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
