Introduction to paediatric orthopaedics

Question 1

What are biomechanical differences in children?

Answer 1

Ligaments stronger than growth plate

Young bone more porous

Question 2

What are physiological differences in children?

Answer 2

Remodelling
Overgrowth
Progressive deformity
Speed of healing much faster

Question 3

What is normal development of the lower limb?

Answer 3

Femoral anteversion
Bow legs
Flat feet

Question 4

What are possible presenting parental concerns?

Answer 4

Out toeing
In toeing
Bow legs
Knock knees
Tiptoe walking 
Flat feet
Curved feet
Curly toes

Question 5

What are the 5 S’s of David Jones System of the 5 S’s?

Answer 5

Symmetrical
Symptomatic
Systemic illness
Skeletal dysplasia
Stiffness

Question 6

Where are potential origins for rotational concern?

Answer 6

Hip
Tibia
Foot

Question 7

How is tibial torsion assessed?

Answer 7

Thigh foot angle technique

Patellae position with feet/ankles facing forward

Question 8

What clinical assessment should be done in children presenting with concerns about feet?

Answer 8

Walking if old enough
Standing - alignment from front, patella position, heels/arch/toes/leg length
Tip toes
Staheli rotational profile

Question 9

What is night pain until proven otherwise?

Answer 9

Infection or tumour