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- Advanced Certificate in the Principles of Orthopaedics
Modules
- 15 Sections
- 45 Lessons
- 123 Days
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- Introduction2
- Module 1 - The Orthopaedic Oncall (Complimentary Taster Module)5
- Module 2 - Upper Limb Trauma & Emergencies5
- Module 3 - Lower Limb Trauma & Emergencies4
- Module 4 - Spinal Trauma and other Acute and Elective Spinal Conditions6
- Module 5 - Paediatric Orthopaedics3
- Module 6 - Orthopaedic Pathologies & Oncology5
- Module 7 - Practical & Surgical Orthopaedic Skills5
- Module 8 - Principles of Orthopaedic Imaging and Case Spottors7
- 9.1How to Read X-Rays40 Minutes
- 9.2Commonly Missed Orthopaedic Injuries81 Minutes
- 9.3Xrays of Common Orthopaedic Conditions46 Minutes
- 9.4General Concepts of Orthopaedic Radiographs47 Minutes
- 9.5General Principles of MRI in Orthopaedics37 Minutes
- 9.7Summary Sheet of Key Learning Points
- 9.8Assessment20 Questions
- Module 9 - Orthopaedic Clinical Examination4
- Module 10 - Orthopaedic Upper Limb Conditions3
- Module 11 - Orthopaedic Lower Limb Conditions3
- Module 12 - Orthopaedic Implants & Appliances3
- Module 13 - General Principles of Orthopaedic Practice2
- Student Feedback1
Intoeing
Candidate:
Absolutely. There are three main causes of in-toeing in children: metatarsus adductus, internal tibial torsion, and persistent femoral anteversion. Metatarsus adductus, which is typically noticed at birth, is a congenital foot deformity where the foot turns inward. Internal tibial torsion, usually appearing between 1-2 years of age, is characterized by the inward twisting of the tibia. Persistent femoral anteversion, on the other hand, is typically noted in children over 3 years old and involves the femur being rotated inwards. Each of these can lead to an in-toeing goal, but the age of onset and specific anatomical issue differ.
Candidate:
During the examination of the child’s gait, it’s crucial to observe both with shoes on and barefoot. I would look at the foot progression angle, which indicates the alignment of the foot during walking. A negative foot progression angle, as in this case, suggests in-toeing. When examining the gait, it’s also important to watch for any asymmetry in the lower legs, signs of discomfort or stumbling, or any other abnormalities that could point towards an underlying problem.
Candidate:
The torsional profile helps identify the possible cause of in-toeing. While the child is prone, I would examine the metatarsus adductus by looking at the foot shape in relation to the heel bisector line. Tibial torsion is assessed by the thigh-foot angle or the transmalleolar axis if the foot shape is abnormal. Lastly, I would assess femoral anteversion by evaluating the range of internal and external hip rotation, and by using Ruwe’s method to measure the angle from the vertical.
Candidate:
The surgical intervention for persistent femoral anteversion, which seems to be the most likely cause in this case, would involve cutting and rotating the femora, followed by fixation. However, this is a major surgical procedure with significant risks, and it is generally reserved for severe cases or cases that don’t improve with time or conservative management. Considering that the condition tends to improve over the first decade, and rarely presents a functional problem in adulthood, I would advise the mother that surgery may not be the best option at this point. Instead, we could monitor the child’s condition and consider non-surgical options. It’s also important to reassure her that her daughter is within the normal spectrum, and the in-toeing is more of a cosmetic issue.
Candidate:
Ligamentous laxity is assessed using the Beighton score. The score includes assessments for increased finger and thumb hyperextension, increased elbow and knee hyperextension, and the ability to place palms on the floor with straight legs. Each of these assessments has a certain point value, and the total score is out of 9. Higher scores indicate greater ligamentous laxity. It’s important to assess this as part of the overall evaluation, as it can influence the management plan.