Paediatric orthopaedics
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Unit 600
December 2022
This edition of check considers the investigation and management of paediatric orthopaedic presentations in general practice.
Paediatric deformities can be a source of concern for both parents and clinicians and may present a challenge when determining which require intervention and which will resolve over time.
Hip dysplasia occurs as a result of environmental and genetic factors, with the highest risk in female breech babies (120/1000). Male breech babies have an absolute risk of 26 per 1000, which is lower than that of females with a family history (44/1000) but higher than females in general (19/1000).
Slipped upper femoral epiphysis (SUFE) affects between 0.2 and 10 per 100,000 people, and half of affected adolescents are above the 95th percentile for weight. Boys are affected more often than girls, and at a slighter later age (13.5 years vs 12 years).
Scoliosis has a prevalence of 0.47–5.2%, and although males and females are equally affected for small curves, females are seven times more likely to have a curve >40°.
Flat feet affect up to 14% of children and can be part of a normal developmental profile; interventions can help limit progression of deformity and reduce the rate of chronic, secondary complications.
At the end of this activity, participants will be able to:
Below is a list of the case studies found in this month's edition of check. To see how these case studies unfold and gain valuable insights into this months topic, log into gplearning to complete the course.
Chloe, aged 11 years, is a girl who is medically fit and well. She has been brought in to see you for review of her asymmetrical shoulder. She recently changed schools, and her new physical education teacher noticed that one of her shoulder blades looked more prominent than the other when she was in the pool. The teacher discussed this with Chloe’s mother, who agreed. Chloe has no pain and no history of recent or historical trauma. She uses her arm without any concerns. She takes no medications and has no allergies.
Adrian, aged 10 years, is a grade four student who is unable to weight bear after tripping on the oval at school during his lunch break. He presents accompanied by his mother, Daniella, who is concerned about Adrian’s level of discomfort and reluctance to move his left leg.
Elise, aged 32 years, is a new mother who presents to you with her child, Grace, aged five months. Elise is concerned that Grace has more creases around her left thigh than the right and is not yet showing an interest in rolling over. Grace is her first child and was born at 39 weeks by elective caesarean section because of a breech presentation. Grace had a birth weight of 3.4 kg. There is no relevant family history. Grace is feeding well and putting on weight normally.
Petru, aged 13 years, is a healthy male who enjoys participating in athletics at school. For the past six months he has experienced bilateral medial knee pain, and he went to see a physiotherapist about it. The physiotherapist does not think Petru’s knees are the problem and thinks his knee pain is coming from his feet. Petru attends your clinic with his parents to discuss this.
This unit of check is approved for 8 hours of CPD activity (two hours per case). The 8 hours, when completed, including the online questions, comprise five hours’ 鲍鱼视频al Activities and five hours’ Reviewing Performance.
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Each unit of check comprises approximately five clinical cases, and the choice of cases will cover the broad spectrum of the unit’s topic. Each unit will be led by a GP with an interest and capability in the topic, and they will scope the five different cases for that unit in collaboration with the check team.