Flashcards in Introduction to Paediatric Orthopaedics Deck (28)
Name the components of a child's bone.
-Physis - growth plate
-Diaphysis - shaft
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
What physiological differences are there between child and adult bones?
-Speed of healing much faster
What is the commonest normal variant that is referred?
Intoeing and flexible flat feet
What is normal variation?
-Spectrum/pattern of normal
-Within 2 standard deviations from the mean (Gaussian distribution)
What is physiological development?
Change in shape/angle/appearance with growth
What normal development physiological changes take place?
Give examples of self correcting or non-concerning pathology.
-Persistent femoral anteversion
-Posterior tibial bowing
Excluding true pathology, what possible presenting parental concerns are there?
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
What is the David Jones system of the 5Ss?
-Symmetrical – yes
-Systemic illness- no
-Skeletal dysplasia- no
What is the usual rotational alignment?
What is the usual angular alignment?
What is the natural development of feet walking patterns?
Tendency to in-toe with age
How is a child examined for inroeing?
Identify origin of rotation concern
-Hip (external and internal totation)
Degree of femoral version
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
How can intoeing arise from the tibia?
-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
How can intoeing arise from the feet?
Forefoot adduction: metatarsus adductus
-Normal is between the 2nd and 3rd toe
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
How can problems with angular alignment present?
What is angular alignment normally due to?
Occasional underlying pathology that may require treatment but usually a combination of normal physiology and variation
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
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
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
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
What is included in a rotational profile examination?
-Hips (Galeazzi, FFD, ROM)
Prone: Staheli rotational profile
-Thigh foot angle
-Foot bisector line
When do issues require further investigation?
-Not age appropriate
-Rigid flat foot
-Bow legs (genu varum): could be rickets/blounts