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Musculoskeletal Problems in Children

  • Mark D. Bracker
  • Wilma J. Wooten

Abstract

Rotational problems resulting in gait abnormalities are the most common orthopedic conditions in the pediatric age group. Parents are frequently concerned that their child will grow up deformed or be unable to play sports as they observe in-toeing or out-toeing and seek medical attention. Most rotational abnormalities resolve spontaneously as musculature develops, and knowing this fact is reassuring to parents. Rarely, conditions remain fixed and require surgical correction at an older age. Torsional deformities may be due to problems in the foot (metatarsus adductus), tibia (torsion), or femur and hip (femoral anteversion). Angular abnormalities (bowlegs, knock-knees), if not correcting by age 2, should be investigated more carefully. Certain terminology has been recommended1 as well as specific testing used to evaluate gait (Fig. 20.1).

Keywords

Femoral Head Radial Head Slip Capital Femoral Epiphysis Osteochondritis Dissecans Femoral Anteversion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Branuelt CT, Nelson FR. A manual of orthopedic terminology. St. Louis: Mosby Year Book, 1994.Google Scholar
  2. 2.
    Staheli LT. Torsional deformities. Pediatr Clin North Am 1986;33:1373–83.PubMedGoogle Scholar
  3. 3.
    Engel FM, Staheli LT The natural history of torsional and other factors influencing gait in early childhood. Clin Or-thop 1974;99:12–17.CrossRefGoogle Scholar
  4. 4.
    Kurmar JS, MacEwen GO. The incidence of hip dysplasia with metatarsus adductus. Clin Orthop 1982;164:234–5.Google Scholar
  5. 5.
    Rushforth GF. The natural history of hooked forefoot. J Bone Joint Surg [Br] 1978;60:530–2.Google Scholar
  6. 6.
    Wenger DR, Leach J. Foot deformities in infants and children. Pediatr Clin North Am 1986;33:1411–27.PubMedGoogle Scholar
  7. 7.
    Farsetti P, Weinstein SL, Ponseti IV. The long-term functional and radiographic outcomes of untreated and non-opera-tively treated metatarsus adductus. J Bone Joint Surg [Am] 1994;76:257–65.Google Scholar
  8. 8.
    Brink DS, Levitsky DR. Cuneiform and cuboid wedge osteotomies for correction of residual metatarsus adductus: a surgical review. J Foot Ankle Surg 1995;34:371–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Scoles P. Lower extremity development. In: Scoles P, editor. Pediatric orthopedics in clinical practice. Chicago: Year Book, 1982:78–107.Google Scholar
  10. 10.
    Fabray G, MacEwen GD, Shands AR Jr. Torsion of the femur: a follow-up study in normal and abnormal conditions. J Bone Joint Surg [Am] 1973;55:1726–38.Google Scholar
  11. 11.
    Kling TF, Hensinger RN. Angular and torsional deformities of the lower limbs in children. Clin Orthop 1983;176:136–47.PubMedGoogle Scholar
  12. 12.
    Hensinger R, editor. Standards in pediatric orthopedics. New York: Raven, 1986:53–4.Google Scholar
  13. 13.
    Satenius P, Bankka E. The development of the tibiofemoral angle in children. J Bone Joint Surg [Am] 1975;57:259–62.Google Scholar
  14. 14.
    Renshaw TS. The lower extremity and the knee. In: Renshaw TS, editor. Pediatric orthopedics. Philadelphia: Saunders, 1986:91–122.Google Scholar
  15. 15.
    Mielke CH, Stevens PM. Hemiepiphyseal stapling for knee deformities in children younger than 10 years: a preliminary report. J Pediatr Orthop 1996;16:423–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Cummings RJ, Lovell WW. Operative treatment of congenital idiopathic club foot. J Bone Joint Surg [Am] 1988;70: 1108–12.Google Scholar
  17. 17.
    Ponseti IV. Congenital clubfoot, the results of treatment. J Bone Joint Surg [Am] 1963;45:261–9.Google Scholar
  18. 18.
    Cowell H. Talocalcaneal coalition and new causes of peroneal spastic flatfoot. Clin Orthop 1972;85:16–22.PubMedCrossRefGoogle Scholar
  19. 19.
    Kite JH. Some suggestions on the treatment of congenital clubfoot. J Bone Joint Surg [Am] 1963;45:406–12.Google Scholar
  20. 20.
