Peadiatric Orthopeadics Overview

Question 1

what physiological differences are there between kids and adult ortho? (this is a bad question)

Answer 1

> overgrowth can occur
they heal faster
progressive deformity
remodelling

Question 2

what is the significance of younger bones being more porous?

Answer 2

> tolerates more deformity

> fails in compression tension causing buckle and greenstick fractures

Question 3

what is a greenstick fracture?

Answer 3

a fracture occurring in children where one side of the bone is broken and the other side is only bent

Question 4

in children are the ligaments or the growth plates stronger?

Answer 4

the ligaments

Question 5

what is the significance of the ligaments being stronger than the growth plates?

Answer 5

> sprain and dislocations are difficult to produce

> easy to produce epiphyseal separation

Question 6

what are normal features in development parents may worry is pathology?

Answer 6

> flat feet
> bow legs
> femoral anteversion
> out toeing
> in toeing
> knock knees
> tiptoe walking
> curved toes
> curved feet

Question 7

what is the david jones system for assessing a child?

Answer 7

> symmetrical?
> symptomatic?
> systemic illness?
> skeletal dysplasia?
> stiffness?

Question 8

what would you assess with the patient standing?

Answer 8

> walking
> alignment of the foot
> patellar position
> heels/arch/toes
> leg length
> staheli rotational profile

Question 9

what would you assess with the patient supine?

Answer 9

> leg length
range of movements of the hip
full flexion deformity?
galeazzi (checking hip dislocation)

Question 10

what changes to the lower limbs may require review at a later stage?

Answer 10

> bow legs (rickets)
asymmetry
rigid flat foot

Question 11

what lower limb differences may require treatment?

Answer 11

> tibial torsion
metatarsus adductus
persistent femoral anteversion
curly toes

Question 12

what might lead to intoeing?

Answer 12

> hip: natural changes (at birth there is more external rotation than internal rotation)
tibia: tibial torsion (this can be normal due to inutero moulding and tibial shape)
feet: metatarsus adductus (normal between the 2nd and 3rd toe, self correcting pathology)

Question 13

how would you know that in toeing was coming from the hip?

Answer 13

the knees would also face inward

Question 14

how would you assess if the in toeing was from the tibia?

Answer 14

look at the patellar position with feet/ankles facing forward