An Orthopaedics Guide for Today's GP

Tim Jennings, Maneesh Bhatia

• Publisher: CRC Press
• Year: 2017
• ISBN:
  9781315349374
• Edition: 1
• Topic: Médecine
• Subtopic: Théorie, pratique et référence de la médecine

This practical handbook is an essential reference for GPs when dealing with musculoskeletal disorders, as well as a useful exam prep aid for the common MSK cases that occur in the CSA. Responding to increasing pressures on GPs to reduce the number of referrals and treat more patients in the community, the book covers a breadth of orthopaedic disorders, with clear colour photographs and diagrams to demonstrate techniques in practice.

Chapters are authored by experts in each disorder with GP input, putting a strong focus on diagnosis and easy-to-follow processes for deciding courses of action and investigation. Each section explores the range of treatment options for that topic, including step-by-step injection techniqueswhere relevant, and signposts need-to-know areas with 'red flags'.

This is an important reach-for guide to assist GPs with easy diagnosis and to provide clear direction on next recommended steps.It will also be useful for medical students takingorthopaedicsmodules.

1

Paediatric orthopaedic disorders

SUNIL BAJAJ and NICOLAS NICOLAOU

Introduction

What ages do the different normal variants present?

What are packaging defects?

In-toeing and out-toeing

How does the rotational profile of the lower limb change with the age and development of the child?

What are the causes of in-toeing?

What is metatarsus adductus?

What is the treatment for metatarsus adductus?

What is congenital metatarsus varus?

What is internal tibial torsion?

How do you assess/measure internal tibial torsion?

What is the treatment for internal tibial torsion?

What is excessive femoral anteversion?

How do you measure femoral anteversion?

How do you treat the above condition?

Is in-toeing always physiological?

What is out-toeing?

What are bow legs (genu varum) and knock knees (genu valgum)?

How do you manage bow legs and knock knees?

What are the different feet/toe deformities seen in general practice?

What is pes planus?

What are the different types of flat feet?

How do we differentiate physiological flat feet from pathological flat feet?

How do you manage physiological pes planus?

What are the causes of rigid flat foot?

What is tarsal coalition?

Pathology

Clinical presentation

Investigation

Treatment

Surgical treatment

What is pes cavus?

What is the clinical presentation in children with pes cavus?

How do you manage pes cavus?

Osgood–Schlatter disease

What is the management of Osgood–Schlatter disease?

Is toe walking normal in children?

Management

What are curly toes?

What causes curly toes?

How do you manage curly toes?

The paediatric hip

What is developmental dysplasia of the hip?

What are the risk factors for this condition to be elicited in the history?

How do you clinically assess a child with the above risk factors?

Barlow test

Ortolani test

What is the investigation of choice in a child aged less than 6 months with suspected DDH?

Ultrasound screening

Perthes disease

What is the clinical presentation of perthes disease?

What is SCFE?

What are the clinical manifestations of SCFE?

What is a toddler’s fracture?

What are the causes of limp in a child?

How do you clinically assess a limping child?

Gait assessment

Leg length assessment

Hip and knee examination

Pyrexia

Discitis

Paediatric upper limb problems

What is congenital trigger thumb?

What is camptodactyly?

Wh2.84 at is clinodactyly?

Polydactyly and syndactyly

Proximal radioulnar synostosis

Paediatric spine

What are the causes of back pain in children?

How would you manage back pain in children?

What is scoliosis?

How would you assess a spinal deformity in a child?

What is congenital scoliosis?

What is idiopathic scoliosis?

What are the other spinal deformities in children, other than scoliosis?

What is Scheuermann’s kyphosis?

What is spondylolisthesis?

Summary

Suggested Reading

Introduction

It is important to appreciate that not all paediatric deformities, especially of the lower limbs, are pathological. Quite a few of them are physiological and they are referred to as normal variants of lower limb development. These generally spontaneously get better as the child grows. It is important to differentiate normal variants from pathological conditions that present in a similar fashion. The following table provides some differentiating factors:

Physiological Conditions	Pathological Conditions
Usually symmetrical	Rarely symmetrical
Flexible deformity – correctable	Rigid deformity
Familial (family history positive)	Family history positive or negative
Improves with time	Usually worsens with time
No active treatment generally necessary	Intervention is almost always needed

Physiological deformities/normal variants are an important cause of parental concern.

A detailed history and full clinical examination are generally all that is required to differentiate pathological conditions from normal variants.

What ages do the different normal variants present?

From birth to the first 2 years of life, the following normal variants are present:

1. Packaging deformities
2. Physiological flat foot (pes planus)
3. Physiological bow legs (genu varum)

From 2 years right up to the adolescent age (puberty), the following normal variants are present:

1. Knock knees (genu valgum)
2. In-toeing
3. Out-toeing

What are packaging defects?

Normal variants which are the result of intrauterine moulding are called packaging deformities. These include:

1. Hyper-extension of the knee
2. Postural talipes/calcaneovalgus foot
3. Out-toeing of infants as a result of external rotator contracture
4. Metatarsus adductus

Below is the brief description of some of the above deformities.

In-toeing and out-toeing

In-toeing, most commonly known as pigeon toes (Figure 1.1), refers to an inward pointing foot and is more common than out-toeing (foot points outwards) (Figure 1.2). They are an important cause for parental concern and a frequent referral to paediatric orthopaedic...