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MSK > Normal paediatric growth and development > Flashcards

Normal paediatric growth and development Flashcards

1
Q

what is normal the physiologic evolution of the leg alignment at different ages

A

newborn- varum
1 1/2 to 2 years neutral
2 to 3 1/2 years months valgum
neural from 4-7 years

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2
Q

unilateral deformity=?

A

will not usually resolve with time, pathological

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3
Q

when is a deformity significant

A

only if it is likely to persist and cause physical or mental health problems later in life

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4
Q

describe how bones grow

A

longitudinal from the growth plate (physis) by enchondral ossification

cartilage model forms, primary ossification in shaft, secondary ossification in epiphyses, continued growth at epiphyseal growth plate

(cartilage laid down, inavded by blood supply, mineralised)

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5
Q

when is bone strength at its maximum

A

30 years old

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6
Q

when does bone mass begin to reduce

A

post menopausal or T 50s

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7
Q

who looses bone mass faster, men or women

A

loose at same rate, men just start with more

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8
Q

what fractures can affect growth plates

A

diet/ nutrition

sunshine, vitamins (vit D and A)

injury (to growth plate)

illness (chicken pox/ virus can temporarily halt bone growth, seen in growth arrests marks in bone later)

hormones (GH)

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9
Q

what plays a big part in growth of under 3s

A

nutrition- naturally much more varied anyway

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10
Q

what give an increase chance of underlying genetic or endocrine disorders

A

dysmorphic features in short statured individuals

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11
Q

what are the normal developmental movement stages from 6-9 months to 3 years

A

6-9 months- sits alone, crawls

8-12 months- stands

14-17 months- walks

24 months- jumps

3- manages stairs alone

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12
Q

what are the normal developmental neurological stages from 1-6 months to 3 years

A

1-6 months- loss of primitive relfexes (moro, grasp, stepping, fencing)

2 months head control

9-12 months few words

14 months feeds self, uses spoon

18 months stacks 4 blocks, understands 200 words

3 years potty trained

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13
Q

what can overtreatment and overinvestigation lead to

A

fear of doctors, feelings of stigmatisation, psychologic distress

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14
Q

what is varum

A

bow leg

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15
Q

what is valgum

A

knock kneed

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16
Q

when could a genu varum be abnormal or have an underlying patholgy

A

unilateral
severe (>2sd/16 degrees from mean)
short stature (>2sd)
painful

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17
Q

what measurements for genu varum

A

intercondylar and intermalleolar distances

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18
Q

name 5 causes of pathologic genu varum

A 
skeletal dysplasia (genetic disorder)
rickets (vit D deficiency)
tumours (e.g. enchondroma)
blounts disease 
trauma (physeal injury)
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19
Q

what is blounts disease

A

growth arrest of medial tibial physis of unknown aetiology

20
Q

what is seen on x ray in blounts disease

A

beak like protusion

21
Q

what is the risk of blounts

A

part of bone becoming avascular- falling apart

severe deformity

22
Q

what pathologies can cause genu valgum

A

tumours (rare); enchondroma, osteochondroma (bony projections around growth plate)
rickets
neurofibromatosis
idiopathic

23
Q

when should you refer genu valgum

A

in asymmetric, painful, severe

24
Q

what is intoeing

A

walking with toes pointing inward, often accentuated with running

25
Q

what can intoeing be related to

A 
metatarsus adductus (foot) (most likely)
femoral neck anteversion (thigh/hip)
internal tibial torsion (knee/leg)
26
Q

What is femoral neck anteversion

A

inward twisting of the thigh bone

27
Q

what position do children with femoral neck anteversion sit in

A

W position

28
Q

what is the normal angle of femoral neck anteversion

A

mean 30-40 degrees at birth, slowly unwinds to 10-15 degrees at maturity

29
Q

what can femoral neck anteversion predispose to

A

patellofemoral problems

30
Q

what is internal tibial torsion

A

inwards twisting of the tibia which leads to intoeing

31
Q

when in internal tibial torsion usually seen and when does it usually resolve

A

1-3 years

vast majority resolve by 6 years

32
Q

what is metatarsus adductus

A

when the front half of the foot turns inward- common and benign, resolves

33
Q

what should you do in intoeing

A 
define cause 
reassure
chart/photograph 
review
discharge unless persisting and severe
34
Q

is flat feet normal

A

yes, only develop arch when we start walking as tibialis posterior strengthens

1 in 5 adults have flat feet, usually asymptomatic

35
Q

what are the different types of flat feet

A

flexible- arch appears when on tiptoes (no abnormal bone fusion)

fixed stays flat (possible abnormal bone fusion)

36
Q

what can flexible flat feet be caused by

A

generalised ligamentous laxity or tightness gastrocsleus complex (tight calf muscles)

exclude marfans or neurological muscular conditions

37
Q

what score assess hypermobility

A

modified beighton score

38
Q

when should hypermobility make you worried about

A

CTD

39
Q

what might be the underlying cause of rigid flat feet

A

tarsal coalition (tarsal bars forming between bones which restrict movement)

40
Q

when might fixed flat feet benefit from surgery

A

if painful

41
Q

which toes are most likely to be curly, what treatment

A

3rd or 4th

non, splinting or taping ineffective, vast majority resolve by 6 years

rarely can do flexor tenotomy surgery

42
Q

what is anterior knee pain, who gets it and what causes it

A

localised patellar tenderness

females>males, adolescent

check hips (especially for slipped upper femoral epiphysis in children) but usually resolves with phsyio

43
Q

metatarsal abductus is flexible or fixed

A

fixed

44
Q

what inter mallelous distance suggest valgum

A

> 8cm

45
Q

what intercondylar distance suggest varum

A

> 6cm

MSK (71 decks)

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