Peadiatic orthopeadics: an overview Flashcards
Why are children not small adults?
Anatomical differences
Biomechanical differences
Physiological differences
What is the anatomy of a child’s bone
Epiphysis Physis- growth plate Metaphysis Diaphysis-shaft Apophysis
What are the biochemical differences in chidlren?
Ligaments are stronger than the growth plate and so it is easy to produce epiphyseal seperation and more difficult to dislocate
Young bones are more porous, tolerates mroe deformities, fails in compression as well as tension leading to buckle and green stick fracture
What are the physiological differences in a childs bone?
Remodelling
Overgrowth
Progressive deformity
Speed of healing much faster
What are some handy terms to describe children who have strange bones that will naturally fix themselves
Normal variant Physiological development Self correcting pathology Examples include: Persistant femoral anteversion Metaatarsus adductus Posterior tibial bowing Curly toes
What is the david jones system of assesing an child in orthopeadics
5 S’s
Symmetrical Systemic illness Stiffness Skeletal deformity Symptomatic
What is the david jones system of assesing an child in orthopeadics
5 S’s
Symmetrical Systemic illness Stiffness Skeletal deformity Symptomatic
Where might intoeing problems stem from?
Femur- anteversion of the hip
Tibia-Internal tibial torsion
Foot-Normal beinding between 2nd and 3rd toe
What problems arise with knocked knees?
Wide varitaion in childre, those over 8 years may have an underlyign pathology
What do all babies naturally have?
Flat feet!
What to do in an appointment of a child with a self correcting pathology?
Take history
Examine chikd
Usually talk through examination
Reassure, show graphs if helpful
How can children with a self correcting pathology be clinically assessed?
Walking (if old enough) Standing (foot allignment) Patella postion Heels/arch/toes.leg length from behind Tip toe Staheli rotational profile
How do you perform a rotational profile examination
Supine- leg lengthsm hips, galeazzi, FFD, ROM
Prone- hip rotation/version, thigh/foot angel, foot bisector line
When should further investigations be considered?
Not age apporpriate Assymetry Rigid flat foot Bow legs (genu varum) Bounts Rcikets metatrsus adducots External tibial torsion Persistent femoral anteversion Curly toes
