Principles of paediatric orthopaedics Flashcards
What is the overall aim in paediatric orthopaedics
To improve the growth of the child until they reach skeletal maturity
This includes fracture treatment, management of orthopaedic conditions unique to childhood etc
What are the two main types of defects/abnormalities seen in infants?
- Manufacturing defects
- Packaging defects
What is meant by a manufacturing defect?
A defect that occurs during foetal development that has long term problems i.e spina bifida, proximal femoral focal deficiency (parts of femur are missing during development), congenital scoliosis
What is a meant by a packaging defect?
- A defect caused by how the baby is positioned or pressure in the womb
- Usually when the forces are reversed then these get better.
- There is no underlying manufacturing problem – the limbs are normal and generally these things do well. i.e. Plagiocephaly, infantile postural scoliosis, metatarsus adductus
What are some common normal variant MSK issues seen in infants that often cause concern for parents etc? (5)
- In toed gait
- Bow legs
- Flat feet
- Curly Toes
- Late walkers
What ways can a doctor examine an infant for in toeing?
- Gait angle - is it at an angle whilst walking?
- Forefoot alignment - are the top parts of your feet at the same angle
- Thigh foot angle
- Hip rotation
What is meant by a ‘normal variant’?
An atypical finding that is seen in a percentage of the population, which generally has no clinical significance, and is considered within the spectrum of normal findings
What is in toeing?
In-toeing is where the toes point inwards and can be caused by in-turning at the level of the hips, tibias or feet.
- In newborns - commonly see in-turning of the foot
- Infant - commonly see in-turning of the tibia
- School age - commonly see in-turning of the femur
Affects 1 in 10 children. The vast majority improve but it does not improve in neuromuscular disease i.e cerebral palsy
Bent legs
A rotational deformity
- There’s massively increased range of internal rotation in the hips
- Increased femoral anteversion (inward twisting of the femur causing the knees and feet to turn inward) and an increased range of movement.
- This is a developmental norm and most children have a 40 degree anteversion at birth. Normally there is a 1-2 degree decrease per year and 80% of children reach 10 degrees by 16 years of age
- Rarely treat
What is internal tibial torsion?
An increased thigh foot angle - imagine a line drawn in the centre of the thight and foot - measure the angle between them
- 90% of these spontaneously resolve
- Common cause of intoeing in toddlers
- Thought to be due to intrauterine positioning
- No role for splints, wedges, physio etc
What is metatarsus adductus?
Medial rotation of the forefoot or midfoot
- 90% resolve by 1 year
- It can be graded either by how severe it is or whether it can be corrected passively
- If it is passively correctible this means it can manipulated back into normal position by pushing it for example - flexible
- If it is flexible then there is no role for splintage
Flat feet
Flat foot is normal at birth and diminishes with age
- Seen in all infants
- Only 15% continue into adulthood
- In adults, it is more common in patients wearing the wrong footwear, obese patients and those with ligament laxity (loose)
Curly toes
- Usually seen in the 3rd or 4th toe
- Strong FH associated with this
- Mostly cosmetic problem
- 1/4 improve spontaneously
When is the average age an infant starts to walk?
12 months
but this can vary - 50% of children walk later than this
If a child hasn’t started walking by 18 months then this is a concern
