Principles of Paediatric Orthopaedics

Question 1

When does most of musculoskeletal development occur during foetal development?

Answer 1

First 4-8 weeks of foetal life

Question 2

What is spina bifida?

Answer 2

Congenital disorder in which spinal cord is exposed on outer surface of skin, instead of trapped within the spinal cord

• Can close skin to prevent infection, but child is left with longterm motor issues

Question 3

What is proximal femoral focal deficiency?

Answer 3

When proximal portion of femur is missing in child due to improper development

Question 4

What are some other examples of congenital “manufacturing defects”?

Answer 4

TAR syndrome - thrombocytopenia + absent radius

Thalidomide - drug given to pregnant women, can result in children with absent / underdeveloped limbs

Congenital scoliosis

Question 5

What are manufacturing and packaging defects of children’s orthopaedics?

Answer 5

• Manufacturing: abnormal development due to genetic abnormalities / teratogens
• Packaging: the foetus is orientated differently within the utero, providing abnormal pressure on limbs which can lead to abnormal appearance (usually reversible)

Question 6

What are some examples of packaging defects?

Answer 6

• Metatarsus adductus (abnormal curvature of metatarsal)
• Infantile postural scoliosis
• Plagiocephaly (flattening of vertex of skull - will usually reverse)
• Congenital Torticolis (shortening of SCM due to early engagement of head into pelvis - thought to be due to ischaemic conditions created by compression)

Question 7

Example of a defect that could be either a packaging or a manufacturing defect?

Answer 7

Talipes Equino-varus

-AKA clubfoot: common foot abnormality in which the foot points downward and inward

Question 8

What are 5 MSK abnormalities that cause a lot of concern that is often unfounded?

Answer 8

1. In toed gait
2. Bow legs
3. Flat feet
4. Curly toes
5. Late walkers

Question 9

What is in-toed gait? Where does this abnormality originate on the child’s anatomy? Prognosis?

Answer 9

When the child walks their toes are pointed inward, rather than being straight on

Problem can originate at foot, tibia or femur

Usually resolves with time but will not improve in neuromuscular disease

Question 10

Possible causes of in toed gait?

Answer 10

• Femoral anteversion: inward twisting of femur, increases internal rotation ROM, corrects by 16yo in 80%
• Internal tibial torsion: increased thigh-foot angle, 90% + spontaneously resolve
• Metatarsus adductus: 90% resolve by 1y, only about 5% progress into adulthood

Question 11

How does bowed legs tend to progress?

Answer 11

Between the ages of 2-7 bow legging can occur as part of development

Usually resolves after 7 years of age

Question 12

What test can determine whether a flat foot is pathological or part of normal development?

Answer 12

Is the flat foot flexible or fixed

If flexible it’s fine, if fixed it may be due to developmental pathology

Question 13

When should surgical treatment be considered for abnormally curly toes?

Answer 13

When the toe is providing functional problems and the child is over the age of 6

Otherwise should spontaneously resolve