing
• Symmetry- lack of
• Stiffness
• Syndromes- associated features
• Systemic illness- pyrexia
  Night pain is a red flag for infection and tumour.