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6/10/2019
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Orthopedic Emergencies
Peter Gutierrez, MD
Pediatric Emergency Medicine
Children’s Healthcare of Atlanta
Children’s Healthcare of Atlanta | Emory University
Disclosures
• I have no relevant financial relationships to disclose
• I do not intend to discuss unapproved uses for commercial products
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Children’s Healthcare of Atlanta | Emory University
Objectives
• Upon completion of this educational activity, participants will be able to– Identify common pediatric orthopedic emergencies,
including fractures, dislocations, infection, and overuse injuries
– Choose the correct evaluation tools and initial management for common pediatric orthopedic emergencies
– Recognize pediatric orthopedic emergencies that should be transferred to a pediatric facility
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Children’s Healthcare of Atlanta | Emory University
Topics
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Fractures Dislocations InfectionOveruse Injuries/
Misc
Buckle FracturesNursemaid’s
ElbowSeptic Arthritis
Osgood-Schlatter Disease
Clavicular Fracture
Patellar Dislocations
OsteomyelitisSinding-Larsen-
Johansson Disease
Supracondylar Fractures
Sever Disease
Scaphoid Fracture Slipped Capital Femoral Epiphysis
Salter-Harris Fractures
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Buckle Fractures- Mechanism and Presentation
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Buckle Fracture- Radiographic Findings and Management
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Clavicular Fractures- Mechanism and Presentation
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Children’s Healthcare of Atlanta | Emory University
Clavicular Fracture- Radiographic Findings and Management
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Supracondylar Fractures- Mechanism and Presentation
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Children’s Healthcare of Atlanta | Emory University
Supracondylar Fracture- Type 1
• Both cortices appear intact
• Soft signs present– Anterior humeral line
– Posterior fat pad
– Anterior fat pad
• Management– Posterior long arm splint
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Children’s Healthcare of Atlanta | Emory University
Supracondylar Fracture- Type 2
• Anterior Cortex Disrupted
• Management– Depends on degree of
angulation
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Children’s Healthcare of Atlanta | Emory University
Supracondylar Fracture- Type 3
• Disruption of anterior and posterior cortices
• Management– Almost exclusively
operative management
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Children’s Healthcare of Atlanta | Emory University
Supracondylar Fractures- Neurovascular Status
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Children’s Healthcare of Atlanta | Emory University
Supracondylar Fracture- Management
• Type 1– Need only splint
• Type 2 and 3– Splint for comfort and
refer to emergency department
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Scaphoid Fractures- Mechanism and Presentation
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Children’s Healthcare of Atlanta | Emory University
Scaphoid Fracture- Radiographic Findings and Management
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Children’s Healthcare of Atlanta | Emory University
Salter Harris (SH) Fractures- Mechanism and Presentation
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Children’s Healthcare of Atlanta | Emory University
SH Fractures- Types
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SH Fractures- Management
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Children’s Healthcare of Atlanta | Emory University
Nursemaid’s Elbow- Mechanism and Presentation
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Nursemaid’s Elbow- Radiographic Findings
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Nursemaid’s Elbow- Reduction
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Patellar Dislocation- Mechanism and Presentation
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Children’s Healthcare of Atlanta | Emory University
Patellar Dislocation- Radiographic Findings
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Children’s Healthcare of Atlanta | Emory University
Patellar Dislocation- Management
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Children’s Healthcare of Atlanta | Emory University
Septic Arthritis- Mechanism and Presentation
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Children’s Healthcare of Atlanta | Emory University
Septic Arthritis- Management
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Children’s Healthcare of Atlanta | Emory University
Septic Arthritis- Management
• IF– Feeling cavalier
– Have access to labs
– Hip is the joint involved
• Kocher Criteria– Non-weight bearing
– Fever of 38.5 or higher
– WBC >12
– ESR >40
• Septic arthritis of the hip– 99% chance with 4/4
– 92% chance with 3/4
– 40% chance with 2/4
– 3% chance with 1/4
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Osteomyelitis- Mechanism and Presentation
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Osteomyelitis- Management
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Osgood-Schlatter Disease (OSD)-Mechanism and Presentation
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OSD- Radiographic Findings
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OSD- Management
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Sinding-Larsen-Johansson (SLJ) Disease
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SLJ- Radiographic Findings
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SLJ- Management
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Sever Disease- Mechanism and Presentation
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Children’s Healthcare of Atlanta | Emory University
Sever Disease- Management
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Slipped Capital Femoral Epiphysis (SCFE)-Mechanism and Presentation
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Children’s Healthcare of Atlanta | Emory University
SCFE- Radiograph Findings
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SCFE- Management
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Children’s Healthcare of Atlanta | Emory University
References
• Fleischer and Ludwig’s Textbook of Pediatric Emergency Medicine. 7th Edition
• Yang S, Andras L. “Clavicle Shaft Fractures in Adolescents.” Orthop Clin N Am 48 (2017) 47–58
• Wheeless’s Textbook of Orthopedics. www.wheelessonline.com- multiple topics
• Emedicine- Sever Disease, SCFE
• Medcomic.com
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