    Ponseti IV. Nonoperative treatment of congenital clubfoot. Chicago: American Academy of Orthopedic Surgeons Film Library, 1972.Google Scholar
  21. 21.
    Coleman SS, Chesnut WJ. A simple test for hindfoot flexibility in the cavus foot. Clin Orthop 1977;123:60–6.PubMedGoogle Scholar
  22. 22.
    Paulos L, Samuelson KM. Pes cavovarus: review of a surgical approach using selective soft tissue procedures. J Bone Joint Surg [Am] 1980;62:942–53.Google Scholar
  23. 23.
    Wenger DR, Mauldin D, Speck G, Morgan D, Lieber R. Corrective shoes and inserts as treatment for flexible flatfoot in infants and children. J Bone Joint Surg [Am] 1989;71:800–10.Google Scholar
  24. 24.
    Steward M. Miscellaneous afflictions of the foot. In: Campbell’s operative orthopedics. St. Louis: Mosby, 1980: 1703.Google Scholar
  25. 25.
    Grice DS: An extra-articular arthrodesis of the subtalar joint for correction of paralytic flat foot in children. J Bone Joint Surg [Am] 1985;34:927–31.Google Scholar
  26. 26.
    Salter RB, Zaltz C. Anatomic investigation of the mechanism of injury and pathologic anatomy of “pulled elbow” in young children. Clin Orthop 1971;77:134.PubMedGoogle Scholar
  27. 27.
    Southmayd W, Ehrlich MB. Idiopathic subluxation of the radial head. Clin Orthop 1976;121:271.PubMedGoogle Scholar
  28. 28.
    Beligere N, Harris V, Pruzansky S. Progressive bony dysplasia in Apert syndrome. Radiology 1981;139:593–7.PubMedGoogle Scholar
  29. 29.
    Triantafyllou SJ, Wilson SC, Rychak JS. Irreducible “pulled elbow” in a child: a case report. Clin Orthop 1991;284:153.Google Scholar
  30. 30.
    Hardinse K. The etiology of transient synovitis of the hip in childhood. J Bone Joint Surg [Br] 1970;52:100–7.Google Scholar
  31. 31.
    Bickerstaff DR, Neal LM, Booth AJ, Brennan PO, Bell MJ. Ultrasound examination of the irritable hip. J Bone Joint Surg [Br] 1990;72:549–53.Google Scholar
  32. 32.
    Valderrama JAF. The observation hip syndrome and its late sequelae. J Bone Joint Surg [Br] 1963;45:462–9.Google Scholar
  33. 33.
    Cooperman DR, Charles LM, Pathria M, Latimer B, Thompson GH. Post-mortem description of slipped capital femoral epiphysis. J Bone Joint Surg [Br] 1992;74:595–9.Google Scholar
  34. 34.
    Kelsey JL, Southwick WD. Etiology, mechanism, and incidence of slipped capital femoral epiphysis. AAOS Instruct Course Lect 1972;21:182.Google Scholar
  35. 35.
    Fahey JJ, O’Brien ET. Acute slipped capital femoral epiphysis: review of the literature and report of ten cases. J Bone Joint Surg [Am] 1965;47:1105–27.Google Scholar
  36. 36.
    Kallio PE, Paterson DC, Foster BK, Lequene GW Classification in slipped capital femoral epiphysis. Clin Orthop 1993; 294:196–203.PubMedGoogle Scholar
  37. 37.
    Loder RT, Richards BS, Shapiro PS, Reznick LR, Aronsson DD. Acute slipped capital femoral epiphysis: the importance of physical stability J Bone Joint Surg [Am] 1993;75: 1134–40.Google Scholar
  38. 38.
    Townsend DJ, Tolo VT. Congenital dislocation of the hip. Curr Opin Rheum 1994;6:183–6.CrossRefGoogle Scholar
  39. 39.
    Hensinger RN. Congenital dislocation of the hip. Ciba Clin Symp 1979;31:3–31.Google Scholar
  40. 40.
    Rosendahl K, Markestad T, Lie RT. Ultrasound in the early diagnosis of congenital dislocation of the hip: the significance of hip stability versus acetabular morphology. Pediatric Radiol 1992;22:430–3.CrossRefGoogle Scholar
  41. 41.
    Graf R. Hip semiography: how reliable? Sector scanning versus linear scanning? Dynamic versus static examination? Clin Orthop 1992;281:18–21.PubMedGoogle Scholar
  42. 42.
    Weinstein SL. Congenital hip dislocation: long-range problems, residual signs and symptoms after successful treatment. Clin Orthop 1992;281:69–74.PubMedGoogle Scholar
  43. 43.
    Harris IE, Dickens R, Menelaus MB. Use of the Pavlic harness for hip displacements: when to abandon treatment. Clin Orthop 1992;281:29–33.PubMedGoogle Scholar
  44. 44.
    Catterall A. The natural history of Perthes’ disease. J Bone Joint Surg [Br] 1971;53:37–53.Google Scholar
  45. 45.
