1. The A B C’s of Playground Bone and Joint Injuries Brett Cascio, MD LTC, US Army Reserve Medical Director, Memorial Sports Medicine LSUHSC and McNeese St. Clinical faculty

2. Topics Emergencies Fractures Casts Little League/overuse injuries Concussions

3. Emergencies Dislocations Open fractures Supracondylar elbow fracture SCFE Septic joint Compartment Syndrome - cast

4. Dislocation Should you reduce?

5. Open Fracture

6. Supracondylar elbow fracture 3 types Type 3 can be a vascular emergency

7. SCFE Slipped Capitol Femoral Epiphysis Can worsen rapidly Can cause necrosis of femoral head Forced ext rot w/ flex

8. Septic Joint Hip and knee Limping or will not bear weight Fever, effusion Sexually active teens http://www.rch.org.au/fracture-education/growth_plate_injuries/Physeal_growth_plate_injuries/

9. Compartment syndrome Swollen, tight compartment Usually with trauma but can be exercise induced Tight cast Can lead to kidney failure and permanent disability

10. Fractures Open (compound) or closed Displaced or nondisplaced

11. Buckle or Greenstick FRACTURE

14. Growth Plate Fracture Bones grow longer and wider Growth plates on ends of bones from femur to finger Periosteum – can get entrapped

15. SALTER HARRIS

16. SALTER HARRIS I

17. SCFE – Slipped Capital Femoral Epiphysis

18. SALTER HARRIS II

19. SALTER HARRIS III

20. SALTER HARRIS IV

21. SALTER HARRIS V Very bad – growth arrest

22. Triplane Happens because way growth plate fuses

23. ACL avulsion Swollen painful stiff knee

24. Tibial tubercle avulsion Patella tendon tears bone Its like Osgood Schlatter’s Disease on steroids Swollen painful stiff knee

25. Ankle Sprain vs fracture Often it is hard for orthopaedic docs to decifer

26. Toe/finger injuries Don’t underestimate

27. 5 th Metatarsal Fracture Jone’s Fracture?

28. Back Stress Fracture? Herniated disc

29. SUSPICIOUS FRACTURES Recurrent injuries lethal in 10% First born, step, premature, learning disabled Over half of fxs in first year No predominant abuse pattern Chip fracture of distal femur metaphysis Multiple fractures of different stages of healing Femur fxs in pre-ambulatory children Skull rib scapula fxs Ulna nightstick fractures

30. Splint vs Cast Splint safer Cast stronger Don’t get wet Don’t put anything in cast to scratch

31. Splint vs Cast

33. STOP Sports Injuries Sports Trauma and Overuse Prevention Overuse injuries Epidemic “Little league” elbows and shoulders Coaches and PE teachers and PARENTS http://www.stopsportsinjuries.org/

34. Little League Elbow, Shoulder Tommy John Salter 1 fract vs UCL tear Risk factors http://www.cincinnatichildrens.org/health/l/little-league-shoulder/?sa=X&ved=0ahUK EwjpwJib7KLLAhVHNSYKHVcfBo4Q9QEIGTAA

35. Sever’s Disease osteochondritis

36. Head bone - Concussions Huge increase in public awareness Memorial Sports Program IMPACT testing Find resources in your area

37. Hip Bone Hip labrum tears Dancers, kickers, Fastest growing type of injury Repair vs. debride Psoas tendon Impingement

38. Thank you Emergencies Fractures Dislocations Casts Little League/overuse injuries Concussions www.casciosportsmed.com