Chapter 44 Paediatric Orthopaedics

Immature skeletons heal rapidly and can remodel with growth but physeal injury or muscle imbalance may lead to progressive deformity. Three coordinated signalling centres control limb development: the apical ectodermal ridge; the mesodermal zone of polarising activity; and the ectodermal driven wingless-type. 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. Intoeing is defined as a negative foot progression angle and results from one or more lower limb torsional anomalies. Extoeing is less common but results from relative femoral retroversion, external tibial torsion or flexible flat feet. Toe walking is a phase in normal gait development. 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 4, which affects enchondral bone formation.

Multiple Choice Questions
Weblinks

Journal articles

https://eor.bioscientifica.com/view/journals/eor/6/7/2058-5241.6.200155.xml/ (free)

A recent review of the multidisciplinary input required to manage children with acute bone and joint infection.

https://eor.bioscientifica.com/view/journals/eor/5/2/2058-5241.5.180106.xml?rskey=n5fXFl&result=1&body=pdf-36027 (free)

https://eor.bioscientifica.com/view/journals/eor/6/2/2058-5241.6.200076.xml?rskey=HX62Ny&result=1 (free)

If you do need to manage flat feet (flexible or stiff) surgically, these two articles will help define your indications and your likely outcomes.

Websites

https://global-help.org/

Global HELP provides a free, online medical library with a primary focus on children’s health in underserved communities. It covers a wide variety of both medical and surgical topics and includes full textbooks as well as articles and advice sheets – often translated into several languages.

https://hipdysplasia.org/

This website helps doctors and patients to understand the problems associated with developmental dysplasia of the hip (DDH) and aims to reduce the physical, social and economic burden for children and adults affected by neonatal hip instability and DDH.

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