Paediatrics Flashcards
Statistically, normal is defined as how many SDs from the mean?
Within 2
The growth plate of the bone is AKA the
Physis
Bones grow how (2)
1) Longituindally from the growth plate by enchondral ossification
2) By appositional growth from the periosteum (making bones thicker)
All physis contribute roughly the same growth to their respective bone. True/false?
False (the inferior femur physis contributes 70%, while the anterior contributes 12%)
Factors affecting bone growth and development (5)
1) Diet / nutritional status
2) Sunshine (vitamins D and A)
3) Injury
4) Illness
5) Hormones (e.g. GH lack)
What’s the 6-9 month motor milestone?
Sits alone, crawls
8-12 month motor milestone?
First steps
14-17 month motor milestone?
Walking
24 month motor milestone?
Jumping
3 years motor milestone?
Managing stairs alone
By which month should primitive reflexes have disappeared?
6 months
By which age should head control have been achieved?
2 months
Genu varum is AKA
Bow legs
Genu valgum is AKA
Knock knees
Valgus is always abnormal. True/false?
False (around 6 degrees is usually normal)
Genu varum is always abnormal. True/false?
False - it is normal aged <2 years old. Only abnormal if persisting or significant (>2SDs) or painful
Describe Blount’s Disease
Growth arrest of medial tibial physis of unknown cause
What’s the classical sign of Blount’s Disease on X-ray
Beak-like protrusion
Treatment option for Blount’s
Medical arrest of growth of tibial physis on other side to allow the lagging side to “catch up”
Intoeing is when the child…
Walks on the toes pointing in (pigeon toed). May be related to femoral neck anteversion.
Describe femoral neck anteversion
When the femoral neck has an increased internal rotation relative to the hip - patients will tend to sit in a “W position” (Britney Spears)
What’s the normal femoral neck rotation at maturity?
10-15 degrees
Treatment option for metatarsus abductus
Serial casting
In anterior knee pain, it is important to check which other site?
Hips
Barlow tests if the hip can be dislocated easily. Which anatomical movement is undertaken in this test?
Hip adduction with an anterior force to promote dislocation
Ortolani test is performed with which movements?
Flexion, adduction and anterior force onto the hip
Ortolani exacerbates/ reduces dislocation?
Reduces
Extra skin folds suggest a pathology with which site?
Hip
X-ray is useful in screening for abnormalities in young children. True/false?
False - hip is mostly cartilage and difficult to visualise
What is the preferred imaging modality for screening of joints in young?
Ultrasound
Early treatment of DDH is with which type of harness?
Pavlik -> gives around 90-95% normal hip function
A Pavlik harness maintains which movements of the hips?
Flexion and abduction to force the femur to grow back into the acetabulum
Later diagnosis in DDH is classed at diagnosis at which age?
> 2 years
Later diagnosis of DDH requires which treatment?
Open reduction and hip spiker
Which % of DDH cases will have NO risk factors?
60%
DDH affects girls or boys more?
Girls
DDH tends to affect both hips equally. True/false?
False - left hip more commonly involved
Risk factors for DDH include (2)
1) 1st degree relative with DDH
2) Breach position birth
Late presenting (>3 years) DDH generally never have a normal hip. True or false?
True
DDH presenting symptoms (4)
1) Painless limp
2) Short limb
3) Asymmetric creases
4) Trendelenburg gait
Perthes tends to affect which type of child?
“Dennis the Mennis” style boys, usually 4-8 years old.
The underlying pathology in Perthes is…
Idiopathic AVN of the head of femur
What are some signs of SUFE? (2)
1) Shortened limb
2) External rotation
Trethowan’s Sign is what & useful in which condition?
Drawing a line up the neck of the femur it should hit the femoral head - will be used in diagnosing a SUFE
What is needed to make a diagnosis of SUFE?
Lateral & AP X-rays
SUFE is late diagnosed in which % of cases?
50%
Transient synovitis tends to present at which age range
2-5 years
SUFE tends to present at which age range?
11-15 years
Short stature is commonly pathologic, T/F?
