Paediatric Lower Limb

Question 1

Head in baby

Answer 1

Developing brain
Fontanelles
Rudimentary viscerocranium
Larger neurocranium vs smaller viscerocranium
Facial development quite prompt
Straight eustacian tube with close relationship with adenoid
Glabella and supraciliary arches with mastoid processes are absent
Sutures of skull are open

Question 2

Why is neurocranium relatively large

Answer 2

To accommodate developing brain

Question 3

Why is neurocranium v flexible

Answer 3

allow it to pass through birth canal

Question 4

What ensures flexibility of neurocranium

Answer 4

Fontanelles

Question 5

Frontal fontanelle

Answer 5

Can show signs of high pressure, high CSF or be depressed if dehydrated
Allows ultrasound imaging of brain without exposing newborn to radiation

Question 6

If sutures close too early

Answer 6

Can cause deformation of head and face

Question 7

Big head baby complications

Answer 7

Babies are gravity dependant

Having heavy head on a short and not very mobile neck –> at first weight is shifted towards head

Question 8

Structural deformity example

Answer 8

Talinthus equinavarus

Question 9

Hip dysplasia

Answer 9

Position in womb and RFs are indicator to measure hip congruity for possible developmental hip dysplasia–> do X ray

Question 10

why are airways obstruction risk in babies

Answer 10

Narrow airways
Large occiput and tongue
Smaller oral cavity
Flexed neck in lying

Question 11

Epiglottis/larynx

Answer 11

C3/4
high at first
–> implications for feeding/breathing/oedema

Question 12

Babies breath through

Answer 12

Nose

Question 13

Thorax

Answer 13

Horizontally oriented ribs
Cartilage>bone
Relatively large organs- large heart, so hard for lungs to expand

Question 14

Respiratory muscles

Answer 14

Type 1
Muscles lack tone/power/co-ordination
–> leads to fatigue

Question 15

Lung development

Answer 15

Alveoli small in size and number –> small SA for gaseous exchange

Question 16

Neck and spine

Answer 16

Different–> more elastic

Question 17

Facet joints

Answer 17

Shallower and more horizontal in kids

Question 18

Ligaments + joint capsule

Answer 18

More stretchable

Question 19

Uncinate processes

Answer 19

Absent

Contribute to stability

Question 20

Nuchal muscles

Answer 20

Weak

Contribute to flexibility

Question 21

Vertebral bodies

Answer 21

Anterior wedging of vertebral bodies
Spinous process less developed
–> decrease the stabilising effects of paraspinal muscles
–> hypermobility of spine

Question 22

Primary curves

Answer 22

Thoracic and sacral curvature formed during foetal development

Question 23

Secondary curves

Answer 23

Develop after birth
Cervical curvature- 1st one- forms as result of lifting head
Lumbar curvature- 2nd one- forms as result of sitting and walking

Question 24

Vertebral ossification centres

Answer 24

i.e. imaging of the odontoid

Spina bifida- due to non-fusion at back of head yet

Question 25

Spinal growth

Answer 25

‘ascent’ of the spinal cord

Descent of viscera (larynx)

Question 26

Phases

Answer 26

o	Sit- 6 months
o	Crawl- 9 months
o	Walk with support- 1 year
o	Walk without- 15 months
o	Run- 18 months
o	Can skip stages and times vary

Question 27

Walking

Answer 27

Walking base is wider
Stride length + speed are lower
Cycle time shorter
No heel strike at initial contact- whole foot
Limited stance phase knee flexion
Whole leg is externally rotated in swing
Swing is shorter
No reciprocal arm swinging

Question 28

Power generation

Answer 28

Youngest children use hip flexor and extensor muscles more than ankle power flexors for power generation
When toddlers walk, most of muscles activated through most of cycle- not very energy efficient

Question 29

Theory that development is…

Answer 29

Proximal –> distal

Question 30

Lower limb normal variants

Answer 30

Physiological genu varum (bow legs) –> straight –> physiological genu valgum (knock knees) –> straight

Question 31

Flat feet

Answer 31

Not being able to wear footwear/uncomfortable
Skin breakage and blisters
If stand on tip toes and arch is reappearing- good sign- means flat feet are flexible

Question 32

Immature bone characteristics

Answer 32

Significant osteopenic potential

Periosteum in paediatric bone is thicker- reduces displacement fractures and chance of open fractures

Question 33

Growth plates

Answer 33

Physis- area of developing tissue near the end of the long bone- regulates and helps determine length and shape of bone
Weakest section of skeleton, and fractures happen
May have complications
Can stop growth or stimulate growth

Question 34

Non-accidental fractures

Answer 34

e.g. spiral fractures of humerus or femur in toddler and younger children- strongly linked and should be careful history background examinations used to determine child at risk and safeguard

Question 35

Slipped Captio Femoral Epiphysis (SUFI)

Answer 35

• 8 and 16 years
• thigh hip and knee pain
• hip pain can radiate to knee first or groin
• presents with limp or antalgic gait
• restricted internal rotation and obligatory external rotation during hip flexion, leg length discrepancy
• Management- surgical

Question 36

Perthe’s

Answer 36

• avascular necrosis of proximal femoral epiphysis of hip
• initiated by disruption of blood flow to head of femur
• most common between 4-10 but can be 2-14
• child presents with knee or hip pain with limb
• restriction in Rom and leg length discrepancy
• can produce permanent deformity of femoral head which can lead to OA in future

Question 37

Physical activity kids

Answer 37

Average 6 year old spends 2 hours a day watching TV secondary to playing/outdoor activities
Huge gap between boys and girls
Only 28% of kids achieved 1 hour at school and 22% achieved after school

Question 38

F words

Answer 38

Function
Fitness
Friends
Family
Fun
Future