Principles of Paediatric Orthopaedics

Question 1

What are the causes of intoeing and tripping?

Answer 1

• Femoral anteversion
• Int. tibial torsion
• Metatarsus adductus

Question 2

Is femoral anteversion a developmental norm?

Answer 2

Yes

Question 3

What does internal tibial torsion look like and how can it be treated?

Answer 3

• Increased thigh foot angle
• 90% spontaneously resolve
• Splints, wedges and insoles

Question 4

How can gait be analysed?

Answer 4

• Observation
• Video
• 3D instrumented: lab, force plate and EMG

Question 5

What is a gait cycle?

Answer 5

Single sequence of functions by one limb

Question 6

What is a step length?

Answer 6

Distance between corresponding successive points of heel contact of the opposite feet

Question 7

What is stride length?

Answer 7

The distance between successive points of heel contact of the same foot

Question 8

What is a walking base?

Answer 8

The side to side distance between the line of the two feet

Question 9

What is a cadence?

Answer 9

The number of steps per unit time (Normal is 100-115 steps/min)

Question 10

What are the phases and components of a gait cycle?

Answer 10

• Stance phase
• Swing phase
• Single support
• Double support

Question 11

What are the subdivisions of the stance phase of the gait cycle?

Answer 11

• Heel contact
• Foot flat
• Mid stance
• Heel off
• Toe off

Question 12

What are the subdivisions of the swing phase of the gait cycle?

Answer 12

• Acceleration
• Mid swing
• Deceleration

Question 13

List the common gait abnormalities

Answer 13

• Antalgic gait
• Lateral trunk tilt - Trendelenberg
• Functional leg-length discrepancy
• Increased walking base
• Inadequate dorsiflexion control
• Excessive knee extension

Question 14

What are the features of an antalgic gait and what are the common causes?

Answer 14

• The stance phase on the affected side is shortened
• Corresponding increase in stance on unaffected side
• Splinter in foot, OA and tendinitis

Question 15

What are the features of a lateral trunk tilt (Trelenberg gait) and what are the common causes?

Answer 15

• Usually unilateral
• Bilateral = waddling gait
• Painful hip, hip abductor weakness, leg-length discrepancy and abnormal hip joint

Question 16

What are the features of functional leg length discrepancy and name the four common compensations?

Answer 16

• Swing leg is longer than stance leg

- Circumduction, hip hiking, steppage and vaulting

Question 17

What are the common causes of an increased walking base?

Answer 17

• Deformities: abducted hip and valgus knee

- Instability: cerebellar ataxia and proprioception deficits

Question 18

What are the features of inadequate dorsiflexion control and what are the common causes?

Answer 18

• In stance phase: foot slap
• In swing phase: toe drag
• Weak tibialis anterior and spastic plantarflexors

Question 19

What are the features of excessive knee extension and what are the common causes?

Answer 19

• Loss of normal knee flexion during the stance phase
• Knee can go into hyperextension
• Hyperextension deformity of the knee
• Quadriceps weakness, quadriceps spasticity and knee flexor weakness

Question 20

What are the five S’s for identifying pathology ?

Answer 20

• Symptoms: night pain and NWB
• Symmetry: lack of it
• Stiffness: of joints and paralysis
• Syndromes
• Systemic illness: pyrexia

Question 21

If a child has night pain which two conditions would you want to rule out?

Answer 21

• Tumour

- Infection