Musculoskeletal Development

Question 1

What is talipes?

Answer 1

Clubfoot - abnormality of the ankle and foot present at birth (bilateral in 50%)

Question 2

What is this a presentation of?
A fixed abnormality in the foot and ankle that restricts active and passive movement at the ankle. Inversion, adduction of forefoot relevant to hindfoot, plantarflexion.

Answer 2

Talipes equinovarus (fixed)

Question 3

What is this a presentation of?
Abnormality in the foot and ankle that restricts active movement at the ankle, passive movement is preserved. Inversion, adduction of forefoot relevant to hindfoot, plantarflexion.

Answer 3

Positional talipes

Question 4

What are the causes of talipes?

Answer 4

1. Majority isolated and asymptomatic

2. 20% associated with genetic syndromes

Question 5

What is the management for talipes?

Answer 5

1. Ponseti’s method - foot manipulated and placed in serial plaster casts, correction is gradual
2. If failed - surgery to Achilles tendon, ligaments and bone.
3. If positional talipes - regular stretching and self-correcting.

Question 6

What is this describing?

Abnormal development of the hip joint in utero, unilateral in 80%, more common in left hip.

Answer 6

Congenital hip dysplasia

Question 7

What is the spectrum of congenital hip dysplasia from and to?

Answer 7

From stable acetabular dysplasia to established hip dislocation.

Question 8

What are the risk factors for congenital hip dysplasia?

Answer 8

1. History in 1st degree relative
2. Breech presentation
3. Multiple pregnancy
4. Female (80%)
5. First born

Question 9

How is congenital hip dysplasia diagnosed from birth to 3 months old?

Answer 9

1. Positive finding in Ortolani’s and Barlow’s manoeuvres at screening - feel click/clunk.
2. Asymmetrical skin creases at upper thigh.

Question 10

How is congenital hip dysplasia diagnosed from 3 months to 1 year old?

Answer 10

1. Limited leg adduction
2. Leg length discrepancy (Galeazzi test)
3. Asymmetry of leg creases

Question 11

How is congenital hip dysplasia diagnosed in a mobile child?

Answer 11

1. Limp

2. If bilateral - excessive lumbar lordosis and waddling gait

Question 12

What is Ortolani’s manoeuvre?

Answer 12

Attempt to relocate a partially dislocated hip.

Question 13

What is Barlow’s manoeuvre?

Answer 13

Aims to sublux or dislocate an unstable hip.

Question 14

What is Galeazzi’s manoeuvre?

Answer 14

1. Child lies supine, hips and knees flexed, feet flat on table, ankles touching buttocks.
2. Test is +ve if knees at different heights.

Question 15

How should you investigate suspected congenital hip dysplasia?

Answer 15

1. In newborn period - USS hip

2. >6 months - hip X-ray

Question 16

What is the management for congenital hip dysplasia?

Answer 16

1. Mild dysplasia - delay by 2-8 weeks for spontaneous resolution.
2. Pavlik harness - prevents hip extension and adduction while allowing flexion and abduction.
3. Surgery if harness does not help/condition presents >6 months old.