Spinal Ortho Flashcards
What is the normal variation of childhood alignment of the lower limb?
Newborn - varus alignment.
- 5-2 years - neutral alignment.
- 5-3.5 years - valgus alignment.
4-7 years - neutral alignment
How do bones grow?
Enchondral ossification - longitudinal growth from the growth plate (physis).
Appositional growth - circumferential from the periosteum (bone gets wider).
How does bone growth occur at the growth plate?
The epiphyseal plate is a layer of hyaline cartilage.
Chondrocytes are stacked on this plate which then ossify into bone.
This process repeats and bone grows.
Which physes contribute to bone growth more than others?
What factors affect the growth plate?
Diet/nutrition.
Sunshine, vitamins (D and A).
Injury.
Illness - growth arrest lines seen in bone from when the person was ill with flu etc.
Hormones (growth hormone).
What do you need to know in terms of growth percentiles and short stature?
1/5 children less than 2S.D. below the mean for their age will have an underlying pathologic reason e.g. low GH.
Age <3 growth much more variable – can cross centiles. Nutrition plays a big part.
Look at parents height.
What do dysmorphic features in a growing child mean?
Dysmorphic features -> increased chance underlying genetic or endocrine disorder.
When is it normal for a child to lose primitive reflexes (e.g. moro, grasp, stepping, fencing)?
1-6 months - loss of primitive reflexes (moro, grasp, stepping, fencing).
When does a child normally gain head control?
2 months - head control.
When does a child normally sit alone, crawl?
6-9 months - sits alone, crawls.
When does a child normally stand?
8-12 months - stands.
When does a child normally start speaking a few words?
9-12 months - few words.
When does a child normally start feeding themselves?
14 months - feeds self, uses spoon.
When does a child normally start to walk?
14-17 months - walks.
When does a child normally learn to stack 4 blocks and understand 200 words?
18 months - stacks 4 blocks, understands 200 words.
When does a child normally learn to jump?
24 months - jumps.
When does a child normally manage stairs alone?
3 years - manages stairs alone.
When does a child normally learn to potty train?
3 years.
What orthopaedic deformities are variations of normal?
Genu varum or valgum.
Intoeing.
Flat feet.
Curly toes.
When would you refer someone to orthopaedics for their genu varum?
Could be due to abnormal or underlying pathology if:
- Unilateral (asymmetry >5 degrees).
- >2S.D/16 degrees from mean.
- Short stature >2 S.D.
- Painful.
What are pathological causes of genu varum?
Skeletal dysplasia (dwarfism).
Rickets (vitamin D deficiency).
Tumour e.g. enchondroma.
Blounts disease.
Trauma -> physeal injury.
What is Blounts disease?
Growth arrest of the medial tibial physis of unknown aetiology.
