Principles of Paediatric Orthopaedics

Question 1

What are some “manufacturing” defects in infants?

Answer 1

• Spina Bifida - spinal cord exposed on outer skin
• Proximal femoral focal deficiency - parts of femur are missing
• TAR (thrombocytopenia with absent radius) Syndrome
• Thalidomide
• Congenital scoliosis

Question 2

Name some “packaging” defects in infants?

Answer 2

• Metatarsus Adductus
• Infantile postural scoliosis
• Plagiocephaly - rarely needs intervention
• Congenital Torticolis - potentially a vascular issue, rarely requires surgery
• These defects can often be fixed once pressure removed out of womb

Question 3

What is a defect that can be developmental or “packaging”?

Answer 3

•Talipes Equino-varus - club foot

Question 4

What are some MSK issues that cause concern?

Answer 4

• In toed gait
• Bow legs
• Flat feet
• Curly Toes
• Late walkers

Question 5

What is paediatric orthopaedics?

Answer 5

• 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
• Fracture Treatment
• Management of orthopaedic conditions unique to childhood
• Management of conditions that are affected by development and growth
• MSK variants that cause concern

Question 6

What is “in toeing”?

Answer 6

• A foot progression angle that is negative - toes point in

* Vast majority improve but not those due to neuromuscular disease

Question 7

What is “in toeing” often caused by in the newborn?

Answer 7

Foot

Question 8

What is “in toeing” often caused by in the infant?

Answer 8

Tibia

Question 9

What is “in toeing” often caused by in a child of school age?

Answer 9

Femur

Question 10

What is femoral anteversion?

Answer 10

• Developmental norm
• 40degress at birth
• 1-2degree decrease pa
• 80% reach 100 by 16yoa
• Increased = increased internal rotation of the hips

Question 11

What is internal tibial torsion?

Answer 11

•Increased thigh foot angle
•90% + spontaneously resolve
•No role for splints, wedges, physio etc.
INTERNAL TIBIAL TORSION

Question 12

What is metatarsus adducts?

Answer 12

•90% resolve by 1y
•Stretching - does no harm
•5% persist to adulthood
•If flexible, no role for splintage
METATARSUS ADDUCTUS

Question 13

At what age is surgical intervention considered?

Answer 13

Secondary school age

Question 14

Are flat feet normal at birth?

Answer 14

Yes

Question 15

What characterises flexible flat fleet?

Answer 15

• Diminishes with age

* Insoles = No benefit

Question 16

What characterises flexible flat fleet?

Answer 16

• Diminishes with age
• Insoles = No benefit (may reduce pain)
• See in all infants (fat foot and lax ligaments)
• Many Children have them
• 15% Adults
• Commoner with shoes, obese, Ligament laxity
• In adult soldiers not associated with symptoms
• Shoes, arch supports, heel cups no influence

Question 17

What characterises stiff flat feet?

Answer 17

• Cannot bring up toe
• Underlying pathology
• Very small proportion of all flat feet

Question 18

Which toes are usually affected by curly toe?

Answer 18

•3rd, 4th

Question 19

What causes curly toes?

Answer 19

• Strong Family History

* Tightness flexor tendons

Question 20

How are curly toes treated?

Answer 20

• Taping no help in long term
• Mostly cosmetic problem
• ¼ improve spontaneously

Question 21

When is a flexor tenotomy considered for curly toes?

Answer 21

•After 6 years if causing a functional problem

Question 22

What is the normal walking age?

Answer 22

• 12 months = Mean
• ‘Normal’ ≠ Mean
• 50% of children walk later than the mean
• Concern after 18months - look for underlying neurological problems

Question 23

What are the 5 Ss for paediatric orthopaedic referral?

Answer 23

• Symptoms
• Symmetry (Really •Asymmetry reason to refer)
• Stiffness
• Syndromes
• Systemic Illness