PAEDIATRIC PAEDIATRIC ORTHOPAEDICSORTHOPAEDICS

ORTHO - PAEDICSORTHO - PAEDICS

Children are not small AdultsChildren are not small Adults

Anatomic differencesAnatomic differences

Centers of ossificationRadiolucent growth plateThicker and stronger periosteum

Biomechanic differencesBiomechanic 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 compressionGrowth remodeling based in asymmetric

growth of physis and periosteum

Clinical examination-The grate Clinical examination-The grate ArtArt

Children never lie

Children cry

Listen to the mother

Congenital deformities

Family history

Abused child

Congenital deformitiesCongenital deformities

Infantile hip Dysplasia or Congenital dislocation of the Hip

Coxa Vara-Coxa Valga Paediatric Foot

C.D.H-IncidenceC.D.H-Incidence

1-6\1000 birthsLeft hip is affected about twice as

frequently as the rightHighest risk for first born girlsFamily historyScoliosis[10 times grater incidence]

EtiologyEtiology

Familiar tendencyJoint laxityAcetabular dysplasiaMechanical factorsDeficiency in growth of the labrum[limbus]Hormonal abnormalities

Physical AssessmentPhysical Assessment

Apparent limb’s shorteningOrtolani’s testBarlow’s testLimited abduction[no more than half way]Assymetrical skin creasesPerineal gapLate walking,waddling gait

Radiologic assessmentRadiologic assessment

XraysUltrasonographyComputed tomographyMagnetic Resonance Imaging

TreatmentTreatment

Closed treatment:Pavlik harness,Von Rosen harness,Frejka pillow

Surgical procedures:Salter acetabular osteotomy,Chiari acetabular osteotomy,femoral osteotomies

Slipped Capital Femoral Slipped Capital Femoral EpiphysisEpiphysis

IncidenceIncidence

Boys age 12 to14, girls age 10 to 12Caucasian children 1 to 3 per 100.000Black males,higher incidence[7 to 8 per

100.000]

Etiologic factorsEtiologic factors

ObesityRapid growth spurtsEndocrinopathies[hypothyroidism,renal

rickets,hypogonadism]Mechanical factors

Clinical PresentationClinical Presentation

PreslipAcute slipChronic slip[3 weeks]Acute on chronic slip

Diagnostic ImagingDiagnostic 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

TreatmentTreatment

ManipulationPinningOsteotomies

Legg-Calve-Perthes’ Legg-Calve-Perthes’ DeaseaseDeasease

IncidenceIncidence

1 in 10.000Particularly rare in black childrenUsually 4-8 years oldBoys are affected 4 times as often as girlsHigher incidence in underprivileged

communities

PathogenesisPathogenesis

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

PathologyPathology

Stage 1: Ischaemia and bone deathStage 2:Revascularizasion and repairStage 3: Distorsion and remodeling

TreatmentTreatment

Analgesia-? Skin tractionSupervised neglectContainment:1/Hips widely abducted,in

plasteror in removable splint 2/Varus osteotomy of femur or pelvis

FracturesFractures

Greenstick fracturesInjuries of physis

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