Peadiatric Orthopaedics Flashcards
When is a deformity significant?
if it is likely to persist and cause physical or mental health problems later in life
by what process do bones grow?
enchondral ossification
what is another name for the growth plate of a bone?
physis
bones grow in a _______ direction from teh growth plate
longitudinal
name some factors affecting the growth plate
diet/nutrition
Vitamins (D & A)
injury
illness
hormones (GH)
desrcibe varum knee alignment
‘bow legged’ the knees face out the way
describe valgum knee alignment
‘knock kneed’ knees facing in the way
genu varum is normal up until what age?
<2yrs old
give examples of pathological genu varum
skeletal dysplasia
rickets
tumour
blounts disease
trauma
what is blounts disease?
growth arrest of the medial tibial physis
what casues blounts disease?
unkown aetilogy (possibly due to weight overload)
give some examples of pathological genu valgum
tumours
rickets
neurofibromatosis
idiopathic
when does genu valgum peak?
age 31/2
what is the management of genu valgum?
chart and monitor
If asymmetric or painful then refer
under what circumstance would surgery be considered for gune valgum?
if at age 11 the intermalleolar distance was >8cm
describe intoeing
child walks with toes ponting inwards (pigeon toed)
what could intoeing be related to?
femoral neck anteversion
internal tibial torsion
metatarsus adductus
what is the mean degree of rotation of the femoral neck at birth?
30-40o
what should the mean degree of rotaion of the feumr be at maturity?
10-15o
femroal anteversion can predispose what problem?
patellofemroal problems
internal tibial torsion is mostly seen in what age group? the vast majority resolve by what age?
usually seen in toddlers (1-3yrs) and resolves by 6 yrs
is bracing and orthotics necessary for internal tibial torsion?
no- they are ineffectieve andnot required
what can be used to correct metatarsal adductus if it does resolve?
casting may help between 6 and 12 months old
how is intoeing managed?
define the cause
chart/photograph
review and discharge
how common is flat feet in adults?
1 in 5
everyone is born wth flat feet but what develops to correct this?
medial arch- this develops as tibialis posterior strengthens
in flat feet what can be used to determine if it is fixed or flexible?
gastocsoleoeus complex
in rigid flat foot there may be an underlying bony connection, what is this called?
tarsal coalition
curly toes affects who and which toes?
common in younger children and mostly 3rd or 4th toes
splinting and tapign are effective in curly toes true/false?
false- they are ineffective
in rarely perssiting cases of curly toes what surgical intervention may be carried out?
felxor tenotomy
anterior knee pain more commonly affects males or females?
females
if someone presents with knee pain what should you always check in the examintation?
Hips- there could be an obstruction to obturator nerve
what is the management for most cases of anterior knee pain?
physiotherapy
what is a common paediatric hip problem?
Developmental Dysplasia of the Hip (DDH)
DDH commonly affects girls/boys more?
girls
which hip is DDH more common in?
left (20% cases are biliateral)
what kind of tests are the Ortolani and Barlow?
Instability tests
what doe the Ortolani test, test for?
tests for posterior dislocation and identifies dislocated hip that can be reduced
when is the Ortolani test positive?
if the hip is dislocated
what does the Barlow test, test for?
tests for dislocatable hip
hips that can be pushed out with gentle pressure
of those with a positvie barlow test how many spontaneously resolve?
80% resolve spontaneously
at what age do the ortolani and barlow tests become unreliable?
after 6 weeks
what is key to successful treatment of DDH?
early diagnosis
how are dislocated/ persistently unstable hips in newborns treated?
reduced and held with speical pavlik harness
how are mild cases of DDH treated in newborns?
close observation and serial examination
late diagnosis of DDH results inw hat treament?
open reduction
late presentation of DDH (>2yrs) will likely result in what to treat?
combined femoral and acetabular surgery
what is the treatment for infection in a joint?
antibiotics
aspiration/arthrotomy
what is transient synovitis?
inflammation of the synovium of a joint- commonly hip
transient synovitus usuallu occurs after what?
upper RTI
