Children's orthopaedics

Question 1

What is the typical alignment of the knees in children <2 years of age>

Answer 1

Genu varum

Question 2

What is the typical alignment of the knees in children >2 years of age?

Answer 2

Genu valgum

Question 3

What is Blount’s disease and is it a cause of genu varum or genu valgum?

Answer 3

Growth arrest of the medial tibial physis

Pathological cause of genu varum

Question 4

Femoral neck anteversion causes the appearance of genu varum or genu valgum?

Answer 4

Genu valgum

Usually of no consequence, however it may predispose to some patellofemoral problems

There is little no indication for surgery

Question 5

Are we born with pes planus or pes cavus?

Answer 5

pes pLanus = fLat feet

The medial arch develops while walking as the tibias posterior strengthens

Question 6

Where should be examined in a child presenting with anterior knee pain?

Answer 6

The knee and the hip

Question 7

What are some risk factors for dysplastic hip?

Answer 7

Breech position in utero or at delivery
Family history
First born girls

Question 8

What is Barlow’s test?

Answer 8

This is an instability test

It involves abducting and applying pressure to the knees to test if the hip can be dislocated

Question 9

What is Ortolani test?

Answer 9

Flexing and adducting the leg and applying pressure on the greater trochanter to test for posterior dislocation

Question 10

What early management intervention should be done for a child with a dysplastic hip?

Answer 10

Pavlik Harness - this can be given to centre the hip joint

This gives a 95% chance that the child will grow up to have a normal hip

Question 11

Which sex is more commonly affected by developmental dysplasia of the hip?

Answer 11

Females

Question 12

What is developmental dysplasia of the hip?

Answer 12

Dislocation and subluxation of the femoral head during the perinatal period which affects subsequent development of the hip joint

Question 13

What differentials should be considered in a preschool child presenting with a limp?

Answer 13

Infection
Transient synovitis
Late presenting DDH
Juvenile idiopathic arthritis

Question 14

What is the Kocher Criteria?

Answer 14

Kocher criteria is used to distinguish between septic arthritis and transient synovitis in a child with an inflamed hip

It takes into account; temperature, CRP, WCC and the ability to bear weight

Question 15

What is the most common cause of hip pain in childhood?

Answer 15

Transient synovitis

Question 16

What is transient synovitis?

Answer 16

Self-limiting inflammation of the synovium of a joint

blood tests are normal - there is an effusion but not an infection

Question 17

Upper respiratory tract infections can predispose to which disorder of the hip?

Answer 17

Transient synovitis

Question 18

How is transient synovitis managed?

Answer 18

It is self-limiting and therefore resolves with rest

Question 19

What is perthes?

Answer 19

Idiopathic osteochondritis of the femoral head

The femoral head transiently loses its blood supply resulting in necrosis with subsequent abnormal growth

Question 20

Who would perthes present in?

Answer 20

Ages 4-8
Boys
Small, hyperactive (e.g young boys with ADHD)

Question 21

How does perthes present?

Answer 21

Limp

Pain

Mostly unilateral

Question 22

How is perthes managed and what are the long-term outcomes?

Answer 22

No specific treatment other than regular follow-up

Advise rest and limited activity

Idiopathic AVN can occur and there is a higher risk of early onset OA

Question 23

What is SUFE?

Answer 23

Slipped upper femoral epiphysis

Question 24

Who does SUFE present in?

Answer 24

11-15 year olds

More common in; male, black and obese patients

*OVERWEIGHT PRE-PUBERTAL ADOLESCENT BOYS

Question 25

How does SUFE present?

Answer 25

ADOLESCENTS WHO CAN’T WEIGHT BEAR

Some may present with knee or distal thigh pain alone

Question 26

What sign might you see on X-ray of a patient with SUFE?

Answer 26

Threthowan’s sign

The femoral head has slipped down

*NB it is very important that both a lateral and AP x-ray are taken

Question 27

What are the typical ages of presentation of the different hip disorders in children?

Answer 27

DDH - 1-18 months
Transient synovitis - 2-6 years old
Perthes - 4-8 year olds
SUFE - 11-15 year olds