Principles of Paediatric Orthopaedics

Question 1

Why is children’s fracture management different to adults?

Answer 1

Children’s bone is better at remodelling

Question 2

What is meant by manufacturing problems and packaging problems?

Answer 2

Manufacturing- more major problems which occur early stages of embryological development
Packaging- basically normal child but has been a bit squashed in the womb, things will improve after delivery

Question 3

Where does longitudinal growth occur?

Answer 3

Epiphyseal growth plate

Question 4

Spina bifida?

Answer 4

Spinal cord is at skin surface, as notochord doesn’t close. Can sometimes covered by a thin layer of skin.
Leaves child with neurological problem

Question 5

Proximal femoral focal syndrome?

Answer 5

Child has some pieces of their femur missing

->can vary between a small part of femur missing to half of it missing

Question 6

TAR syndrome?

Answer 6

Bilateral absent radius bone

Question 7

Thalidomide?

Answer 7

Lack of limbs due to thalidomide drug for morning sickness

->still given for myeloma

Question 8

Congenital scoliosis?

Answer 8

Abnormality of bones; vertebrae may form a joint together on only one side for example

Question 9

In which children does packaging defects more commonly occur?

Answer 9

First child as uterus is smaller

Question 10

Metatarsus adductus?

Answer 10

Bent foot- foot gets squashed in utero

Question 11

How does metatarsus adductus resolve?

Answer 11

After birth, can massage the foot and it gets better

Question 12

Infantile postural scoliosis?

Answer 12

Infant born with curved spine but normal spine on x-ray

->only scoliosis type which does not progress

Question 13

Only type of scoliosis more common in boys?

Answer 13

Infantile postural scoliosis

->occurs in utero and 75% of cases get better within first year

Question 14

Plagiocephaly?

Answer 14

Flat head- squashed

->goes normal a few months after delivery

Question 15

Congenital torticolis?

Answer 15

Child is born looking to one side
Treating by massaging muscle

Question 16

What is Talipes Equino-Varus also known as?

Answer 16

Club foot

Question 17

In toeing?

Answer 17

When walking forwards, child’s feet are turning inwards

Question 18

If a newborn has in-toeing, where is the problem occurring?

Answer 18

Foot

Question 19

If an infant has in-toeing, where is the problem occurring?

Answer 19

Tibia

Question 20

If a school age child has in-toeing, where is the problem occurring?

Answer 20

Femur

Question 21

Which age group tends to more commonly get in toeing?

Answer 21

Children aged 2-5, affects 1 in 10

Question 22

When is the one time in toeing will not get better?

Answer 22

If a child is born with neuromuscular disease e.g. cerebral palsy

Question 23

What is meant by bowed legs?

Answer 23

Bent legs where the distance between ankles is less than the distance between knees

Question 24

Treatment for bowing of legs?

Answer 24

Not required- this is a physiological occurrence and by teens, most legs have straightened out

Question 25

When you you refer a child to orthopaedics with an angular lower limb deformity?

Answer 25

If it is asymmetric
Abnormal for age (e.g. leg bowing occurring >18 months or knee knocking occurring > 7yrs)

->don’t get too bogged down by ages, this is a guide used to Aberdeen, just think it abnormal for age or asymmetric

Question 26

Are flat feet normal at brith?

Answer 26

Yes- bones of foot have not ossified
Reducing with age and arches form so no treatment needed.

Question 27

Which factors increase risks of a child having flat feet?

Answer 27

Those who wear shoes (study done in tribes where some children wore shoes and other didn’t), obesity and ligament laxity

Question 28

Management of flat feet?

Answer 28

No management required- no benefit of arch supports or insoles

Question 29

Curly toe?

Answer 29

Curly toe- it is what it is

Question 30

Which toes are more commonly affected by curly toe?

Answer 30

3rd or 4th toe

Question 31

Management of curly toe?

Answer 31

None required- taping does not help in long term.
1/4 resolve spontaneously.
If causing a functional problem e.g. nail digging into other toe, tenotomy may be considered if over age of six

Question 32

What is the average walking age?

Answer 32

12 months

->but very wide spectrum of normal

Question 33

5 S’s of when to refer to paediatric orthopaedics?

Answer 33

Symptoms
Symmetry (asymmetrical is the reason to refer though)
Stiffness
Syndromes
Systemic illness