Pediatric Orthopedic Conditions

Question 1

List 3 deformities that can lead to in-toeing (pigeon toed).

Answer 1

Metatarsus adductus
Internal tibial torsion (most common cause)
Increased femoral anteversion

Question 2

What is the difference between femoral anteversion vs retroversion?

Answer 2

Anteversion = in toeing with femoral neck angle >25-30 degrees

Retroversion = out toeing with femoral neck angle <10 degrees

Question 3

What is the most common congenital foot deformity?

Answer 3

Metatrsus aducutus (forefoot points inward)

Question 4

What is talipes equinovarus?

Answer 4

Clubfoot

Foot is plantarflexed, adducted and inverted

Question 5

How is talipes equinovarus treated?

Answer 5

Casting, splinting, stretching and in severe cases, surgery is required

Question 6

What is the difference between genu valgum and varus?

Answer 6

Valgum = excessive medial tibial torsion
Varus = excessive lateral tibial torsion

Question 7

Describe the age norms for genu varum and valgus (5).

Answer 7

1. Genu varum is normal in newborns and infants
2. Maximal varum present at 6-12 months of age
3. LE gradually straighten with a zero tibiofemoral angle by 18-24 months
4. Knees gradually drift into valgus and is maximal around 3-4 years with an average medial tibiofemoral angle of 12 degrees
5. Genu valgum spontaneously corrects by age 7 to the adult alignment of LE

Question 8

What are the normal values of genu valgum in males versus females?

Answer 8

Males = 7 degrees
Females = 8 degrees

Question 9

What is hip dysplasia?

Answer 9

Abnormality in the size, shape, orientation or organization of the femoral head, acetabulum or both.

Question 10

List 5 diagnostic tests that should be performed when assessing an infant for hip dysplasia.

Answer 10

Barlow test
Ortolani test
Limited hip abduction
Galeazzi sign
Klisic sign

Question 11

What is the gold standard treatment for hip dysplasia?

Answer 11

Pavlik harness

Question 12

What is transient synovitis?

Answer 12

Acute onset of sudden hip pain in children ages 3-10

Transient inflammation of the synovium of the hip

Question 13

List 5 signs and symptoms of transient synovitis.

Answer 13

1. Unlilateral hip or groin pain
2. Crying at night
3. Antalgic limp
4. Recent hx of upper respiratory tract infection
5. Decreased hip abduction and IR with clinical exam

Question 14

What is Legg-Calve-Perthes Disease? What is visible on an MRI?

Answer 14

Blood supply is interrupted to the femoral head

MRI shows positive bony crescent sign

Question 15

List 3 clinical signs of Legg-Calve-Perthes Disease.

Answer 15

1. Characteristic psoatic limp due to weakness of psoas major; moves in ER, flexion and adduction.
2. Gradual onset of aching pain at hip, thigh and knee
3. AROM limited in abduction and extension

Question 16

What occurs with a slipped capital femoral epiphysis?

Answer 16

Femoral head is displaced posteriorly and inferiorly in relation to the femoral neck and within the confines of the acetabulum.

Question 17

List 3 clinical signs of a slipped capital femoral epiphysis.

Answer 17

1. AROM restricted in abduction, flexion and IR
2. Pain is described as vague at knee, thigh and hip
3. Positive Trendelenburg gait in chronic cases

Question 18

How is a slipped femoral capital epiphysis treated?

Answer 18

Operative internal fixation to prevent avascular necrosis

Question 19

What is the most common cause of heel pain in growing children?

Answer 19

Sever’s disease (calcaneal apophysitis)

Caused by repetitive microtrauma due to increased traction by the Achilles tendon on its insertion site

Question 20

What are characteristics of growing pains?

Answer 20

Pain in bilateral legs at night that is not associated with redness, temperature, swelling or tenderness

Question 21

What is Panner’s disease?

Answer 21

Localized avascular necrosis of the capitulum leading to loss of subchondral bone

Question 22

What is plagiocephaly?

Answer 22

Development of a flat spot on the back or side of the head as the skull is soft and malleable