False - only 1 in 5 children less than 2SD below mean for age will have an underlying pathology
Which people should you look at when assessing a child’s short stature?
Parents (for height)
Genu varum/valgus is normal in <2 year olds?
Varum
What are some features of genu varum that would make you want to refer an infant? (4)
Unilateral
Severe (>2SD from mean)
Short stature (>2SD)
Painful
What are some pathologic causes for genu varum? (5)
1) Skeletal dysplasia
2) Rickets
3) Tumour
4) Blount’s Disease
5) Trauma
What are some pathologic causes for genu valgum? (4)
1) Tumours
2) Rickets
3) Neurofibromatosis
4) Idiopathic
Genu valgum/varum is normal at 3.5 years old?
Valgum
What are some features for referral of genu valgum in a 3.5 year old?
Painful, asymmetric, severe >2SD, >8cm intermalleolar distance by 11-years old.
Which conditions are associated with intoeing? (3)
1) Femoral Neck Anteversion
2) Internal Tibial Torsion
3) Metatarsus Adductus
Patients with femoral neck anteversion tend to sit in which position?
W-position
Femoral neck anteversion is always pathologic, T/F?
False - usually of no problems (except patellofemoral problems)
Femoral neck anteversion needs to be corrected surgically, T/F?
False - little role for surgery (only if severely deformed)
Internal tibial torsion is usually seen at which age?
Toddlers (1-3)
Internal tibial torsion will not self-correct, T/F?
False - vast majority resolves by 6 years old.
Is orthotics & bracing useful in treatment of internal tibial torsion?
No, these are ineffective. Surgery is very rarely used.
Metatarsus adductus always needs correction, T/F?
False - usually self-resolving. Serial casting may be needed (6-12 months)
Intoeing is generally treated surgically, T/F?
False - usually just needs definition of cause (e.g. femoral neck), reassurance and charting with review.
T/F: Children are born with flat feet.
True (arch develops with tibialis posterior)
How many adults have flat-feet?
1:5
What test is done on flat-feet to check cause?
Flexion - if they are fixed it suggests a bony deformity (e.g. tarsal coalition), if they are flexible it suggests all ligaments are present but there may be other errors (e.g. ligamentous laxity or tight gastrosoleus).
Orthotics are commonly used to treat flat feet, T/F?
False - only used if pain is present (as there is no consequences of having flat feet)
A tight gastrocsoleus complex causing flat feet can be treated how?
Stretching
Curly toes are treated with splintage/ taping. T/F?
False - ineffective. Rarely can be treated with flexor tenotomy.
What knee alignment is present at 18 months?
Normally straight (minimal valgus)
What knee alignment is present at 3.5 years?
Valgus
What knee alignment is present at 7 months?
Straight
A 2year,, 6 month old child will normally have which knee alignment?
Valgus
Symptoms of a transient synovitis (4)
1) Insidious
2) Low-grade pyrexia (if any)
3) Reduced ROM/ slight pain only.
4) Normal blood tests. US shows an effusion.
T/F: Perthes tends to be bilateral.
False - only bilateral in 10% of cases
Is Perthes painful?
Yes
What are options for treating Perthes? (4)
1) Maintain hip abduction (compliance very poor)
2) Rest and activity modification (vast majority)
3) Bracing (some cases)
4) Surgery (rare)
Perthes has a much better prognosis if presenting/ diagnosed before which age?
7 years old
Complication of Perthes
OA (early onset, 18 years old)
SUFE Is more common in women/men?
Men
What % of SUFE cases will be acute (unstable, sudden onset, rapidly progressive)?
10% (most are chronic and stable)
Surgical option for stabilising the physis in SUFE?
Screws into femur
What’s controversial about SUFE surgery in ONE hip joint?
25% of people will have a contralateral slip in the next 1-2 years. Some surgeons advocate to do both at same time even if unilateral.
Adolescent unable to weight-bear is what until proven otherwise?
SUFE
Acute unstable SUFE is a surgical emergency, T/F?
True
