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Normal and abnormal in Paediatric Orthopaedics; what should we do

Normal and abnormal in Paediatric Orthopaedics; what should we do. James Hunter Nottingham. Clinics and Team. Kathryn Price Monday KRP1B James Hunter Tuesday JBH2B Dominik Lawniczak Tuesday DL22B Julian Chell Thursday JC34B Hip instability Tuesday Mark Batt Friday MEB5P

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Normal and abnormal in Paediatric Orthopaedics; what should we do

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  1. Normal and abnormal in Paediatric Orthopaedics; what should we do James Hunter Nottingham

  2. Clinics and Team • Kathryn Price Monday KRP1B • James Hunter Tuesday JBH2B • DominikLawniczak Tuesday DL22B • Julian Chell Thursday JC34B • Hip instability Tuesday • Mark Batt Friday MEB5P • Physio Clinic Friday JBH5P

  3. Normal Growth • Growth is predictable • Boys half adult height aged 2 • Tanner and Whitehouse • Legs half adult length age • 3 for girls • 4 for boys (Paley)

  4. Leg growth cm/yr 0.6 1.2 0.7 0.7 • Proximal femur 15% • Distal femur 37% • Proximal tibia 28% • Distal tibia 20%

  5. Normal Variation

  6. Flat feet • Flexible flat feet are normal • 90 % at age 1 • 20 % of adults • Associated with generalised laxity • Doesn’t all “get better”

  7. Flat feet

  8. Flexible

  9. Flat feet: Jack’s test

  10. Flat feet ; red flags • Pain • Stiffness • Peroneal spasm

  11. Stiff

  12. Flat feet; differential • Infection • Inflammation eg arthritis • Tarsal coalition • Tumours

  13. Flat feet: tarsal coalition

  14. Stiff

  15. Flat feet: management • Flexible flat feet are normal • Orthotic if painful retain if effective • First orthotic from shop or internet • Treat other conditions on merit

  16. Intoeing • Persistent femoral anteversion • aka femoral torsion • Tibial torsion • Metatarsus adductus

  17. Intoeing: examination • Foot progression angle • Range of hip movement • Thigh-foot angle • Inter-malleolar angle • Foot curvature (from below)

  18. Intoeing: examination

  19. Intoeing: examination

  20. Intoeing

  21. Intoeing: W position

  22. Intoeing: management • Advice • Torsional differences do not • Reduce athletic performance • Lead to degenerative changes • Metatarsus adductus mostly resolves if flexible • The only definitive management is osteotomy • Bracing stresses joints

  23. Metatarsus adductus

  24. Bow legs

  25. Bow legs

  26. Salenius and Vankka

  27. Bow legs

  28. Bow legs • Red flags • Unilateral • Progressive after age 3 • Blount’s is physiological varus gone wrong • Common in • Overweight • Early walkers • US black population

  29. Bow legs: Blount’s

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