Pediatric Orthopedics Lecture Notes
Presenter
- Name: Jeremy Rush
- Location: San Antonio, Texas
- Disclosure: No financial disclosures
- Objective: Review commonly tested subjects in pediatric orthopedics
Key Topics Covered
Trauma and Specific Fractures
Non-Accidental Trauma (NAT)
- Important in patients under 3 years
- Mandated reporting by physicians
- Suspicious Fractures:
- Spiral humerus and femur fractures (esp. in non-ambulatory children)
- Transverse femur fractures (more common in NAT)
- Metaphyseal corner and distal humeral transphyseal fractures
- Posterior rib fractures (almost pathognomonic)
- Presentation: Skin lesions (bruising, burns)
- Skeletal Survey: Can reveal healing stages of fractures
Elbow Fractures
- Supracondylar humerus fractures:
- Common in children, especially extension type (95%)
- Gartland classification guides treatment:
- Type 1: Non-displaced, treated with casting
- Type 2: Angulated, treated with pinning or casting
- Type 3 & 4: Displaced, treated with reduction and pinning
- Complications: Nerve injuries (AIN common), vascular injuries
- Pink Pulseless Fracture:
- Fracture with no pulse but perfused hand
- Requires urgent reduction and pinning
- Monitor for compartment syndrome
- Lateral Condyle Fractures:
- Second most common elbow injury
- Requires internal oblique x-rays for displacement assessment
- Treated with casting or internal fixation
Femur Fractures
- Consider NAT
- Treatment Based on Age:
- Up to 6 months: Pavlik harness
- 6 months - 5 years: Closed reduction and spica casting
- Older children: Options include external fixation, submuscular plating, or intramedullary nails
Specific Conditions and Injuries
Osteomyelitis and Infections
- Common in children, hematogenous spread
- Common Pathogens: Staph aureus, MRSA, Group B strep, Kingella
- Clinical Indicators: Warm, tender limb, history of trauma
- Treatment: Antibiotics, potential surgical debridement
Scoliosis
- Adolescent Idiopathic Scoliosis:
- Curve >10 degrees
- Female predominance
- MRI for atypical patterns, progression, or neurologic issues
- Treatment:
- Curves >45-50 degrees: Surgery (instrumentation and fusion)
- Curves >25 degrees in immature children: Bracing (recent studies support efficacy)
Developmental Dysplasia of the Hip
- Risk Factors: Breach presentation, female sex, first born, family history
- Examination: Barlow and Ortolani maneuvers
- Treatment:
- Birth to 6 months: Pavlik harness
- 6-18 months: Closed reduction and casting
-
18 months: Open reduction and osteotomy
Slipped Capital Femoral Epiphysis (SCFE)
- Risk Factors: Obesity, endocrine disorders
- Symptoms: Knee pain, obligate external rotation
- Treatment: Pinning in situ; prophylactic pinning for contralateral hip in certain cases
Limb Length Discrepancies
- Etiologies include congenital conditions, trauma, and infections
- Treatment Options:
- Observation or shoe lift for discrepancies <2 cm
- Epiphysiodesis or shortening for 2-5 cm
- Combination of shortening/lengthening for >5 cm
Miscellaneous Topics
Clubfoot
- Congenital deformity with genetic components
- Treatment: Ponseti casting (mnemonic: CAVE)
- Recurrence: Associated with brace non-compliance
Muscular Dystrophy
- Types: Duchenne's and Becker's (both X-linked recessive)
- Symptoms: Proximal muscle weakness, Gower's sign
- Scoliosis Treatment: Surgical intervention at lower thresholds due to rapid progression
Rickets
- Characteristics: Short stature, varus angulation, bone pain.
- Radiographic Findings: Fissile cupping and widening
Achondroplasia
- Most common form of short limb dwarfism
- Genetic defect in FGFR3
These notes summarize the essential details from the lecture on pediatric orthopedics. They provide a comprehensive overview of key topics, conditions, and treatments relevant to the field.