1. Paediatric Orthopaedics E.E.Fogarty F.R.C.S.I, F.R.A.C.S

2. Socrates

3. HEMLOCK Hemlock was frequently administered to criminals Is sedative and antispasmodic Prescribed as a remedy in cases of undue nervous motor excitability Overdose produces paralysis

4. Limp Normal gait Causes of limp Investigations

5. Normal Gait Bipedal Rhythmic and effortless Depends On a number of reflexes Intact locomotor system

6. Gait Cycle

7. Walking Cruise before 1year Walk at 14-18months Develop a mature(adult) gait at 3years

8. Limp Is any disturbance of gait Is due to one or more of 3 general causes Pain Weakness Structural abnormalities

9. Types of Limp Antalgic Neuromuscular Trendelenberg Short leg gait

10. Causes of Limp Congenital Coxa vara, congenital short limb Inflammatory Juvenile chronic arthritis,transient synovitis Infectious Osteomyelitis,septic arthritis,discitis

11. Causes of Limp Developmental Scfe, Ddh, Perthes, acquired limb length discrepancy Neoplastic Benign Malignant Secondary tumours

12. Causes of Limp Traumatic Toddlers and stress fractures Neuromuscular Metabolic Haematological Referred Appendicitis

13. Stress Fracture Adolescent Upper Tibia Looks aggressive

14. Stress Fracture

15. Investigations Plain x-rays Scannogram plus wrist x-ray MRI,CT scan, Bone scan FBC,ESR

16. Hip Intoeing Transient synovitis Development dysplasia of the hip Perthes disease Slipped capital femoral epiphysis

17. Intoeing Common condition Large number of children May be simple or complex Femur Tibia Foot Familial tendency

18. Line of progression Foot progression angle

22. Transient Synovitis Inflammatory condition. Cause unknown. Peak incidence 3-6 years. Mild U.R.T.I. Pain and limp. Resolves in 48 hours. May need aspiration.

23. Ultrasound Femur Capsule Normal Effusion

24. Joint Pain

25. Joint Fluid Aspiration Normal JRA SA Color yellow yellow Blood stained Clarity clear cloudy turbid Viscosity very high low very low WBC count 20000 PMN 75% Gram’s stain-ve -ve+ve in 30-40% Culture-ve -ve+ve in 50-60%

26. Developmental Dysplasia of the Hip Incidence 0.1% 4 times commoner in girls Risk factors 1 st. Born Breech Oligohydramnios

27. Diagnosis Ortolani Barlow Asymmetrical folds Galeazzi sign Limp X-ray U/S

28. Ortolani Test Ortolani manoeuvre to determine if the hip is dislocated

29. Barlow’s Test the Barlow is a provocative test for a dislocatable hip

30. Asymmetrical Folds

31. Galeazzi Sign

32. Ultrasound The  angle, which is a measurement of the slope of the superior aspect of the bony acetabulum, and the  angle, which evaluates the cartilaginous component of the acetabulum

33. Ultrasound Indications for ultrasonography are not universally established Overdiagnosis above the expected incidence of DDH Not Cost–effective

34. Treatment 0-6 months Pavlik 6-18 months Traction and casting More than 18 months Open reduction Osteotomy

35. Thoracic band Shoulder straps Stirrups Ant. Post. Straps

36. Perthes Ischaemic necrosis Collapse and repair Peak incidence 4-9 yrs Limp no pain Classification Lat.Pillar Containment

37. Knee Genu varum Genu valgum

38. Genu Varum

39. Genu Valgum

40. Foot Flatfoot Metatarsus varus Talipes equino-varus Pes cavus

41. Flatfoot Mobile Infantile Postural Temporary Spastic Neuromuscular

42. Physiological Pes Planus

43. Metatarsus Varus Partly genetic Normal hindfoot Adducted forefoot Usually resolves May need stretching and casting

44. Talipes Equino-varus 1.2/1000 live births Stiff Smaller calf Deformities Equinus Inversion Adduction Stretching,strapping Surgery

45. Pes Cavus Neurological Pma Dysraphism Friedrich’s ataxia