Paediatric Orthopaedics Flashcards
What are the some abnormal features of the lower limb that usually correct with age?
- Overlapping toes
- Internally rotated feet
- Flat feet
How do bones grow from the growth plate?
Enchondral ossification
How do bones grow from the periosteum?
Appositional growth
What are the factors affecting the growth plate?
Diet Sun Vitamins A and D Injury Illness Hormones - particularly Growth Hormone
How can you tell if short children have a pathological process underlying this?
Parents height
Dysmorphic features
Age over 3 - as under 3 growth much more variable and can cross centiles . Nutrition big factor here
What measure defines a child of short stature?
Those less than 2 standard deviations under the mean for those of their age
What should a child be able to do at 6-9 months?
Sit alone
Crawl
What should a child be able to do at 8-12 months?
Stand
What should a child be able to do at 14-17 months?
Walk
What should a child be able to do at 24 months?
Jump
What should a child be able to do at 3 years?
Climb stairs alone
What is Genu Varum?
Bow legged
What is Genu valgum?
Knock kneed
How does knee alignment vary with age?
Newborn and under 2 - genu varum
Peak at 3 and half and then after - genu valgum
What is mean knee alignment for adults?
-5 degrees of valgus
When is Genu varum pathological?
Unilateral
Severe - greater than 2 SD or 16 degrees from normal
Short stature
Painful
SHOULD BE REFERED
What can cause pathological genu varum?
Skeletal dysplasia
Rickets
Tumour i.e. enchondroma
Blounts disease
Trauma = physeal injury
What is blounts disease?
Grwoth arrest at medial tibial physis
? caused by weight overload
What is the sign of Blounts disease on X ray?
Beak like protrusion
When is genu valgum pathological?
Asymmetric
Painful
Severe - over 2 SD
What are the causes of pathological genu valgum?
Tumour
Rickets
Neurofibromatosis
Idiopathic
When is surgery considered for genu valgum?
If less than 8 cm intermalleolar distance at aged 11
What are possible causes of intoeing?
Femoral neck anteversion
Internal tibial torsion
Metatarsus adductus
What is femoral neck anteversion?
Increased pointing if femoral neck anteriorly. Sit in W position
Usually 30-40 degrees at birth but will be 10-15 degrees at maturity
What is the treatment of Metatarsus adductus that will not passively correct?
Serial casting at aged 6 -12 months
Is flat feet normal at birth?
Yes
Medial arch develops as walking strengthens tibialis posterior
What are the two types of flat feet?
Flexible or fixed/ rigid
What is the cause of flexible flat feet?
Generalised ligamentous laxity
Tight gastrocsoleus complex = stretching
What is rigid flat feet?
Flat feet caused by bony connection = tarsal coalition
What are the features of curly toes?
Common in young children but resolve by 6 years
Mostly 3rd and 4th toes
How can you tell between fixed and flexible flat foot?
Tip toe test
When are orthotics indicated in flexible flat foot?
If it is painful
