Unit 3: Orthopaedic Conditions in Childhood Flashcards
Describe genu valgum and genu varum
The normal alignment of the knee is in valgus and when a child stands to attention there is normally a gap of 4cm or so between the feet. If this gap is increased the knees are in varus and if it is increased they are in valgus
What is the prognosis of genu valgum/varum?
Rarely, if ever serious, and by the age of 7 nearly all children with these conditions will have developed a normal knee alignment
List the three causes of in-toeing
Femoral neck variation, tibial torsion, abnormal forefeet
Describe femoral neck angle variation
During the later stages of the normal development of the fetus, the leg rotates on the pelvis so that the acetabulum points almost backwards and the femoral head on the neck is orientated forwards. Sometimes this rotatory process is not completed by birth so the femoral neck is more anteriorly orientated than normal. This reflects in a child’s posture and they will have an in-toed gait. This delayed development will correct itself by age 10, very rarely surgery may be required
Discuss tibial torsion
The bone is warped along its vertical axis; this is a normal variation and should be ignored
Discuss abnormal forefeet
It is dubious whether corrective surgery is ever justified, vast majority correct spontaneously by age 7 and any residual hooking rarely causes functional difficulties
Discuss flat feet
A flat foot is generally a normal variation. Mobile flat feet are entirely innocuous. A rigid flat foot is rare at any age and usually implies an underlying bony abnormality of the foot, occasionally can be a sign of a serious disease such as rheumatoid arthritis
Describe curly toes
Minor overlapping or crossing of the toes is common. Most correct spontaneously and should be left alone
List four minor childhood disorders
Knock knees/bow legs, in-toeing, flat feet, and curly toes
What are the two types of flat feet?
Mobile and rigid
What is Osgood Schlatter’s disease?
Osgood Schlatter’s disease is an inflammation of the attachment of the patellar tendon to the growing tibial epiphysis, caused by excess traction by the quadriceps. The cause is uncertain but it may be an overuse injury
Describe the management of Osgood Schlatter’s disease
The condition is episodic and can usually be treated by rest. The child will cease to have symptoms in middle adolescence when the epiphysis fuses
What is adolescent knee pain?
Adolescent knee pain occurs mostly in girl and is of unknown cause. Rarely on arthroscopy chondromalacia patellae may be seen
Describe the management of adolescent knee pain
Most girls grow out of the condition, if symptoms persist an arthroscopy may be necessary
What is congenital dislocation of the hip?
Child is born with an abnormal femoral head, or acetabulum, or both, which predisposes to dislocation
What is the frequency of occurrence of CDH?
One/two live births per thousand
List the ages at which children should be screened for CDH
Children should be screened at birth, three months, six months and twelve months
How do we treat early CDH?
Early CDH is treated by splintage
How do we treat late CDH?
If picked up late but before weight bearing, management involves a period of gentle traction followed by open or closed manipulation. It is then splinted in plaster for three months
If picked up late and once walking has commenced, major surgery is required
What are the long-term consequences of CDH if the diagnosis is missed?
Osteoarthritis and limp
What is talipes equino varus (club foot)?
This is a deformity of the foot which makes it look like a golf club