Paeds

Question 1

Langenskiold’s Classification

Answer 1

Blount’s Disease I - Irregularity of the growth plate, medial beaking of the metaphysis II - Saucer shaped defect in the medial metaphysis at its junction with the growth plate. Wedging of upper tibial epiphysis III - Deepening of saucer into a step in the metaphysis. Irregularity of medial epiphysis IV - Growth plate inclined distally at medial side. Irregularity of medial epiphysis. Epiphysis occupies step in metaphysis V - The epiphysis is split in two, with the medial aspect inclined distally; this gives the appearance of a double epiphyseal plate VI - The medial growth plate ossifies but the lateral part remains

Question 2

Waldenstrom’s stages

Answer 2

1. Initial (necrotic)
2. Fragmentation
3. Reossification
4. Remodeling

Question 3

Catteral’s Stages

Answer 3

Group I – involvement of the anterior portion of the capital epiphysis with no collapse or sequestrum

Group II – involvement of up to 50% with sequestrum formation

Group III – 75% involvement with collapse and sequestrum formation

Group IV – involvement of the entire capital epiphysis

Question 4

Herring Classification

Answer 4

1. Group A – no collapse of the lateral pillar and no significant radiolucency in the lateral pillar
2. Group B – The lateral pillar has retained at least 50% of its height, a width of more than a few mm and substantial ossification
3. Group B/C Border – added 2004 JBJS

A very narrow lateral pillar (2-3mm) which is >50% of the original height

A lateral pillar with very little ossification but with at least 50% of the original height

A lateral pillar with exactly 50% of original height that is depressed in relation to the central pillar

1. Group C – The lateral pillar has retained less than 50% of its height. The lateral pillar is always shorter than the central pillar in group C hips.

Question 5

Classification of SCFE

Answer 5

Chronological

Preslip Pain, no XR changes. Probably due to synovitis.

Acute Less than 3/52 sx. Found in 10-15% of patients.

Acute on chronic An acute exacerbation with a background of sx lasting longer than 3/52.

Chronic Sx lasting longer than 3/52. Found in around 80%.

Extent of Slip

Pre-slip No movement but pain and there may be widening or irregularity of physis

Mild Less than 1/3 slip

Moderate 1/3 to ½ slip

Severe Greater than ½ slip

Loder

Stable - Able to walk with or without crutches

Unstable - Unable to walk