Paediatric Orthopaedics

Question 1

What are the some abnormal features of the lower limb that usually correct with age?

Answer 1

• Overlapping toes
• Internally rotated feet
• Flat feet

Question 2

How do bones grow from the growth plate?

Answer 2

Enchondral ossification

Question 3

How do bones grow from the periosteum?

Answer 3

Appositional growth

Question 4

What are the factors affecting the growth plate?

Answer 4

Diet
Sun
Vitamins A and D
Injury
Illness
Hormones - particularly Growth Hormone

Question 5

How can you tell if short children have a pathological process underlying this?

Answer 5

Parents height

Dysmorphic features

Age over 3 - as under 3 growth much more variable and can cross centiles . Nutrition big factor here

Question 6

What measure defines a child of short stature?

Answer 6

Those less than 2 standard deviations under the mean for those of their age

Question 7

What should a child be able to do at 6-9 months?

Answer 7

Sit alone

Crawl

Question 8

What should a child be able to do at 8-12 months?

Answer 8

Stand

Question 9

What should a child be able to do at 14-17 months?

Answer 9

Walk

Question 10

What should a child be able to do at 24 months?

Answer 10

Jump

Question 11

What should a child be able to do at 3 years?

Answer 11

Climb stairs alone

Question 12

What is Genu Varum?

Answer 12

Bow legged

Question 13

What is Genu valgum?

Answer 13

Knock kneed

Question 14

How does knee alignment vary with age?

Answer 14

Newborn and under 2 - genu varum

Peak at 3 and half and then after - genu valgum

Question 15

What is mean knee alignment for adults?

Answer 15

-5 degrees of valgus

Question 16

When is Genu varum pathological?

Answer 16

Unilateral

Severe - greater than 2 SD or 16 degrees from normal

Short stature

Painful

SHOULD BE REFERED

Question 17

What can cause pathological genu varum?

Answer 17

Skeletal dysplasia

Rickets

Tumour i.e. enchondroma

Blounts disease

Trauma = physeal injury

Question 18

What is blounts disease?

Answer 18

Grwoth arrest at medial tibial physis

? caused by weight overload

Question 19

What is the sign of Blounts disease on X ray?

Answer 19

Beak like protrusion

Question 20

When is genu valgum pathological?

Answer 20

Asymmetric

Painful

Severe - over 2 SD

Question 21

What are the causes of pathological genu valgum?

Answer 21

Tumour

Rickets

Neurofibromatosis

Idiopathic

Question 22

When is surgery considered for genu valgum?

Answer 22

If less than 8 cm intermalleolar distance at aged 11

Question 23

What are possible causes of intoeing?

Answer 23

Femoral neck anteversion

Internal tibial torsion

Metatarsus adductus

Question 24

What is femoral neck anteversion?

Answer 24

Increased pointing if femoral neck anteriorly. Sit in W position

Usually 30-40 degrees at birth but will be 10-15 degrees at maturity

Question 25

What is the treatment of Metatarsus adductus that will not passively correct?

Answer 25

Serial casting at aged 6 -12 months

Question 26

Is flat feet normal at birth?

Answer 26

Yes

Medial arch develops as walking strengthens tibialis posterior

Question 27

What are the two types of flat feet?

Answer 27

Flexible or fixed/ rigid

Question 28

What is the cause of flexible flat feet?

Answer 28

Generalised ligamentous laxity

Tight gastrocsoleus complex = stretching

Question 29

What is rigid flat feet?

Answer 29

Flat feet caused by bony connection = tarsal coalition

Question 30

What are the features of curly toes?

Answer 30

Common in young children but resolve by 6 years

Mostly 3rd and 4th toes

Question 31

How can you tell between fixed and flexible flat foot?

Answer 31

Tip toe test

Question 32

When are orthotics indicated in flexible flat foot?

Answer 32

If it is painful