Paediatric Orthopaedics

Question 1

What is ‘flat foot’?

Answer 1

When the arch of the foot doesn’t fully develop, and this may appear as weak ankles which turn inwards

Question 2

What is the treatment for ‘flat foot’?

Answer 2

Orthotics to aid the arch with stretching or surgery

Question 3

What are the potential causes of flat feet?

Answer 3

Muscle imbalances or issues with the tarsal bones

Question 4

What may persistent toe walking in older children indicate?

Answer 4

Cerebral palsy, DMD or nervous system disorders

Question 5

How may toe walking be corrected?

Answer 5

A cast for the foot and ankle or stretching of the calf muscles

Question 6

What is club foot?

Answer 6

Where the foot looks like a foot; also known as talipes equinovarus which means there is a fixed varus and equinus deformity and calf underdevelopment

Question 7

What is the epidemiology of club foot?

Answer 7

1 in 1,000 children have it and it’s more common in boys

Question 8

What are the risk factors for developing club foot?

Answer 8

Breech presentation, connective tissue disorders, too little amniotic fluid, Edwards Syndrom

Question 9

How is club foot treated?

Answer 9

Ponseti method - manipulative technique to correct the foot using braces and stretching

Question 10

What is the Ponseti method?

Answer 10

Method of manipulative treatment for club foot

Question 11

What is Edward’s syndrome?

Answer 11

Trisomy 18

Question 12

What is hip dysplasia?

Answer 12

When the hip joint is mal-aligned

Question 13

How common is congenital hip dysplasia?

Answer 13

1.5 in 1,000 children

Question 14

What are the risk factors for congenital hip dysplasia

Answer 14

Breech delivery and family history of club foot or scoliosis, and is commoner in females

Question 15

How may congenital hip dysplasia present in infants?

Answer 15

Tends to be double creases when the leg is turned outwards, with asymmetric gluteal folds (double crease on affected side)

Question 16

Why is the use of x-ray limited in the diagnosis of congenital hip dysplasia in infants?

Answer 16

As the femoral head doesn’t ossify until 4-6 months and therefore won’t be visible on x-ray

Question 17

How may an ultrasound be used to diagnose congenital hip dysplasia?

Answer 17

The femoral head will move back on the gluteal muscles, causing the fibres to look more vertical

Question 18

How is ‘Barlows test’ used to diagnose congenital hip dysplasia?

Answer 18

Knees are brought together and pushed on slightly whilst the infant is lying down. If the hip can be dislocated like this, this is a positive test

Question 19

How is ‘Ortolani test’ used to diagnose congenital hip dysplasia?

Answer 19

This usually follows on from Barlows test, and involves abducting the hip to see whether the hip will pop back in, to confirm the diagnosis

Question 20

How is ‘Galeazzi test’ used to diagnose congenital hip dysplasia?

Answer 20

Flex the hip and knee and see if there is a leg length discrepancy in the height of the knee, affected side will be shorter

Question 21

How is congenital hip dysplasia treated?

Answer 21

Under 6 months = Pavlik harness to keep the femoral head in the true acetabulum
Over 6 months or doesn’t work = closed reduction with hip spikes or open reduction

Often resolves spontaneously though, however.

Question 22

What is Perthes’ disease?

Answer 22

Self-limiting avascular necrosis of the femoral head often due to loss of the acetabular branch of the obturator artery which supplies the femoral head

Question 23

Is Perthes’ disease usually unilateral or bilateral?

Answer 23

Unilateral

Question 24

What are the four stages of Perthes’ disease?

Answer 24

Necrosis, fragmentation, reossification and remodelling

Question 25

Describe the necrosis stage of Perthes’ disease

Answer 25

A portion of the femoral head dies and the shape of the femoral head changes, causing pain, stiffness and inflammation and this takes up to one year

Question 26

Describe the fragmentation stage of Perthes’ disease

Answer 26

The dead cells from the necrosis of the femoral head are then absorbed and replaced by new bone, and as the new bone forms it produces varying femoral head shapes, this takes 1-3 years to take place

Question 27

Describe the reossification stage of Perthes’ disease

Answer 27

The femoral head continues to growth with new bone cells, taking 1-3 years

Question 28

Describe the remodelling stage of Perthes’ disease

Answer 28

New bone cells are gradually replaced by normal bone cells and remodelling continues, and this can take 1-3 years or more

Question 29

What is slipped upper femoral epiphysis (SUFE)?

Answer 29

Where the epiphysis (growth plate) of the femur stays in place, but the femoral neck and shaft displace

Question 30

Which side is more likely to be affected by SUFE?

Answer 30

Left hip

Question 31

What are risk factors for SUFE?

Answer 31

Obesity, hypothyroidism, deficiency or increased androgen production and trauma

Question 32

How may SUFE appear on x-ray

Answer 32

Hip joint may appear as ice-cream falling off it’s cone

Question 33

How may Klein’s line be useful in diagnosing SUFE on x-ray?

Answer 33

This is a line drawn along the superior border of the femoral neck, and should cross at least a portion of the femoral head, if the femoral head drops below this line, this is indicative of SUFE

Question 34

How may SUFE be treated?

Answer 34

Rest, analgesia, surgery (to close growth plate with screws or bone removal)

Question 35

What is Blount’s disease?

Answer 35

where there is a growth problem of the distal tibia (in the medial compartment) which causes tibia varus)

Question 36

What is thought to be the cause of Blount’s disease?

Answer 36

Effect of weight (obesity) on the growth plate

Question 37

What is Osgood Schlatters disease?

Answer 37

Quadriceps insert onto the tibial tuberosity, which causes the tuberosity to be pulled due to exercise. This causes the bone to grow anteriorly at the insertion point.

Question 38

What type of condition are Severs’ and Schlatters disease?

Answer 38

Osteochondroses

Question 39

What may cause Osgood Schlatters disease?

Answer 39

Repeated traction from patellar ligament on tibial tuberosity (due to heavy exercise) or avulsion fractures to part of the tibial tuberosity