    Gerberg LF, Micheli LJ. Nontraumatic hip pain in active children: a critical differential. Phys Sports Med 1996;24:69–74.CrossRefGoogle Scholar
  46. 46.
    Gershuni DH. Preliminary evaluation and prognosis in Legg-Calvé-Perthes disease. Clin Orthop 1980;150:16–22.PubMedGoogle Scholar
  47. 47.
    Fackler CD. Nonsurgical treatment of Legg-Calvé-Perthes disease. Instr Course Lect 1989;38:305–8.PubMedGoogle Scholar
  48. 48.
    Catterall A. Adolescent hip pain after Perthes’ disease. Clin Orthop 1986;209:65–9.PubMedGoogle Scholar
  49. 49.
    Micheli LJ. The traction apophysitises. Clin Sports Med 1987; 6:389–404.PubMedGoogle Scholar
  50. 50.
    Medlar RC, Lyne ED. Sindig-Larsen-Johansson disease: its etiology and natural history. J Bone Joint Surg [Am] 1978; 60:1113–6.Google Scholar
  51. 51.
    Osgood RB. Lesions of the tibial tubercle occurring during adolescence. Boston Med J 1903;148:114–17.CrossRefGoogle Scholar
  52. 52.
    D’Ambrosia RD, MacDonald GL. Pitfalls in the diagnosis of Osgood-Schlatter disease. Clin Orthop 1975;110:206–9.PubMedCrossRefGoogle Scholar
  53. 53.
    Krause BL, Williams JP, Catterall A. Natural history of Osgood-Schlatter disease. J Pediatr Orthop 1990;10:65–8.PubMedGoogle Scholar
  54. 54.
    Flowers MJ, Bhadreshwar DR. Tibial tuberosity excision for symptomatic Osgood-Schlatters disease. J Pediatr Orthop 1995;15:292–7.PubMedCrossRefGoogle Scholar
  55. 55.
    Binazzi R, Felli L, Viccari V, Borelli P. Surgical treatment of unresolved Osgood Schlatter lesion. Clin Orthop 1993;289: 202–4.PubMedGoogle Scholar
  56. 56.
    Sever JW. Apophysitis of the os calcis. NY Med J 1912;95: 1025–9.Google Scholar
  57. 57.
    Micheli LJ. The traction apophysitises. Clin Sports Med 1987;6:389–404.PubMedGoogle Scholar
  58. 58.
    Peck DM. Apophyseal injuries in the young athlete. Am Fam Physician 1995;51:1891–5.PubMedGoogle Scholar
  59. 59.
    Guhl J. Arthroscopic treatment of osteochondritis dissecans. Clin Orthop 1982;167:65–74.PubMedGoogle Scholar
  60. 60.
    Aglietti P, Buzzi R, Bassi PB, Fioriti M. Arthroscopic drilling in juvenile osteochondritis dissecans of the medial femoral condyle. Arthroscopy 1994;10:286–91.PubMedCrossRefGoogle Scholar
  61. 61.
    Wiltse LL, Newman PH, Macnab I. Classification of spondylolysis and spondylolisthesis. Clin Orthop 1976;117:23–9.PubMedGoogle Scholar
  62. 62.
    Hensinger RN. Spondylolysis and spondylolisthesis in children and adolescents. J Bone Joint Surg [Am] 1989;71:1098–1107.Google Scholar
  63. 63.
    Gelfand MJ, Strife JL, Kereiakes JG. Radionuclide bone imaging in spondylolysis of the lumbar spine in children. Radiology 1981;140:191–5.PubMedGoogle Scholar
  64. 64.
    Boxall D, Bradford DS, Winter RB, Moe JH. Management of severe spondylolisthesis in children and adolescents. J Bone Joint Surg [Am] 1979;61:479–95.Google Scholar
  65. 65.
    Sorensen KH. Scheuermann’s juvenile kyphosis. Copenhagen: Munksgaard, 1964.Google Scholar
  66. 66.
    Hensinger RN, Greene TL, Hunter LY. Back pain and vertebral changes simulating Scheuermann’s kyphosis. Spine 1982;6:341–2.Google Scholar
  67. 67.
    Bradford DS. Juvenile kyphosis. In: Bradford DS, Lonstein JE, Moe JH, et al, editors. Moe’s textbook of scoliosis and other spinal deformities. 2nd ed. Philadelphia: Saunders, 1987:347–68.Google Scholar
  68. 68.
    Gutowski WT, Renshaw TS. Orthotic results in adolescent kyphosis. Spine 1988;13:485–9.PubMedCrossRefGoogle Scholar
  69. 69.
    Cobb J. Outline for study of scoliosis. AAOS Instruct Course Lect 1948;5:261–275, Ann Arbor, J. W Edwards.Google Scholar
  70. 70.
    Moe JH, Byrd JA III. Idiopathic scoliosis. In: Bradford DS, Lonstein JH, Moe JH, et al, editors. Moe’s textbook of scoliosis and other spinal deformities. 2nd ed. Philadelphia: Saunders, 1987:191–232.Google Scholar

Copyright information

© Springer Science+Business Media New York 1998

Authors and Affiliations

  • Mark D. Bracker
  • Wilma J. Wooten

There are no affiliations available

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