Download presentation
1
Common Pediatric Orthopedic Clinical Problems
Saunders Jones Jr. MD
2
Common Pediatric Orthopedic Problems
Metabolic Developmental Congenital Traumatic Infectious Neoplastic Neuromuscular
3
Radiological “hole in the bone”
Fibrous cortical defect Aneurysmal Bone cyst “bone island” Giant cell tumor Infection Ewing’s Sarcoma Enchondroma
4
Fibrous cortical defect (Fibroxanthoma)
5
Unicameral bone cyst Next to growth plate Active vs Inactive
Falling leaf sign
6
ABC Aneurysmal bone cysts may occur in patients aged years, with a peak incidence in those aged 16 years. About 75% of patients are younger than 20 years. Four phases of pathogenesis are recognized, as follows: Osteolytic initial phase Active growth phase, which is characterized by rapid destruction of bone and a subperiosteal blow-out pattern Mature stage, also known as stage of stabilization, which is manifested by formation of a distinct peripheral bony shell and internal bony septae and trabeculae that produce the classic soap-bubble appearance. Healing phase with progressive calcification and ossification of the cyst and its eventual transformation into a dense bony mass with an irregular structure.
7
ABC
9
Ewing's Sarcoma
10
Incidence of Ewings
11
Ewings
12
Giant Cell tumor Not ped age group
13
Osteochondromas or Multiple Exostoses
Cartilaginous cap covered by a bursa Impinge on local structures CT shows cap < 1cm in thickness Can be excised due to structural problems SMALL incidence (<1% per lesion) of transformation to Chondro sarcoma (or Osteogenic less common)
14
Multiple Exostoses Found in areas around growth plates
Can occur in multiple locations or singularly Usually not Neoplastic Bone with cartilaginous cap Grows normally with growth of the rest of the skeleton
15
Osteochondromas B9 Cartilaginous cap Impinges on local structures
16
Osteochondromas Another view
17
Osteochondroma
18
Osteochondroma
19
Osteochondroma microscopic
20
Osteosarcoma
21
Osteosarcoma Some bone elements
22
Enchondroma
23
Non ossifying Fibroma
24
Metabolic Pediatric Category
Rickets Osteogenesis Imperfecta
25
Rickets Radiologic changes in the growth plate Vitamin problem
26
Osteogenesis Imperfecta
28
Twisty Bendy Feet Most common is metatarsus adductus
FPS fetal packaging syndrome Normal rotation of feet in utero Should respond to gentle massage and SWN Shoes could be worn in reverse (r-l l-r) if there is any “last” in the shoe
29
Metatarsus adductus/clubfoot (tell tale medial crease)
30
Twisty Bendy Feet Clubfeet “talipes equino-varus”
Metatarsus adductus, heel equinus and varus and talus adductus Tell tale crease on lat underneath malleolus Thinning and atrophy of lower leg Needs attention based on severity of deformity, START TREATMENT AT BIRTH !!! Refer early
31
Club feet Metatarsal Talus Hindfoot Leg atrophy
32
Endstage Club feet
33
Clubfoot casting In the nursery or soon as possible
34
Club foot Casting Must go above the knee to control rotation
Plaster is the best Soak off night before Manipulation and then maintenance of that correction
35
Limited clinic Tenotomy
New
36
Twisty Bendy legs
37
Twisty Bendy Legs Internal Tibial Torsion
Normal adult rotation is degrees external Normal unwinding of child's lower legs Not significantly affected by orthotics or treatment !!! Sight along tibial crest and look at malleoli Reassure (look for other conditions)
38
Twisty Bendy Legs Bendy knees/legs 2-4-6 years
Genu varus / genu valgus Normal variants Radiographs for Blount’s Disease Vitamins Orthotics (?)
39
Blount’s vs. Normal
40
Twisty Bendy Legs Femoral anteversion
Femur is turned in at the hip causing “pigeon towed gait” Sit on their feet SWN Education Twister cables!!?!?!?!?
41
Femoral anteversion
43
Pes Planus “flat feet” Common in infants and up to about 8 years of age Painful flat feet is different…tarsal coalition or other condition Some pes planus is genetic or racial Look at mom’s feet!!!
