Introduction to Paediatric Orthopaedics Flashcards
(28 cards)
Name the components of a child’s bone.
- Epiphysis
- Physis - growth plate
- Metaphysis
- Diaphysis - shaft
- Apophysis
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?
- Remodelling
- Overgrowth
- Progressive deformity
- 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)
- Age matched
What is physiological development?
Change in shape/angle/appearance with growth
What normal development physiological changes take place?
- Femoral anteversion
- Bow legs
- Flat feet
Give examples of self correcting or non-concerning pathology.
- Persistent femoral anteversion
- Metatarsus adductus
- Posterior tibial bowing
- Curly toes
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
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
- Symptomatic- no
- Systemic illness- no
- Skeletal dysplasia- no
- Stiffness- no
What is the usual rotational alignment?
Axial
What is the usual angular alignment?
Coronal
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)
- Tibia
- Foot
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?
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
How can intoeing arise from the feet?
Forefoot adduction: metatarsus adductus
- Normal is between the 2nd and 3rd toe
- Normal variant
- Self-correcting pathology
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?
- Knocked knees
- Bow legs
- Flat feet
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
