44 Paediatric orthopaedics

ABNORMALITIES OF THE KNEE AND LOWER LEG Many knee problems in children or adolescents are self-li...

ABNORMALITIES OF THE UPPER LIMB Minor finger abnormalities are common ( Table 44.11 not all requir...

ANKLE Parents are often concerned that minor abnormalities will limit function but this is rarely...

Anterior knee pain In adolescents the extensor mechanism of the knee is a common site of knee p...

Back pain Children report back pain less frequently than adults, although >50% will have had one ...

Blount’s disease The aetiology of the disordered growth in the posteromedial proximal tibial phys...

Brachial plexopathy Neonatal brachial plexus injury is still common, with a devas - tating e ff ec...

CLINICAL DILEMMAS The limping child Children may limp because of pain, weakness, deformity or to...

CONGENITAL AND DEVELOPMENTAL ABNORMALITIES 1 CONGENITAL AND DEVELOPMENTAL ABNORMALITIES 1 CONGENI...

Cerebral palsy Cerebral palsy (CP) is caused by a non-progressive insult to the developing brain ...

Complications of bone and joint sepsis Treated appropriately , most cases of sepsis resolve with...

Congenital pseudarthrosis of the tibia This rare condition presents with an anterolateral bow of ...

Congenital radial head dislocation The dislocation is usually posterolateral, compared with the c...

Congenital talipes equinovarus (the ‘club foot’) In true congenital talipes equinovarus (CTEV) th...

DEVELOPMENT OF THE MUSCULOSKELETAL SYSTEM The upper limb bud forms on the lateral wall of the 4-...

Developmental dysplasia of the hip DDH defines the spectrum of hip instability , ranging from th...

Discoid meniscus This invariably a ff ects the lateral meniscus, which is abnor - mally thick and ...

Fibular hemimelia In fibular hemimelia there is a congenital failure of formation of the lateral...

Flat foot All children (<3 years) have flat feet with a fat pad obscuring the arch. Over time, the...

Generalised skeletal dysplasias Achondroplasia Achondroplasia is caused by a gain-in-function mut...

INFECTION Worldwide, osteoarticular infection remains a frequent cause of significant morbidity ....

Intoeing gait Intoeing is defined as a negative foot progression angle and results from one or mor...

INTRODUCTION Immature skeletons heal rapidly and can remodel with growth but physeal injury or mu...

Knock knees and bowlegs All children start life with bowlegs, often accompanied by internal tibia...

Kyphosis When a kyphosis exceeds the normal 20–50° the cause may be postural or structural. Scheu...

Learning objectives To be familiar with: Physiological versus pathological development of the • m...

Legg–Calvé–Perthes disease Incidence and aetiology This rare condition, characterised by the deve...

METABOLIC BONE DISEASE Rickets In rickets, the primary problem is inadequate mineralisation of g...

NEUROMUSCULAR CONDITIONS Joint stability and limb function rely on the complex integra - tion of ...

NORMAL VARIANTS Many normal variants of growth and development cause parental concern. The commo...

Non-accidental injury No child is exempt but some children are at particular risk, including thos...

OF THE SKELETON Although many skeletal abnormalities are identified ante - natally or at birth, ot...

Osteochondritis dissecans Osteochondritis dissecans (OCD) a ff ects the lateral aspect of the medi...

Osteomyelitis As with septic arthritis, bone infection is usually caused by haematogenous spread....

Other foot and ankle conditions Most postural deformities such as metatarsus adductus and calcane...

PAIN Congenital deformities Congenital vertebral deformities are failures either of formation (a ...

Polio . Despite an e ff ective polio vaccine, this disease still occurs. About 1–2% of patients d...

Postural abnormalities Many babies are subjected to moulding pressures in utero . At birth they e...

Radial club hand This longitudinal failure of formation is commonly associ - ated with other mal...

Radioulnar synostosis Failure of proximal separation of the embryonic radius and ulna means tha...

Scoliosis The term ‘scoliosis’ describes spinal deformity in three planes: lateral curvature is t...

Septic arthritis Joint infection is usually secondary to haematogenous spread but direct inoculat...

Slip of the capital (upper) femoral epiphysis (SCFE/SUFE) The physis connects the proximal femora...

Slip of the capital (upper) femoral epiphysis (SCFE/SUFE) The physis connects the proximal femora...

Spina bifida The extent of the disability varies with the level of the lesion: upper motor neuro...

Spondylolisthesis Spondylolysis defines a defect in the pars interarticularis of the vertebra. Th...

disease) Osteogenesis imperfecta (OI) represents a spectrum of condi tions linked by a qualitati...