A limb deformity can be defined as distortion from the normal form and this may be in the form of leg length discrepancy (LLD), angular deformity, rotational deformity, or a combination of these. Untreated substantive limb deformity can cause symptoms and affect limbs functions. An accurate assessment and appropriate treatment are the key to success in managing these patients.

Upper limb involvement and impaired functional use of the hand is common in CP [1, 2]. It is typically evident by 1 year of age when infants fail to achieve certain motor milestones such as a refined pincer grasp. Neurological impairment can manifest with spasticity, weakness, or, in the case of dyskinetic CP, involuntary movement and fluctuations in tone [3]. Management of upper limb impairment in CP requires a comprehensive multidisciplinary team approach, with the goal of improving function, providing comfort, enabling good hygiene, or addressing cosmetic concerns.

The same sentiments still apply from our first edition’s chapter that general FRCS (Tr & Orth) exam guidance material can become a little dull and tedious to most candidates. We again have tried to avoid any unnecessary repetition of material, concentrating on the important details vital for exam success.

Pelvic injuries are uncommon in children and account for approximately 1–2% of all paediatric fractures [1–3], with high-energy motor vehicle accidents being the commonest cause [4]. Efficient primary assessment using Adult Trauma Life Support (ATLS) and Paediatric Life Support (PLS) principles, with subsequent secondary/tertiary surveys, will guide immediate management and identify associated injuries.

The distal femoral physis grows at 10 mm per year and contributes to 70% of the femoral growth and to 40% of the growth of the lower limb [1]. Distal femur fractures account for 1% of all physeal injuries and are often caused by motor vehicle accidents [2] and sporting activities [3].

Teratologic dislocation of the hip is a distinct form of hip dislocation that usually occurs with other disorders such as arthrogryposis, myelodysplasia and neuromuscular diseases. These hips are dislocated before birth, have limited range of motion and are not reducible on examination (or even by closed reduction under general anaesthesia) (Figure 4c.1).

Spinal deformities are probably the most complex deformities to understand, analyse, and treat in orthopaedic practice. This is because of the many small vertebrae in the spine, inherent instability of facet joints, reliance on muscle strength to maintain stability, various compensatory mechanisms to accommodate for a deformity, and strong bending forces that the spine endures.

Perthes disease is avascular necrosis (AVN) of the femoral head in a growing child caused by interruption of blood supply to the femoral head. The condition was first described by Waldenström, but he attributed it to tuberculosis. It was then described more accurately by Arthur Legg (American), Jacques Calvé (French), and George Perthes (German) almost at the same time – hence the name Legg–Calvé–Perthes disease (LCPD).

Wrist fractures are the commonest paediatric fracture, comprising 20% of all fractures in children. The majority are simple torus fractures caused by compression forces acting along the main axis of the bone, with buckling of the cortices, often more pronounced on the concave side (Figure 17.1). Greenstick fractures occur from a bending force with a unicortical break of the convex side.

A substantial proportion of referrals to paediatric orthopaedic clinics consist of normal physiological variants in growing children. Careful history and examination, and knowledge of the clinical course of rotational and angular deformities allow accurate assessment of children to exclude pathology and provide reassurance to parents. The aim of this chapter is to highlight areas of normal variation in paediatric orthopaedic practice and to identify abnormal features that require further investigation.

Neuromuscular disorders (NMDs) constitute a major part of paediatric orthopaedic work. As most conditions are chronic and their management requires high-ordered thinking, they are generally considered good exam cases.

Paediatric shoulder injuries are common and frequently associated with organized sports. Boys are more commonly affected, and injuries tend to occur as a consequence of contact with a surface, in sports such as rugby or wrestling, or in the overhead throwing athlete [1].