Paed Ortho - Intro

Question 1

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Answer 1

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Question 2

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Answer 2

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Question 3

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Answer 3

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Question 4

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Answer 4

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Question 5

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Answer 5

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Question 6

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Answer 6

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Question 7

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Answer 7

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Question 8

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Answer 8

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Question 9

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Answer 9

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Question 10

What are the “classes” of abnormal presentations in children that arn’t true pathologies?

Answer 10

Normal Variants
Physiological Development
Self-Correcting Pathologies

Question 11

How many pediatric referrals to orthopaedics are normal variation?

Answer 11

Well over 50% with intoeing and flexible flat feet being the commonest reasons for refferal

Question 12

What “pathologies” are part of physiological development and not pathology?

Answer 12

Young children with bow legs, knock knees, flat feet or excessive anteversion.
This is actually normal for their age and will grow into the adult shape

Question 13

What is a self-correcting pathology?

Answer 13

Not a true pathology, its a problem that mostly correct themselves during growth.

Question 14

How do you assess a childs hip rotation?

Answer 14

Get them to lie on their front with legs flat
Flex one knee and rotate the leg out for medial rotation of hip and in for lateral rotation. (pics in slides)

Question 15

What can cause normal intoeing in children?

Answer 15

Children have increased hip anteversion and lateral rotation.
May also be Tibial Torsion which is also normal for their age.
Can be Metatarsus Adductus, meaning the metatarsals are bent medially, again almost every patient grows out of it themselves.

Only be concerned if its 1 sided or painful.

Question 16

How do we assess for tibial torsion?

Answer 16

With the thigh foot angle.
while they’re lying on their front lift up the foot and look down the foot against the thigh to see the angle between them.

Question 17

How would you clinically assess a child?

Answer 17

• Walking
• Standing (alignment from front / Patellar position / length from behind)
• Tip Toe
• Stahelli rotational Profile (done with child lying on front)

Question 18

What presentations of a child might require further investigation?

Answer 18

• Outside the normal age boundary for their presentation. E.g. Bow legged at the wrong age i.e. after age 2
• Assymetry. 1 leg intoeing/bowing/longer etc,

Question 19

What presentations may require treatment?

Answer 19

Metatarsus Adductus - Rarely
Tibial Torsion
Persistant Femoral Anteversion
Curly Toes

Basically only needs to be done if the child is past the age where they might outgrow it themselves