Introduction to Paediatric Orthopaedics and Normal Variation Flashcards Preview

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Flashcards in Introduction to Paediatric Orthopaedics and Normal Variation Deck (25)
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1
Q

Which part of a bone contains the growth plate?

A

The metaphysis

2
Q

Why don’t X-rays tell you much in young children?

A

Cartilage model in bone is yet to ossify

3
Q

—In Children -

Ligaments stronger than growth plate

—easy to produce epiphyseal separation

—difficult to produce dislocations or sprains

A
4
Q

What is the result of a young persons bone being more porous?

A

It tolerates more deformation

Fails in compression as well as tension

Buckle freactures and green stick fractures

5
Q

How does the speed of healing compare in children vs adults

A

Speed of healing is much faster in children

6
Q

What is the definition of normal variation?

A

Lies within 2 standard deviations from the mean) depends on the age and the population)

7
Q

What parts of normal development may seem concerning?

A

Femoral anteversion (pigeon toed appearance)

Bow legs

Flat feet

8
Q

What may fall under the category of self-correcting or non-concerning pathology?

A

Persistent femoral anteversion

Metatarsus adductus - Metatarsus adductus, also known as metatarsus varus, is a common foot deformity noted at birth that causes the front half of the foot, or forefoot, to turn inward.

Posterior tibial bowing

Curly toes

9
Q

For what reasons might parents be concerned about in their child?

A

—Out toeing

—In toeing

—Bow legs

—Knock knees

—Tiptoe walking

—Flat feet

—Curved feet

—Curly toes

10
Q

What is the david jones system of the 5 S’s?

A

—Symmetrical – yes

—Symptomatic- no

—Systemic illness- no

—Skeletal dysplasia- no

—Stiffness- no

11
Q

Which planes are associated with the terms rotational alignment and angular alignment?

A

—Rotational alignment- axial

—Angular alignment- usually coronal

12
Q

What is the natural development for in-toeing and out-toeing?

A
13
Q

What are the potential origins for intoeing?

A

Hip

Tibia

Foot - use of foot bisector line

14
Q

What is a sign that the intoeing is as a result of the hips?

A

The knee caps will be equally facing inward if intoeing pathology is arising from the hips

If it does not correct then it is ‘persistant femoral anteversion’, this usually grows out by age 12 yrs

Ability to W sit?

15
Q

How is tibial torsion assessed?

A

Clinically:

—- thigh foot angle technique

—- patellae position with feet/ ankles facing forward

Thigh foot angle generally increases with age

16
Q

How do you tell if the intoeing arises at the feet?

A

Foot bisector line should emerge between the 2nd and the 3rd toe

17
Q

What are the issues with angular allignment of the legs?

A

Knocked knees

Bow legs

Flat feet

—Occasional underlying pathology that may require treatment but usually a combination of normal physiology and variation

18
Q

How do the legs bow in normal variation?

A
19
Q

When should bow legs be considered possible for an undderlying pathology?

A

Bow legs over the age of 8 years

20
Q
A

The bowing appears worse in the infant than it truly is becasue the the infants hip is held in external rotation

Knee alignment can change quite notably in the growing child

21
Q

When does flat footedness remain a normal variant?

A

If the foot is mobile and it is asymptomatic

22
Q

What is the clinical assessment for all this?

A

Walking

Standing:

  • Alignment from front
  • Patella position
  • Heels/arch/toes/leg length from behind

—Tip toe (if old enough)

—Staheli rotational profile

23
Q

When might further review or investigation be necessary?

A

—Not age appropriate - can’t walk for example

—Assymetry

—Rigid flat foot

—Bow legs (genu varum)

  • —Blounts
  • —Rickets
24
Q

Which things rarely require treatment

A

—Metatarsus adductus

—Tibial torsion (external typically more than internal)

—Persistant femoral anteversion

—Curly toes

Most of the time it is

Normal variants

Physiological changes

Self correcting/ non-concerning pathologies

25
Q
A