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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 James Hunter Nottingham
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
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)
Leg growth cm/yr 0.6 1.2 0.7 0.7 • Proximal femur 15% • Distal femur 37% • Proximal tibia 28% • Distal tibia 20%
Flat feet • Flexible flat feet are normal • 90 % at age 1 • 20 % of adults • Associated with generalised laxity • Doesn’t all “get better”
Flat feet ; red flags • Pain • Stiffness • Peroneal spasm
Flat feet; differential • Infection • Inflammation eg arthritis • Tarsal coalition • Tumours
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
Intoeing • Persistent femoral anteversion • aka femoral torsion • Tibial torsion • Metatarsus adductus
Intoeing: examination • Foot progression angle • Range of hip movement • Thigh-foot angle • Inter-malleolar angle • Foot curvature (from below)
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
Bow legs • Red flags • Unilateral • Progressive after age 3 • Blount’s is physiological varus gone wrong • Common in • Overweight • Early walkers • US black population