Paeds Ortho and Normal Variation

Question 1

What are the biomechanical differences in childrens bones comprared to adult bones?

Answer 1

Ligaments stronger than growth plates (epiphiseal separation)
Bones more porous and plastic

Question 2

What are the self correcting pathologies seen in children’s bones?

Answer 2

Persistent femoral anteversion
Metatarsus adductus
Posterior tibial bowing
Curly toes

Question 3

What parental concerns in skeletal development should be concerning to parents?

Answer 3

Out/in-toeing
Bow legs
Knock knees
Tiptoe walking
Flat feet
Curved feet
Curly toes

Question 4

What are the David Jones 5S’s?

Answer 4

Symmetrical
Symptomatic
Systemic illness
Skeletal displasia
Stiffness

Question 5

How is intoeing examined?

Answer 5

Identify origin of rotation (hip, tibia, foot)
Assess rotation in that area
Femoral retro/anteversion

Question 6

How do you assess the tibia as cause of intoeing?

Answer 6

Thigh foot angle technique

Patellae position with feet/ankles facing forwards

Question 7

How do you assess the foot as cause of intoeing?

Answer 7

Check forefoot adduction - metatarsus adductus

Question 8

How do you examine for the natural development of the feet?

Answer 8

Arch development
Heel raise test
Jacks test
Foot progression in gait

Question 9

What child orthopaedic presentations require further investigation/review?

Answer 9

Asymmetry
Rigid flat foot
Bow legs