Children’s Orthopaedic Disorders
Impact on Adulthood
Peter Templeton FRCS(Orth) Consultant Orthopaedic Surgeon
Children’s Orthopaedics
Elective Trauma
Outline
Abnormal
– Developmental Dysplasia of the Hip – Congenital Talipes Equinovarus – Perthes Disease – Rheumatoid Arthritis – Septic Arthritis – SUFE
Normal Questions
Developmental Hip Dysplasia
Spectrum girls > boys dislocated 2:1000 risk factors
– family history – breech
Screening
Clinical examination Ultrasound Screening Leeds Health Pathways – Unequal thigh creases and clicky hips in babies
DDH
Up to 6 months of age
DDH
6 - 18 months
DDH
18 months - 3 years
DDH
Over 3 years
DDH
Why treat it early?
Congenital Talipes Equinovarus
2:1000 F=M 40% bilateral Cause? Treatment
– non-operative – operative – Aims
Perthes Disease
1:10000 M>F Age 4 - 8 years Prognosis ~ 70% Treatment
– Maintain movement – No high impact sports – ? surgery
Juvenile Chronic Arthritis
1:1000 F>M Types
– Oligoarthritis – Polyarthritis – Systemic
Outcome 75% good Treatment
Septic Arthritis
Knee / hip / ankle Neonates / child / adolescent Symptoms
– pain – off feet – fever – raised WCC / CRP – effusion on US
Septic Arthritis
Cartilage dissolves Emergency treatment Complications
– – – – – sinus avascular necrosis dislocation of the hip destruction of the joint short limb
Slipped Upper Femoral Epiphysis
M>F 2:100000 last 2 years of growth painful limp Hip or knee pain short, ER of leg
SUFE - Treatment
Insitu fixation single cannulated screw
Normal Children
Babies are bow-legged and flat footed
Normal Children
Toddlers have flat feet & intoe!
Normal Children
Young children have knock knees, flat feet & intoe!
Normal Children
Adolescents tend to just intoe
Conclusion
Overview Normal children Prompt diagnosis Maximise function