Children's Orthopaedics Flashcards

1
Q

how does knee alignment change during childhood?

A

newborn has genu varus (bow legged)
1.5 - 2 yrs = straight
2.5 yrs = slight genu valgus
4-6 yrs = straight allignment

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2
Q

what indicates that an abnormality may be a problem and not just something that will resolve?

A

unilateral

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3
Q

what is the definition of a deformity?

A

something likely to persist and cause physical or mental health problems later in life

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4
Q

how does bone grow longitudinally?

A

from the growth plate (physis) by echondral ossification

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5
Q

how does bone grow circumferentialy?

A

from the periosteum by appositional growth

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6
Q

females lose bone density at a faster rate than males, true or false?

A

false

both at the same rate but males start with a higher bone density

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7
Q

what happens at the growth plate?

A

stacking of chondrocytes - they die and act as scaffold for new bone laid down by osteoblasts

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8
Q

which part of the bone is most vulnerable to fracture in childhood?

A

growth plate?

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9
Q

what factors affect the growth plate?

A
diet
sunshine - vit D&A
injury
illness
hormones (growth hormone)
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10
Q

is short stature always pathological?

A

no
only 1 in 5 children 2SD below normal have a pathological reason
growth is very variable <3 y/o

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11
Q

normal movement at 6-9 months?

A

sits alone

crawls

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12
Q

normal movement at 8-12 months?

A

stands

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13
Q

normal movement at 14-17 months?

A

walking

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14
Q

normal movement at 24 months?

A

jumping

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15
Q

normal movement at 3 years?

A

can manage stairs alone

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16
Q

normal cerebral development at 1-6 months?

A

loss of primitive reflexes - moro, grasp, stepping, fencing

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17
Q

normal cerebral development by 2 months?

A

head control

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18
Q

normal cerebral development by 9-12 months?

A

few words

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19
Q

normal cerebral development by 14 months?

A

feeds self

uses spoon

20
Q

normal cerebral development by 18 months?

A

stacks 4 blocks

understands 200 words

21
Q

normal cerebral development by 3 years?

A

potty trained

22
Q

give 4 common variations of normal in children

A

genu varum or valgum
intoeing
flat feet
curly toes

23
Q

what is varum?

A

bow legged

24
Q

what is valgum?

A

knock kneed

25
Q

how does varum/valgum vary with age?

A

infant = varuk
18 months = straight
3.5 years = valgum
7 years = straight

26
Q

who is genu varum normal in?

A

age <2

persisting varum can run in families

27
Q

what are 5 abnormal causes for genu varum?

A
skeletal dysplasia
rickets - Vit D deficiency
tumour
blounts disease
trauma - physeal injury
28
Q

what is blounts disease?

A

arrest of growth at the medial tibia growth plate causing growth disorder and varum deformity

29
Q

what does blounts disease look like?

A

typical beak like protrusion on X ray

30
Q

what can cause genu valgum?

A

tumours
rickets
neurofibromatosis
idiopathic

31
Q

when can genu valgum be normal?

A

until around 3.5 years

32
Q

when would genu valgum require referral or treatment?

A

if asymmetric, painful or severe

if >8cm intramalleolar distance at age 11 - need surgery

33
Q

what is intoeing?

A

child walks with toes pointing in

“pigeon toed”

34
Q

how can you exaggerate intoeing?

A

running

35
Q

what can cause intoeing?

A

femoral neck anteversion
internal tibial torsion
metatarsus addctus
combination

36
Q

what is femoral neck anteversion and what is the classical presentation?

A

inward twisting of the femur (usually points anteriorly)

children sitting in the “W” position

37
Q

how can femoral neck anteversion be tested for?

A

get child to lie prone

bend knees and rotate legs outwards

38
Q

what can femoral neck anteversion cause risk of?

A

patellofemoral problems

39
Q

what is internal tibial torsion and how is it treated?

A

inward twisting of the tibia
usually seen in toddlers <3 but vast majority resolve by 6 yrs
usually none needed, surgery done in very rare cases

40
Q

what is metatarsus adductus?

A

curving of the foot towards the medial side

benign and usually resolves

41
Q

what is usually done for intoeing?

A

no treatment
find cause and reassure
might chart, photograph and review

42
Q

what is flat feet?

A

medial arch doesn’t develop in childhood as tibialis posterior strengthens

43
Q

what are the symptoms of flat feet?

A

usually none

no proven consequences

44
Q

how do you test flat feet?

A

stand on toes to determine if flexible or fixed
- flexible = arch appears
- fixed = stays flat
calf tightness assessment

45
Q

what can cause flexible and fixed flat feet?

A

flexible - ligament laxity or tightness

fixed - bony connection known as tarsal coalition

46
Q

what must you remember to check with anterior knee pain?

A

hips

47
Q

what is curly toes?

A

toes (usually 3rd or 4th) are scrunched up

common in young children and usually resolves by 6 yrs