Peadiatric Orthopaedics

Question 1

When is a deformity significant?

Answer 1

if it is likely to persist and cause physical or mental health problems later in life

Question 2

by what process do bones grow?

Answer 2

enchondral ossification

Question 3

what is another name for the growth plate of a bone?

Answer 3

physis

Question 4

bones grow in a _______ direction from teh growth plate

Answer 4

longitudinal

Question 5

name some factors affecting the growth plate

Answer 5

diet/nutrition

Vitamins (D & A)

injury

illness

hormones (GH)

Question 6

desrcibe varum knee alignment

Answer 6

‘bow legged’ the knees face out the way

Question 7

describe valgum knee alignment

Answer 7

‘knock kneed’ knees facing in the way

Question 8

genu varum is normal up until what age?

Answer 8

<2yrs old

Question 9

give examples of pathological genu varum

Answer 9

skeletal dysplasia

rickets

tumour

blounts disease

trauma

Question 10

what is blounts disease?

Answer 10

growth arrest of the medial tibial physis

Question 11

what casues blounts disease?

Answer 11

unkown aetilogy (possibly due to weight overload)

Question 12

give some examples of pathological genu valgum

Answer 12

tumours

rickets

neurofibromatosis

idiopathic

Question 13

when does genu valgum peak?

Answer 13

age 3¹/₂

Question 14

what is the management of genu valgum?

Answer 14

chart and monitor

If asymmetric or painful then refer

Question 15

under what circumstance would surgery be considered for gune valgum?

Answer 15

if at age 11 the intermalleolar distance was >8cm

Question 16

describe intoeing

Answer 16

child walks with toes ponting inwards (pigeon toed)

Question 17

what could intoeing be related to?

Answer 17

femoral neck anteversion

internal tibial torsion

metatarsus adductus

Question 18

what is the mean degree of rotation of the femoral neck at birth?

Answer 18

30-40^o

Question 19

what should the mean degree of rotaion of the feumr be at maturity?

Answer 19

10-15^o

Question 20

femroal anteversion can predispose what problem?

Answer 20

patellofemroal problems

Question 21

internal tibial torsion is mostly seen in what age group? the vast majority resolve by what age?

Answer 21

usually seen in toddlers (1-3yrs) and resolves by 6 yrs

Question 22

is bracing and orthotics necessary for internal tibial torsion?

Answer 22

no- they are ineffectieve andnot required

Question 23

what can be used to correct metatarsal adductus if it does resolve?

Answer 23

casting may help between 6 and 12 months old

Question 24

how is intoeing managed?

Answer 24

define the cause

chart/photograph

review and discharge

Question 25

how common is flat feet in adults?

Answer 25

1 in 5

Question 26

everyone is born wth flat feet but what develops to correct this?

Answer 26

**medial arch**- this develops as tibialis posterior strengthens

Question 27

in flat feet what can be used to determine if it is fixed or flexible?

Answer 27

gastocsoleoeus complex

Question 28

in rigid flat foot there may be an underlying bony connection, what is this called?

Answer 28

tarsal coalition

Question 29

curly toes affects who and which toes?

Answer 29

common in younger children and mostly 3rd or 4th toes

Question 30

splinting and tapign are effective in curly toes true/false?

Answer 30

false- they are ineffective

Question 31

in rarely perssiting cases of curly toes what surgical intervention may be carried out?

Answer 31

felxor tenotomy

Question 32

anterior knee pain more commonly affects males or females?

Answer 32

females

Question 33

if someone presents with knee pain what should you always check in the examintation?

Answer 33

**Hips**- there could be an obstruction to obturator nerve

Question 34

what is the management for most cases of anterior knee pain?

Answer 34

physiotherapy

Question 35

what is a common paediatric hip problem?

Answer 35

**D**evelopmental **D**ysplasia of the **H**ip (DDH)

Question 36

DDH commonly affects girls/boys more?

Answer 36

girls

Question 37

which hip is DDH more common in?

Answer 37

left (20% cases are biliateral)

Question 38

what kind of tests are the **Ortolani** and **Barlow**?

Answer 38

Instability tests

Question 39

what doe the **Ortolani** test, test for?

Answer 39

tests for posterior dislocation and identifies dislocated hip that can be reduced

Question 40

when is the **Ortolani** test positive?

Answer 40

if the hip is dislocated

Question 41

what does the **Barlow** test, test for?

Answer 41

tests for dislocata**b**le hip hips that can be pushed out with gentle pressure

Question 42

of those with a positvie barlow test how many spontaneously resolve?

Answer 42

80% resolve spontaneously

Question 43

at what age do the ortolani and barlow tests become unreliable?

Answer 43

after 6 weeks

Question 44

what is key to successful treatment of DDH?

Answer 44

early diagnosis

Question 45

how are dislocated/ persistently unstable hips in newborns treated?

Answer 45

**reduced** and held with speical **pavlik harness**

Question 46

how are mild cases of DDH treated in newborns?

Answer 46

close observation and serial examination

Question 47

late diagnosis of DDH results inw hat treament?

Answer 47

open reduction

Question 48

late presentation of DDH (\>2yrs) will likely result in what to treat?

Answer 48

combined femoral and acetabular surgery

Question 49

what is the treatment for infection in a joint?

Answer 49

antibiotics aspiration/arthrotomy

Question 50

what is transient synovitis?

Answer 50

inflammation of the synovium of a joint- commonly hip

Question 51

transient synovitus usuallu occurs after what?

Answer 51

upper RTI