PAEDIATRIC ORTHOPAEDICS

ORTHO - PAEDICS

Children are not small Adults

Anatomic differences Centers of ossification Radiolucent growth plate Thicker and stronger periosteum

Biomechanic differences Osteoid of a child’s bone is not significantly less calcified,but the density of a young’s bone is certainly less Pores prevent the extension of a fracture line Porous nature allows failure in compression Growth remodeling based in asymmetric growth of physis and periosteum

Clinical examination-The grate Art Children never lie Children cry Listen to the mother Congenital deformities Family history Abused child

Congenital deformities Infantile hip Dysplasia or Congenital dislocation of the Hip Coxa Vara-Coxa Valga Paediatric Foot

C.D.H-Incidence 1-6\1000 births Left hip is affected about twice as frequently as the right Highest risk for first born girls Family history Scoliosis[10 times grater incidence]

Etiology Familiar tendency Joint laxity Acetabular dysplasia Mechanical factors Deficiency in growth of the labrum[limbus] Hormonal abnormalities

Physical Assessment Apparent limb’s shortening Ortolani’s test Barlow’s test Limited abduction[no more than half way] Assymetrical skin creases Perineal gap Late walking,waddling gait

Radiologic assessment Xrays Ultrasonography Computed tomography Magnetic Resonance Imaging

Treatment Closed treatment:Pavlik harness,Von Rosen harness,Frejka pillow Surgical procedures:Salter acetabular osteotomy,Chiari acetabular osteotomy,femoral osteotomies

Slipped Capital Femoral Epiphysis

Incidence Boys age 12 to14, girls age 10 to 12 Caucasian children 1 to 3 per Black males,higher incidence[7 to 8 per ]

Etiologic factors Obesity Rapid growth spurts Endocrinopathies[hypothyroidism,renal rickets,hypogonadism] Mechanical factors

Clinical Presentation Preslip Acute slip Chronic slip[3 weeks] Acute on chronic slip

Diagnostic Imaging Lateral Head-shaft Angle[Southwick’ method] >60, 30-60,30> Klein’s line Epiphyseal height Physeal widening One third uncovered metaphysis,grade 1 Two thirds,grade 2 More than two thirds,grade 3

Treatment Manipulation Pinning Osteotomies

Legg-Calve-Perthes’ Deasease

Incidence 1 in Particularly rare in black children Usually 4-8 years old Boys are affected 4 times as often as girls Higher incidence in underprivileged communities

Pathogenesis Blood supply of femoral head:1/metaphyseal vessels which penetrate the growth disc 2/lateral epiphyseal vessels running in the retinacula 3/scanty vessels in the ligamentum teres Between 4 and 7 years of age blood supply and venous drainage depends almost entirely on the lateral epiphyseal vessels

Pathology Stage 1: Ischaemia and bone death Stage 2:Revascularizasion and repair Stage 3: Distorsion and remodeling

Treatment Analgesia-? Skin traction Supervised neglect Containment:1/Hips widely abducted,in plasteror in removable splint 2/Varus osteotomy of femur or pelvis

Fractures Greenstick fractures Injuries of physis

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