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Congenital talipes equinovarus (the ‘club foot’) In true congenital talipes equinovarus (CTEV) the three- dimensional deformity is fixed ( Figure 44.29 ). Intrauterine moulding can cause an identical pattern that is postural and therefore correctable. Incidence...

DEVELOPMENT OF THE MUSCULOSKELETAL SYSTEM The upper limb bud forms on the lateral wall of the 4-week embryo, followed promptly by the lower limb bud. By 2 /uni00A0 months, di ff erentiation of the limb elements is complete. Most congenital limb anomalies aris...

Developmental dysplasia of the hip DDH defines the spectrum of hip instability , ranging from the hip that is in joint but has a shallow (dysplastic) acetabulum and may be ‘pushed out’ (Barlow positive) to the dislocated hip that is irreducible (Ortolani nega...

Discoid meniscus This invariably a ff ects the lateral meniscus, which is abnor - mally thick and covers most of the tibial plateau. The child presents with a painful clunk on knee extension. MRI is usually diagnostic. Surgery is indicated for relief of pain...

Fibular hemimelia In fibular hemimelia there is a congenital failure of formation of the lateral ‘column’ of the lower leg ( Figure 44.26 and Table 44.9 ). TABLE 44.9 Classical radiographic features of /f_i bular hemimelia. Foot and ankle Absent lateral rays...

Flat foot All children (<3 years) have flat feet with a fat pad obscuring the arch. Over time, the longitudinal arch develops but 15% of adults have flat feet influenced by familial and racial factors. All flat feet have a flattened medial arch with a valgus heel b...

Generalised skeletal dysplasias Achondroplasia Achondroplasia is caused by a gain-in-function mutation in the FGFR3 (fibroblast growth factor receptor 3) gene, located on the short arm of chromosome (Chr) 4, which a ff ects enchondral bone formation. It is auto...

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

Intoeing gait Intoeing is defined as a negative foot progression angle and results from one or more lower limb torsional anomalies ( Figure 44.1 and Table 44.2 ). Persistent femoral neck anteversion presents clinically with excessive internal rotation at the hi...

INTRODUCTION Immature skeletons heal rapidly and can remodel with growth but physeal injury or muscle imbalance may lead to progressive deformity . The conservative treatment of common conditions, such as developmental dysplasia of the hip (DDH), considers r...

Knock knees and bowlegs All children start life with bowlegs, often accompanied by internal tibial torsion. By the age of 2–3 years they have devel oped knock knees, which regress towards the normal adult tibiofemoral angle of 7° valgus by age 7 ( Figure 44....

Kyphosis When a kyphosis exceeds the normal 20–50° the cause may be postural or structural. Scheuermann’s disease presents as a progressive structural adolescent kyphosis characterised radiologically by >5° vertebral wedging at three adjacent levels with end-p...

Learning objectives To be familiar with: Physiological versus pathological development of the • musculoskeletal system Diagnosis and treatment of developmental dysplasia of • the hip Learning objectives To be familiar with: Physiological versus pathological de...

Legg–Calvé–Perthes disease Incidence and aetiology This rare condition, characterised by the development of A VN of the proximal femoral epiphysis, predominantly a ff ects boys aged 4–7 years; 10% develop bilateral disease. Although the aetiology is unclear, ...

METABOLIC BONE DISEASE Rickets In rickets, the primary problem is inadequate mineralisation of growing bone ( Table 44.5 ). In severe cases the classic radiographic features are seen at all physes with significant deformity ( Figure 44.11 ). Medical treatment ...

NEUROMUSCULAR CONDITIONS Joint stability and limb function rely on the complex integra - tion of the musculoskeletal and neurological systems. Damage to either leads to one of several conditions linked only by the during the period of skeletal growth. Manag...

NORMAL VARIANTS Many normal variants of growth and development cause parental concern. The common problems relate to tripping and falling, an intoeing gait, bowlegs, knock knees and flat feet. In general, if they are symmetrical, symptom-free and in an - othe...

Non-accidental injury No child is exempt but some children are at particular risk, including those under 3 years of age, those with disabilities and those in families su ff ering socioeconomic deprivation. A careful clinical assessment is required ( Figure 44....