Paediatric Orthopaedics and Normal Variation

Question 1

Anatomy of a childs bone

Answer 1

epiphysis (cartilage)
physis
metaphysis
diaphysis (shaft)
apophysis

Question 2

What part of the bone is the growth plate?

Answer 2

physis

Question 3

What part of the bone contains the secondary ossification centre?

Answer 3

epiphysis

Question 4

What part of the bone contains the primary ossification centre?

Answer 4

metaphysis and diaphysis

Question 5

Features of a babys knee compared to an adults X ray

Answer 5

no platella
no proximal tibia
no joints
BECAUSE LARGE PORTION IS STILL CARTILAGE

Question 6

Biomechanical differences of childrens bones compared to adults

Answer 6

Bones are bendy
Ligaments stronger than growth plate
more porous bones
- tolerates more deformation (plasticity)
- fails in compression as well as tension

Question 7

Physiological differences of childrens bones vs adults

Answer 7

remodelling
- doesn't occur in adults
- heals with an angle, then straightens 
- over a few months
overgrowth 
progressive deformity
speed of healing much faster

Question 8

What is a self correcting or non concerning pathology?

Answer 8

Will sort itself out, not a true pathology

Question 9

Examples of self correcting pathologies

Answer 9

persistent femoral anteversion
metatarsus adductus
posterior tibial bowing
curly toes

Question 10

What are some possible parental presenting concerns?

Answer 10

out/in toeing
bow legs 
knock knees 
tip toe walking
flat feet 
curved feet 
curly toes

Question 11

David jones system of 5Ss

Answer 11

symmetrical 
symptomatic
systemic illness
skeletal dysplasia
stiffness

Question 12

types of alignment

Answer 12

rotational alignment (around the axis
angular alignment (usually coronal)

Question 13

Presentation of angular alignment

Answer 13

knocked knees
bow legs
flat feet

Question 14

What is natural about babies feet?

Answer 14

they are flat - large medial foot pat in the arch and have not learnt yet to walk or weight bear

Question 15

What is the main immunoglobulin found in breast milk?

Answer 15

IgA

Question 16

What is a complete fracture?

Answer 16

Both sides of cortex are breached

Question 17

What is a toddlers fracture?

Answer 17

Oblique tibial fracture in infants

Question 18

What is a plastic deformity?

Answer 18

Stress on bone resulting in deformity without cortical disruption

Question 19

What is a greenstick fracture?

Answer 19

Unilateral cortical breach only

Question 20

What is a buckle fracture?

Answer 20

Incomplete cortical disruption resulting in periosteal haematoma only

Question 21

What classification system is used to classify paediatric fractures that affect the growth plate?

Answer 21

Salter-Harris system

Question 22

Salter harris system scores

Answer 22

I - fracture through physis only (x ray often normal)
II - Fracture through metaphysis and physis
III - fracture through the physis and the epiphysis to include the joint
IV - fracture involving the physis, metaphysis and epiphysis
V - crush injury involving physis (x ray might resemble type I and appear normal)

Question 23

What is the name for clubfoot and when is it picked up?

Answer 23

Talipes Equinovarus

Picked up on newborn exam

Question 24

Presentation of clubfoot

Answer 24

Inverted and plantar flexed foot

Not passively correctable

Question 25

What % of club foot cases are bilateral?

Answer 25

50%

Question 26

Associations of club foot

Answer 26

Idiopathic
Spina bidida
CP
Edwards syndrome
Oligohydramnios
Arthrogryposis

Question 27

What trisomy is Edwards syndrome?

Answer 27

Trisomy 18

Question 28

Management of club foot

Answer 28

Ponseti method
- manipulation and casting soon after birth
- deformity usually corrected after 6 - 10 weeks
- Achilles tenotomy required in 85% of cases but this can be done under local
Night time braces until 4 y/o

Question 29

Relapse rate of club foot

Answer 29

15%

Question 30

Most common site where osteomyelitis occurs in children (part of bone)

Answer 30

Metaphysis