44
Heel Pain in Adolescent
Sever’s Disease Calcaneal apophysitis X rays show “fractionation” Symptomatic tx with NSAIDs Stretching Limitation of activity ?
45
Sever’s Disease
46
Xray of the Calcaneal Apophysis
47
Stretch for Sever’s Disease
48
Knee Pain in Adolescent
Anterior tibial tubercle pain Osgood-Schlatter’s disease Tibial apophysitis Rest stretching Ice Nsaids Prominent tubercle Hereditary tendencies HIP PAIN MASQUERADES AS KNEE PAIN !!!!! Always xray same side hip!!!
49
Anterior Knee pain Adolescent Female
Increased valgus with tracking problems Squatting and Indian style sitting Quad sets and Nsaids VMO? Usually self limited Make sure nothing else going on…..
50
OSDx and Ant knee pain
51
Osgood Schlatter's
52
Osgood Schlatter’s Disease
53
Hip Pain SCFE Transient synovitis Hip pyarthrosis LCP
54
Slipped Capital Femoral Epiphysis
SCFE Endomorphic Androgenital Onset anterior thigh pain Externally Rotated Gait Can be bilat Rx pin in situ
55
SCFE
56
SCFE
57
SCFE
58
LCP Perthe’s Disease Avascular necrosis of the proximal femoral growth plate Collapse Maintain concentricity and “containment” Multiple bouts of Transient synovitis
59
LCP initial and resorptive phases
60
LCP resorptive and remodeling
61
Congenital Dislocated Hip
Barlow's Ortilani Duration and treatment Age of child at discovery Pavlick harness Closed reduction and casting Open Reduction Subtrochanteric osteotomy Acetabular osteotomy
62
Congenital Dislocation
63
Congenital Hip Dislocation
64
Causes of Hip Pain in Children
CDH 0-2 years 1:4 m:f 20%bilat LCP 4-8 years 5:1 m:f 10% bilat SCFE 10-15 years 1.5:1 m:f 25-40%bilat
65
Idiopathic Adolescent Scoliosis
Not a painful condition If there is pain…look for another cause! OBJECTIVE OF TREATMENT: To prevent deformity as adult Skeletal maturity Onset of menses, Risser sign Criteria for referral relates to progression BracesSurgery runs the gamut
67
Risser sign
68
Risser Sign
69
Nursemaids Elbow
70
Nursemaids Elbow
71
Falls from a Height common in Children
73
Epiphyseal Injuries: only in kids!!!
Salter classification Joint involvement Growth disturbance Thick periosteum
74
Salter One
76
Salter 2
77
Salter 3
78
Salter 4
79
Salter 5
82
Supracondylar elbow fractures
Compartment syndrome because of vascular compromise Characteristic fx due to the shape of the supracondlyar region of the humerus “balancing two canoes”
87
Lines around the elbow
89
Supracondylar fx minimal displacement
90
Displaced Supracondylar fx
91
Medial Epicondyle fx
93
Lateral condyle Salter #?
94
Supracondylar fx
95
Radial Head fxs
96
Displaced Lateral condyle Salter #?
97
Radial Head Fx displaced epiphyseal….Salter# ?
98
Late Sequelae Cubitus varus
99
Fracture Tx in Kids Alignment has different criteria Overgrowth
Maintenance of overall alignment most important Rotation, etc
100
Fracture Tx in Younger Kids (growth potential)
101
Overall Alignment and Residual Growth
102
Fracture Tx in Older Kids
103
Fracture Tx in Even Older Kids
104
Neuromuscular Category
Cerebral Palsy Spastic or Flaccid Birth injury Perinatal cerebral anoxia Hyperactive stretch receptors Contractures Releases, Transfers, Braces etc.
105
Infections Joints Pyarthrosis Infants and young children
Endemic Otitis Media No good lab test X-rays normal Patho-anatomy growth plate vasculature Drain and decompress because of potential damage to cartilage May lead to Osteomyelitis
106
ANY QUESTIONS??? Comments Discussion
107
Thank you
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.