Paeds

Question 1

What is the Salter-Harris classification?

Answer 1

SALTER

Type 1: Straight Across (separation through growth plate)

Type 2: Above (fracture through growth plate extending into metaphysis)

Type 3: Lower (fracture through growth plate extending into epiphysis and joint)

Type 4: Through (fracture across growth plate, epiphysis, and metaphysis)

Type 5: ERasure of growth plate via crush injury to growth plate

Question 2

Describe the rate of growth of a child.

Answer 2

0-2yrs = maximum rate of growth

50% of adult height at ~2-4yrs

50% of adult leg length at 4yrs

Question 3

What is congenital talipes equinovarus?

Answer 3

Club foot - true club foot caused by shortened Achilles tendon

1-2/1,000 live births

Associated with other disorders e.g. spina bifida, DDH, cerebral palsy

Foot inverted and pointed down

Management: gentle passive dorsiflexion or Ponseti method or French functional method or surgery

Question 4

What is developmental dysplasia of the hip?

Answer 4

Femoral head + acetabulum unstable —> hip instability —> hip subluxation/dislocation

1%-3% of live births

Shortened leg

Causes painless limping

Tests: Ortolani & Barlow’s tests, Galeazzi sign (child lying supine with hips and knees flexed to 90 degrees and height of knees compared)

Management:

• <6mnths = brace to maintain hip reduction
• > 6mnths/brace failed = surgery to reduce and remove adductor/psoas tendons, followed by plater cast/abduction brace
• req. freq. hip replacement earlier

Question 5

What are the signs and symptoms of rickets?

Answer 5

note: vit D deficiency OR abnormal phosphate reabsorption

• craniotabes (softening of skull)
• frontal bossing
• delayed closure of fontanelles
• tender swollen joints
• rickety rosary (expansion of costochondral joints)
• bowing of legs
• short stature
• dental deformities
• symptoms of hypocalcaemia

Question 6

What is the surgical management of achondroplasia?

Answer 6

1/20,000 live births

Lenghtening of limbs = arms lengthened to improve function e.g. toileting

Tibial osteotomy = correct bowing

Question 7

Give some causes of genu varum.

Answer 7

Bow legs (reduced Q angle)

• physiological
• rickets
• genetic/skeletal dysplasia
• trauma
• tumour
• infection
• Blount’s disease

Question 8

Give some causes of genu valgum.

Answer 8

Knock kneed (increased Q angle)

• physiological
• rickets
• genetic/skeletal dysplasia
• trauma
• tumour
• infection

Question 9

Describe some common paediatric fractures.

Answer 9

Greenstick = fracture of one cortex and plastic deformity of other cortex

Torus = plastic deformity of one cortex

Supracondylar = e.g. falling out of bunkbed with extended elbow, exclude injury to brachial artery and nerve, can damage growth plate

Question 10

What is a slipped upper femoral epiphysis?

Answer 10

Weakness of growth plate causes the femoral head to slip out of place —> hip/knee pain, stress fracture,

• atraumatic or traumatic
• stable or unstable

Management: surgical closure of epiphysis or corrective osteotomy

Question 11

What are some differentials for a limping child by age?

Answer 11

1-3yrs:

• acute infection (unable to weight bear), increased WCCs and CRP, temp. > 38.5
• transient synovitis
• DDH

4-10yrs:

• transient synovitis
• Perthes’ disease

11-15yrs: SUFE

Question 12

How long should a child refrain from sports after being in a cast?

Answer 12

Double time req. in cast e.g. 2wks in cast, then 4wks no sport

Question 13

What are the components of an emergency trauma paediatric assessment?

Answer 13

Condition 
Witness 
Incident 
Location 
Time 
Escort 
Demeanor

Question 14

What are some possible causes of a child with an intoeing gait?

Answer 14

Hips: femoral anteversion, increased external rotation

Knees: tibial anteversion, increased foot-tibial angle

Feet: metatarsus adductus

Question 15

What are some possible causes of a child with an outoeing gait?

Answer 15

Hips: developmental dysplasia of the hip

Knees: external tibial torsion or femoral retroversion