1. Childhood Orthopaedic conditions: Dilemmas BOTA 2015 Robin W Paton FRCS(Orthopaedic) PhD Visiting Professor, UCLAN Honorary Senior Lecturer, University of Manchester

2. Congenital Talipes Equinovarus (CTEV) CTEV 1 to 2 per 1000 births More common in males Unilateral > bilateral Exclude spinal & syndromic causes C: cavus A: adductus V: Varus E: equinus Bilateral CTEV

3. Congenital talipes Calcaneo-valgus (CTCV) CTCV Rarer than CTEV Associations: pathological DDH fibular hemi-melia spinal disorders vertical talus Deformity: foot towards shin

4. Pes cavus (including plantaris deformity) Secondary causes brain: CP/ Friedrich ataxia spine: cord tether diastematomylia polio spina bifida Peripheral:HSMN muscular dystrophies Trauma:compartment syndrome burns Other:CTEV (iatrogenic) Duchenne’s MD Pes cavus: deformity

5. Pes cavus HMSN (Charcot Marie Tooth) Pathology: autosomal dominant & recessive inheritance autosomal dominant form - Chr-17 myelination protein 22 abnormal Incidence: 1:2500 HSMN I : presents earlier HSMN 2: axonal form Problem: progressive deformity PB/ TA/ weak Intrinsic ms. Hands/feet wasted

6. Pes Planus Secondary Types Flexible types: Hyper laxity Marfans syndrome Ehlos Danlos syndrome Rigid types: tarsal coalition vertical talus JCA osteochondrosis Tarsal coalition: Calcaneo-navicular bar

7. Cerebral palsy Non progressive, brain origin, impaired motor function, presenting < 2 years of age. Incidence:1:400 Pre-natal:maternal infection alcohol/ drugs congenital malformation brain Perinatal:birth trauma/ asphyxia (10%) Low birth weight/ <36 gestation Neonatal jaundice Postnatal: cerebral haemorrhage NAI meningitis Classification Anatomical: hemiplegia diplegia four limb involvement total body involvement Physiological: spastic (UMN) 60% athetoid (basal ganglia) 20% ataxic (cerebellar)

8. Cerebral Palsy Walking prognosis: If can sit independently by 2 years 100% hemiplegia 66% spastic four limb involvement 0% TBI

9. Slipped Upper Femoral Epiphysis (SUFE/SCFE) Epidemiology 1:50,000, > male, black > white 11 to 15 years of age Vulnerable epiphysis: hormonal: hypothyroidism (<25 percentile) growth hormone renal radiation Mechanical: trauma obesity (> 80 th. Percentile)

10. Slipped Upper Femoral Epiphysis (SUFE) Clinical presentation: Symptoms: Limp Often no hip pain Pain radiating to knee Signs: Limited internal rotation of the hip Limited abduction / flexion of the hip Foot in external rotation Unable to weight bear (Loder positive)

11. Case 1 18 month old female

12. Case 1 Age 6 years

13. Case 2 8 year old female

14. Case 2

15. Case 2: 20 months post operatively

16. Case 3 13 year old male

17. Case 5 1.5 year old female

18. Case 5 Post operative 3.5 year old

19. Thank you

20. Case 1 15 year old male Previous surgery aged 18 months right hip