Principles of Paediatric Orthopaedics Flashcards
what is paediatric orthopedics?
•The part of Orthopaedics that concentrates on the study of diseases and injuries affecting individuals with immature musculoskeletal systems and how these pathologies can be managed
Child bone different form adult in may ways
Main different is that there is a growth plate that allows for longitudinal growth but once this fuses skeletal maturity has been achieved
what sort of things are odone and involve din paediatric orthopedics?
- Fracture Treatment
- Management of orthopaedic conditions unique to childhood (big 3)
- Management of conditions that are affected by development and growth
- MSK variants that cause concern
infant abnormalities - what are some manufacturing defects?
- Spina Bifida - Spina bifida is when a baby’s spine and spinal cord does not develop properly in the womb, causing a gap in the spine. Spina bifida is a type of neural tube defect
- Proximal femoral focal deficiency - rare, parts of femur is missing, cant reverse pathology but can improve function
- TAR Syndrome - thrombocytopenia with absent radius, cant operate as have absent platelets so will haemorrhage so need to deal with platelet problem, absence of the radius bone in the forearm and a dramatically reduced platelet count
- Thalidomide - not common now, medication, used for mothers with sickness in pregnancy
- Congenital scoliosis - coronal deviation of the spine that is more than 10 degrees
infant abnormalities - what are some packaging defects?
Most of these resolve
Packaging issues normally present together
- Metatarsus Adductus - a common foot deformity noted at birth that causes the front half of the foot, or forefoot, to turn inward
- Infantile postural scoliosis - idiopathic condition that affects children before the age of 3 and is characterized by the presence of an abnormal curve of the spine to the right or the left
- Plagiocephaly - a condition characterized by an asymmetrical distortion (flattening of one side) of the skull. It is characterized by a flat spot on the back or one side of the head caused by remaining in a supine position for prolonged periods
- Congenital Torticolis - a condition in which an infant holds his or her head tilted to one side and has difficulty turning the head to the opposite side, shortening of SCM
infant abnormalities could be either manufacturing or packaging defects such as what?
Talipes Equino-varus
Postural easily corrected by splintage but may have underlying bone abnormality that is resistant to treatment
Clubfoot is a common foot abnormality, in which the foot points downward and inward. The condition is present at birth, and involves the foot and lower leg. It occurs twice as often (2:1) in males than in females. It may affect one or both feet (50 % are bilateral)
what are some MSK issues that cause concern?
- In toed gait
- Bow legs
- Flat feet
- Curly Toes
- Late walkers
what is in toeing? and who does it occur in?
Toes point in
1:10 Children aged 2-5
Newborn problem with Foot
Infant problem with Tibia
School age problem with Femur
Does not improve in neuromuscular disease
what is Femoral anteversion?
an inward twisting of the thigh bone. Femoral anteversion causes the child’s knees and feet to turn inward, or have what is also known as a “pigeon-toed” appearance
- Developmental norm
- 40 degrees at birth
- 1-2 degrees decrease per year
- 80% reach 10 degrees by 16yoa
what is Internal tibial torsion?
an inward twisting of the tibia, which leads to in-toeing of the foot. Although it may not be noticeable until your child starts to walk, this condition is often present since birth. Internal tibial torsion usually affects both legs and could be related to the child’s position in the uterus
- Increased thigh foot angle
- 90% + spontaneously resolve
- No role for splints, wedges, physio etc
If foot turns in then they have internal tibial torsion and if foot goes out then that is normal
what is Metatarsus adductus?
a common foot deformity noted at birth that causes the front half of the foot, or forefoot, to turn inward
- 90% resolve by 1y
- Stretching ?
- 5% adulthood
- If flexible, no role for splintage
If passively correctable then all that is needed is reassurance
Intoeing – referral & outcome
- n=202 referrals in 33/12
- Median referral age = 4
- 86% reassured at first visit
- We never operate before 10 yoa
Surgical correction only thought about at high school age if the patient has ongoing symptoms
Bowing in coronal plane how does it present?
- Bent legs
- Mostly Physiological
- Treat rarely
Non physiological causes need to be identified but rare as mostly physiological
what is the progession of bowing of the legs as children grow?
Starts in varus then neutral then valgus and then stabilises at adult normal
when should children be referred?
showing when children should be referred
what are some key questions in regards to flat feet?
- What is a flat foot?
- Does it cause problems?
- What is the natural history?
- Do treatments help?
- What to tell patents
whata re flexible flat feet?
- Normal at birth
- Diminishes with age
- Insoles = No benefit
When children stands the medial longitudinal arch is not evident
Jacks test - If lift big toe up then heel turns into varus and the medial longitudinal arch forms and this is called mobile flat foot which is normal variant
Small group of children have a stiff flat foot and have an underlying pathological cause
a common concern is curly toes, why and who does it occur in?
Usually 3rd or 4th toe
Strong Family History
Tightness flexor tendons
Taping no help in long term
Mostly cosmetic problem
¼ improve spontaneously
Most children stretch out the flexor tendons as they develop and adopt a normal shape
If functional problem consider flexor tenotomy (the surgical cutting of a tendon) if over 6 years
what is the walking age?
- 12 months = Mean
- ‘Normal’ not equal Mean
- 50% of children walk later than the mean
Normal is not the same as the mean
