Principles of Paediatric Orthopaedics Flashcards
Why is children’s fracture management different to adults?
Children’s bone is better at remodelling
What is meant by manufacturing problems and packaging problems?
Manufacturing- more major problems which occur early stages of embryological development
Packaging- basically normal child but has been a bit squashed in the womb, things will improve after delivery
Where does longitudinal growth occur?
Epiphyseal growth plate
Spina bifida?
Spinal cord is at skin surface, as notochord doesn’t close. Can sometimes covered by a thin layer of skin.
Leaves child with neurological problem
Proximal femoral focal syndrome?
Child has some pieces of their femur missing
->can vary between a small part of femur missing to half of it missing
TAR syndrome?
Bilateral absent radius bone
Thalidomide?
Lack of limbs due to thalidomide drug for morning sickness
->still given for myeloma
Congenital scoliosis?
Abnormality of bones; vertebrae may form a joint together on only one side for example
In which children does packaging defects more commonly occur?
First child as uterus is smaller
Metatarsus adductus?
Bent foot- foot gets squashed in utero
How does metatarsus adductus resolve?
After birth, can massage the foot and it gets better
Infantile postural scoliosis?
Infant born with curved spine but normal spine on x-ray
->only scoliosis type which does not progress
Only type of scoliosis more common in boys?
Infantile postural scoliosis
->occurs in utero and 75% of cases get better within first year
Plagiocephaly?
Flat head- squashed
->goes normal a few months after delivery
Congenital torticolis?
Child is born looking to one side
Treating by massaging muscle
What is Talipes Equino-Varus also known as?
Club foot
In toeing?
When walking forwards, child’s feet are turning inwards
If a newborn has in-toeing, where is the problem occurring?
Foot
If an infant has in-toeing, where is the problem occurring?
Tibia
If a school age child has in-toeing, where is the problem occurring?
Femur
Which age group tends to more commonly get in toeing?
Children aged 2-5, affects 1 in 10
When is the one time in toeing will not get better?
If a child is born with neuromuscular disease e.g. cerebral palsy
What is meant by bowed legs?
Bent legs where the distance between ankles is less than the distance between knees
Treatment for bowing of legs?
Not required- this is a physiological occurrence and by teens, most legs have straightened out
When you you refer a child to orthopaedics with an angular lower limb deformity?
If it is asymmetric
Abnormal for age (e.g. leg bowing occurring >18 months or knee knocking occurring > 7yrs)
->don’t get too bogged down by ages, this is a guide used to Aberdeen, just think it abnormal for age or asymmetric
Are flat feet normal at brith?
Yes- bones of foot have not ossified
Reducing with age and arches form so no treatment needed.
Which factors increase risks of a child having flat feet?
Those who wear shoes (study done in tribes where some children wore shoes and other didn’t), obesity and ligament laxity
Management of flat feet?
No management required- no benefit of arch supports or insoles
Curly toe?
Curly toe- it is what it is
Which toes are more commonly affected by curly toe?
3rd or 4th toe
Management of curly toe?
None required- taping does not help in long term.
1/4 resolve spontaneously.
If causing a functional problem e.g. nail digging into other toe, tenotomy may be considered if over age of six
What is the average walking age?
12 months
->but very wide spectrum of normal
5 S’s of when to refer to paediatric orthopaedics?
Symptoms
Symmetry (asymmetrical is the reason to refer though)
Stiffness
Syndromes
Systemic illness
