Paeds

Question 1

club foot
Talipes equinovarus (CTEV)

Answer 1

Mid foot, tubtalar and ankle jnt deformity.
Inversion, adduction rel to varus hindfoot, equinus plantarflexion deformity.
Ponsetti long leg grad adjusted cast tx. Surgery if not resp or recurr. Soft tiss rel btw 6-12month.

Question 2

Supracondylar frac

Answer 2

Risk brachial A dam and N stretch.

Question 3

Genu varum bow legs

Answer 3

Causes- physiol, rickets, genet/skel dysplasia, trauma, tum, infec, blounts dis.
Normal if under 18-24 mnths then should resolve.

Question 4

Genu valgum knock knee

Answer 4

Causes- physiol, rickets, genet/skel dysplasia, trauma, tum, infec.
Normal process- 3-4yo up to 20 degs, rarely worsens after 7yo, after 7yo shouldnt be over 12 degs, after 7yo intermalleolar dist should be under 8cm.

Question 5

Femoral neck anteversion

Intoeing

Answer 5

Surgical tx indicated for all over age 10 with sympomatic marked persis fem anteversion.
Other cuases of intoeing- metatarsus adductus and tibial torsion.

Question 6

flexible vs rigid flat foot
Check for hyperflexibil
Normal when learning to walk, arch forms in first few yrs.

Answer 6

Flexible more comm- can form arch but flattens under weight.
Rigis cant form arch.
Pes planus- medial longit arch collapse. Post tibialis tend dysfunc in adults.
Often asymp.
Can get pain medially over PTT, and prog forefoot abduc and hindfoot valgus with loss abil to heel rise.
Also can get foot fatigue, reduc mobil, ankle instabil, callosities.
Tx- orthoses, custom shoe, soft tiss rel, tend transfer, arthrodesis.

Question 7

Slipped upper femoral epiphysis
displ through GP, epiph always slips down and back
Stress frac x GP in upper femur
Adolescents

Answer 7

Px- groin/ant thigh/knee pain, 90% are stable so can weight bear, lim flex/abduc/med rot.
Tretjowans line XR
Tx cannulated screw
Delay dx can cause slip prog, AVN, malunion and fut OA/instabil.
Tx- early int fixat

Question 8

limping child

Answer 8

1-3 yo infec, transient synovitis, DDH.
4-10 yo infec, trnasient synovitis, perthes.
11-15 yo infec, SUFE.

Question 9

septic arhtritis

Answer 9

Cant weight bear, or rigid jnt in pre walkers.
Pyrexic
Raised WCC
Raised CRP

Question 10

DDH

Range from stable acetabular dysplasia to disloc.

Answer 10

Tested at birth- ortolani abduc reduces disloc, barlow adduc provokes disloc.
Early dx imp as early alignment of dypalstic hip can spont resolve. Delay means complex tx less succ.
Classic px- one leg shorter and abducts less.
RFs- breach birth, caesarian for breach, other malformations, sibling with ddh, high birth weight, oligohydramnios, older mother, postmaturity.
Ix- US if under 4.5mnth, XR fo older.
XR perkins line, hilgenrein.
Pavlik harness good outcome if tx as neon, holds in ortolani.
Tx for unstable hips-
6-18mth- arthrography, closed reduc, somet open.
After 18 mnth- open reduc.

Question 11

perthes

Answer 11

Idiopathic de novo AVN of femora head. Self heal but Epiph regen forms oval shape head of femur.
Reossif occurs lat to med.
Int rot and abduc esp lim.
Jnt sp widening on XR and MRI, then smaller deformed fem head.
Risks early OA.
If sev req jnt repl. Varus osteotomy if head had subluxated. Ext fix with hip brace another option but not ideal.
Less sev rest, NSAID, XR monit

Question 12

Hip pain diffs

Answer 12

Septic arth
Tubercular arth
Perthes
SUFE
Inflamm arth
Osteomyelitis
Transient synovitis

Question 13

Cerebral palsy

Answer 13

GMFCS grades of motility.
MSK symps progress, neuro dont.
Comm acq hip disloc due to neuromusc damage- tx to correct posture.

Question 14

supracond frac

Answer 14

Median N
Brachial A
Cubitus varus