Orthopaedics
Paediatric and Congenital Orthopaedics
Paediatric orthopaedics for MBBS and NEET-PG: clubfoot, developmental dysplasia of the hip, Perthes disease, slipped capital femoral epiphysis and cerebral palsy, mapped to NMC codes OR8.1, OR9.1 and OR12.1.
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Paediatric and Congenital Orthopaedics
Paediatric orthopaedics for MBBS and NEET-PG: clubfoot, developmental dysplasia of the hip, Perthes disease, slipped capital femoral epiphysis and cerebral palsy, mapped to NMC codes OR8.1, OR9.1 and OR12.1.
This chapter covers the congenital and developmental disorders of the growing skeleton. It works through clubfoot and developmental dysplasia of the hip, the paediatric hip conditions of Perthes disease and slipped capital femoral epiphysis, and the orthopaedic aspects of cerebral palsy and skeletal dysplasias, all shaped by the fact that the child is still growing.
High-yield: Paediatric and Congenital Orthopaedics
- Congenital talipes equinovarus, or clubfoot, combines hindfoot equinus and varus with forefoot adductus and cavus.
- The Ponseti method of serial casting is the mainstay of early clubfoot treatment and usually avoids major surgery.
- Developmental dysplasia of the hip is screened in the newborn using the Ortolani and Barlow tests.
- Ultrasound is the imaging of choice for developmental dysplasia of the hip in infants under six months because the femoral head is not yet ossified.
- A Pavlik harness is used to treat developmental dysplasia of the hip in young infants by holding the hips flexed and abducted.
- Perthes disease is idiopathic avascular necrosis of the femoral head in children, most often boys aged four to eight.
- Slipped capital femoral epiphysis presents in adolescents, often overweight, with hip or referred knee pain and a limb held in external rotation.
- A child with slipped capital femoral epiphysis should be kept non-weight bearing to prevent further slip, and treatment is in situ fixation.
- Cerebral palsy is a non-progressive disorder of movement and posture from an injury to the developing brain, though its orthopaedic effects change with growth.
- The spastic type is the commonest form of cerebral palsy and leads to contractures, hip subluxation and gait problems.
- Growth plate injuries in children are described by the Salter-Harris classification.
- Osteogenesis imperfecta is a collagen disorder causing brittle bones, blue sclerae and multiple fractures.
- Genu varum and genu valgum follow a normal developmental sequence in young children and usually correct without treatment.
- Any limping child with hip pain must be assessed for septic arthritis, Perthes disease and slipped capital femoral epiphysis by age.
Paediatric hip by age
- **Newborn to infant:** Developmental dysplasia of the hip. Ortolani and Barlow tests, ultrasound, Pavlik harness.
- **4 to 8 years:** Perthes disease, idiopathic avascular necrosis of the femoral head.
- **Adolescent:** Slipped capital femoral epiphysis. Non-weight bearing, in situ fixation.
- **Clubfoot:** Congenital talipes equinovarus. Ponseti serial casting is first line.
NMC competencies in this chapter
- **OR8.1:** Congenital talipes equinovarus and developmental dysplasia of the hip
- **OR9.1:** Paediatric hip disorders: Perthes disease and slipped capital femoral epiphysis
- **OR12.1:** Orthopaedic aspects of cerebral palsy and neuromuscular disorders
Frequently Asked Questions
How is clubfoot treated?
The Ponseti method of gentle serial manipulation and casting, often with a small Achilles tenotomy and later bracing, corrects most clubfeet without major surgery when started early.
How is developmental dysplasia of the hip screened and imaged?
It is screened in the newborn with the Ortolani and Barlow tests. In infants under six months ultrasound is preferred because the femoral head has not yet ossified, so plain x-ray is unreliable.
Which hip conditions present at which ages?
Developmental dysplasia in the newborn and infant, Perthes disease around four to eight years, and slipped capital femoral epiphysis in adolescents, so age guides the differential in a limping child.
Why keep a child with slipped capital femoral epiphysis off their feet?
Weight bearing can worsen the slip and increase the risk of avascular necrosis, so the child is kept non-weight bearing until in situ fixation is performed.
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