Introduction to Paediatric Orthopaedics Flashcards Preview

Systems: MSK AB > Introduction to Paediatric Orthopaedics > Flashcards

Flashcards in Introduction to Paediatric Orthopaedics Deck (28)
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1

Name the components of a child's bone.

-Epiphysis
-Physis - growth plate
-Metaphysis
-Diaphysis - shaft
-Apophysis

2

What biochemical differences are there between child and adult bones?

Child ligament stronger than growth plate
-Easy to produce epiphyseal separation
Difficult to produce dislocations or sprains

Young bone more porous
-Tolerates more deformation (plasticity)
-Fails in compression as well as tension resulting in buckle and green stick fractures

3

What physiological differences are there between child and adult bones?

-Remodelling
-Overgrowth
-Progressive deformity
-Speed of healing much faster

4

What is the commonest normal variant that is referred?

Intoeing and flexible flat feet

5

What is normal variation?

-Spectrum/pattern of normal
-Within 2 standard deviations from the mean (Gaussian distribution)
-Age matched

6

What is physiological development?

Change in shape/angle/appearance with growth

7

What normal development physiological changes take place?

-Femoral anteversion
-Bow legs
-Flat feet

8

Give examples of self correcting or non-concerning pathology.

-Persistent femoral anteversion
-Metatarsus adductus
-Posterior tibial bowing
-Curly toes

9

Excluding true pathology, what possible presenting parental concerns are there?

-Out toeing
-In toeing
-Bow legs
-Knock knees
-Tiptoe walking
-Flat feet
-Curved feet
-Curly toes

10

What is the aim of assessment?

What are parental worries?

Is it a normal variant?
-No: spot the true pathology, is the pathology concerning
-Yes: future development concerns

11

What is the David Jones system of the 5Ss?

-Symmetrical – yes
-Symptomatic- no
-Systemic illness- no
-Skeletal dysplasia- no
-Stiffness- no

12

What is the usual rotational alignment?

Axial

13

What is the usual angular alignment?

Coronal

14

What is the natural development of feet walking patterns?

Tendency to in-toe with age

15

How is a child examined for inroeing?

Identify origin of rotation concern
-Hip (external and internal totation)
-Tibia
-Foot

Degree of femoral version

16

What is the natural development of the hip?

-At birth the hips have more ER than IR
-With age version changes
-If anteversion is excessive it will result in IR of the leg, hence intoeing

17

How can intoeing arise from the tibia?

Tibial torsion
-An element of internal tibial torsion is normal
-Combination of in utero moulding and tibial shape
-Clinically assessed: thigh foot angle technique and patellae position with feet/ ankles facing forward

18

How can intoeing arise from the feet?

Forefoot adduction: metatarsus adductus
-Normal is between the 2nd and 3rd toe
-Normal variant
-Self-correcting pathology

19

How is metatarsus adductus graded?

-Normal: between 2nd and 3rd toe
-Mild: on 3rd toe
Moderate: between 3rd and 4th toes
-Severe: between 4th and 5th toes

20

How can problems with angular alignment present?

-Knocked knees
-Bow legs
-Flat feet

21

What is angular alignment normally due to?

Occasional underlying pathology that may require treatment but usually a combination of normal physiology and variation

22

What is the natural age related development of the legs?

-0-18 months: bow legs
-18-30 months: straight legs
-3-4 years: knock knees
-8-10 years: straight legs

23

What is the natural development of the feet?

-Babies have naturally flat feet
-Arches develop but fat footedness through childhood is a normal variant, provided the foot is mobile and asymptomatic

24

What should you do with a concerned parent?

-Take a history find out the main underlying concern
-Examine the child
-Usually talk through examination to parents
-Reassure, show graphs if helpful

25

How should a child be assessed?

-Walking (if old enough)
-Standing including alignment from front, patella position, heels/ arch/ toes/ leg length from behind
-Tip toe (if old enough)
-Staheli rotational profile

26

What is included in a rotational profile examination?

Supine
-Leg lengths
-Hips (Galeazzi, FFD, ROM)

Prone: Staheli rotational profile
-Hip rotation/version
-Thigh foot angle
-Foot bisector line

27

When do issues require further investigation?

-Not age appropriate
-Assymetry
-Rigid flat foot
-Bow legs (genu varum): could be rickets/blounts

28

What issue may require treatment?

-Metatarsus adductus
-Tibial torsion (external typically more than internal)
-Persistant femoral anteversion
-Curly toes