Pediatric Orthopedics Key Lecture Insights

Aug 14, 2024

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.