Orthopedic disorders in childhood

Question 1

Variations of normal posture

Answer 1

1. Bow legs (genu varum)
2. Knock knees (genu valgum)
3. Flat feet (pes planus)
4. In-toeing and out-toeing
   - Causes of in-toeing = metatarsus varus, medial tibial torsion, persistent anteversion of femoral neck
   - Out-toeing uncommon; when bilateral, often due to lateral rotation of hips and resolves spontaneously
5. Toe-walking (usually from habit; exclude mild CP, tightness of Achilles tendon, or inflammatory arthritis in foot or ankle; exclude Duchenne muscular dystrophy in older boys)

Question 2

Abnormal posture - causes

Answer 2

1. Talipes equinovarus (clubfoot - foot inverted and in plantarflexion)
2. Vertical talus (rocker-bottom foot)
3. Talipes calcaneovagus (foot everted and dorsiflexed)
4. Flat feet (due to tendo-Achilles contracture, tarsal coalition or inflammatory arthropathy)
5. Pes cavus (high arched foot, often associated with neuromuscular disorders)
   ___
6. DDH
7. Scoliosis (lateral curvature of front plane of spine - idiopathic, congenital, secondary)
8. Torticollis (wry neck - due to sternomastoid tumour in infants or muscular spasm/ENT infection/spinal tumour/cervical spine arthritis or posterior fossa tumour)

Question 3

Chronic painful limb, knee and back - causes (3)

Answer 3

1. Growing pains (nocturnal idiopathic pain, age 3-12y)
2. Hypermobility (older children or adolescents)
3. Complex regional pain syndrome

Question 4

Acute onset limb pain - causes (3)

Answer 4

1. Osteomyelitis

Malignant disease

2. Malignant bone tumours (osteogenic sarcoma)
3. Osteoid osteoma (benign tumour)

Question 5

Painful knee - causes

Answer 5

1. Osgood-Schlatter disease
2. Chondromalacia patellae
3. Osteochondritis dissecans (segmental avascular necrosis of the subchondral bone)
4. Subluxation and dislocation of the patella
5. Injuries

Question 6

Back pain - causes (5+3)

Answer 6

1. Mechanical causes - muscle spasm or soft tissue pain from injury
2. Tumours - benign or malignant
3. Vertebral osteomyelitis or discitis
4. Spinal cord or nerve root entrapment
5. Scheuermann disease
6. Spondylolysis
7. Spondylolisthesis
8. Complex regional pain syndrome