Principles of Paediatric Orthopaedics

Question 1

What are the different group of infant abnormalities?

Answer 1

• Manufacturing defects
  
  • Spina bifida
  • Proximal femoral focal deficiency
  • TAR syndrome
  • Thalidomide (medication)
  • Congenital scoliosis
• Packaging defects
  
  • Metatarsus adductus
  • Infantile postural scoliosis
  • Plagiocephaly
  • Congenital torticollis
• Could be either
  
  • Talipes equino-varus

Question 2

What are examples of manufacturing defects?

Answer 2

• Manufacturing defects
  
  • Spina bifida
  • Proximal femoral focal deficiency
  • TAR syndrome
  • Thalidomide (medication)
  • Congenital scoliosis

Question 3

What are examples of packaging defects?

Answer 3

• Metatarsus adductus
• Infantile postural scoliosis
• Plagiocephaly
• Congenital torticollis

Question 4

What is an example of both a manufacturing defect and packaging defect?

Answer 4

• Talipes equino-varus

Question 5

What are 5 MSK issues that precipitate a lot of referrals?

Answer 5

• In toed gait
• Bow legs
• Flat feet
• Curly toes
• Late walkers

Question 6

What are the 3 principle reasons for in toed gait?

Answer 6

• Newborn problems in foot
  
  • Metatarsus adductus
  • 90% resolve by 1 year
• Infant problem with tibia
  
  • Internal tibial torsion
  • Increased thigh foot angle
  • 90% resolve spontaneously, no role for splints, wedges, physio
• School age problem with femur
  
  • Femoral anteversion
  • Normal is 40 degrees at birth, decreases 1-2 degrees per year to adult amount of 10 degrees by 16 years

Question 7

In a newborn, what problem usually causes in toed gait?

Answer 7

• Newborn problems in foot
  
  • Metatarsus adductus
  • 90% resolve by 1 year

Question 8

In an infant, what problem usually causes in toed gait?

Answer 8

• Infant problem with tibia
  
  • Internal tibial torsion
  • Increased thigh foot angle
  • 90% resolve spontaneously, no role for splints, wedges, physio

Question 9

In school age, what problem usually causes in toed gait?

Answer 9

• School age problem with femur
  
  • Femoral anteversion
  • Normal is 40 degrees at birth, decreases 1-2 degrees per year to adult amount of 10 degrees by 16 years

Question 10

What is the treatment for in toed gait?

Answer 10

Most improve, but no improvement in time in neuromuscular disease

Never operate before 10 years

Question 11

In in-toed gait, do the toes point medially or laterally?

Answer 11

Medially (inwards)

Question 12

What is the treatment for bow legs?

Answer 12

This is common and resolves over time most of the time, rarely is treated

Question 13

Infants legs are normally varus or valgus?

Answer 13

Question 14

What is flat feet?

Answer 14

Flat foot is where medial longitudinal arch is not evident when the child stands

Question 15

What is the treatment of flat feet?

Answer 15

Normal at birth and usually diminishes with age, insoles have no benefit

Question 16

What are the 2 kinds of flat feet?

Answer 16

• Mobile flat foot
  
  • When do Jack’s test (raise big toe) arch forms
• Stiff flat foot
  
  • Underlying pathological cause
  • Very rare

Question 17

What is the aetiology of curly toes?

Answer 17

Usually 3^rd or 4^th toe with family history

Due to tightness of flexor tendons

Question 18

What is the treatment of curly toes?

Answer 18

Mostly cosmetic problem, 25% improve spontaneously

If functional problem treat with flexor tenotomy if over 6 years

Question 19

Which toes are usually affected by curly toes?

Answer 19

Usually 3rd or 4th toe

Question 20

What is the mean walking age?

Answer 20

12 months is the mean, remember mean is not normal as 50% of children walk later than the mean

Question 21

What are the 5 S’s of when to refer to paediatric orthopaedics?

Answer 21

• Symptoms
• Symmetry
  
  • Really asymmetry reason to refer
• Stiffness
• Syndromes
• Systemic illness