Paediatric lower limb Flashcards
how do pediatric skulls differ to adult?
- large and flexible neurocranium in comparison to visceral cranium to accomodate rapidly growing brain
- straight eustachian tube in close relationship to adenoid
- supercilliary and mastoid process are absent
- suture are open + fontanelles present
newborn weight distribution
newborns are gravity dependent- weight is shifted towards head as it is large
when are xray performed? minimum age
4 months
why do children present a greater obstruction risk?
- narrow airways
- large occiput and tongue
- smaller oral cavity
- flexed neck in lying
- epiglottis is larger and more floppy
- larynx is high at first (C3/4)
why do newborns present a greater risk of breathing difficulties?
- epiglottis/larynx is high at first (C3/4)
- horizontall orientated ribs
- respiratory muscles lack tone/power/coordination, type 1 –> fatigue
- alveoli small in size and number- smaller SA for gas exchange
- larger organs push diaphragm high
Vertebral column difference in children under 8
- more elastic esp below 8 yrs
- therefore trauma can cause neurodamage more easily
What are the 3 main differences between vertebral columns in adults vs children?
- facet joints are more shallow and horizontal- more easily slipped
- ligaments and joint capsules more stretchable –> pseudosubluzation
absent uncate processes and weak nuchal muscles leading to decreased stability in C spine - bodies are wedge shaped
- spinous process less developed
developmental milestones for walking
- sit 6 months
- crawl 9 months
- walk support 1 yr
- walk unsupported 15 months
- run 18 months
4 spinal curvatures and how they develop
Primary:
- thoracic and sacral form during prenatal development
Secondary:
- cervical from lifting head
- lumbar from sitting and walking
spinal cord in neonates
3 ossification centres with cartilage gaps
development of walking age ?
about 5yrs
from staccato movements during CNS maturation to normal gait pattern
Describe how the exploratory phase of walking differs from adult gait patterns
- wider walking base
- lower stride length and higher cadence
- no heel strike (whole foot)
- limited stance phase knee flexion
- whole leg is externally rotated in swing
- swing is shorter
- no reciprocal arm swinging
Explain how knee alignment changes during childhood development
- toddler- physiological genu varum (bowed)
- straightens
- 5-8yrs physiological genu valgum (knocked)
- then becomes straight
when are physiological knee alignment changes worrying in children?
- asymmetrical
- excessively severe
- impact on life- falling/pain/tripping
- not improving with time
3 common foot problems in infants
- in toeing
- tip toeing (can be natural unless prolonged/severe)
- flat feet
in-toeing patternscan occur on what 3 levels?
- femur (anterversion angle)
- tibia (how it is set within lower limb)
- foot (metatarsal abductus)
Ddx tip toeing
- neuromuscular pathology manifesting in muscular distrophies
- UMN syndromes eg cerebral palsy
- behavioural problems like autism
- hypersenstivity to sole of foot
Therefore need thorough Hx and Ix
paediatric bone has signfiicant what?
osteopaenic potential - very metabolically active
spiral fracture of humerus and femur in the toddler as strongly linked to what?
non-accidental injuries
weakest section of skeleton?
growth plate (physis)
slipped capital femoral epiphysis Presentation/Mx
8- 16y thigh pain hip/knee pain (radiates) limb/antalgic gait restricted internal rotation + obligatory external rotation leg length discrepency Mx is always surgical
age of presentation Perthe’s
4-10
What is the long term risk of Perthe’s disease/avascular necrosis of hip
permanent deformity of femoral head increasing risk of OA in adulthood
