Common Pediatric Orthopedic Injuries

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Common Pediatric Orthopedic Injuries

• Anthony Beutler, MD
• Department of Family Medicine
• USUHS

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Objectives

• What are Growth Plates and Why do I care?
• Osgood-Schlater Disease
• Slipped Capital Femoral Epiphysis
• Radial Head Subluxation
• Toddlers Fracture

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Whats a Growth Plate?

• Growth Plate (epiphyseal plate)
• Epiphysis
• Apophysis (tendon insertion)

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Why Do I Care?
Kids are TRICKY!
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Objectives

• What are Growth Plates and Why do I care?
• Osgood-Schlatter Disease
• Slipped Capital Femoral Epiphysis
• Radial Head Subluxation
• Toddlers Fracture

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Osgood Schlatter Presentation

• Who?
• Young Athlete
• Growing FAST
• Open Growth Plates
• What c/o?
• Pain with activity
• Limp
• Stops playing

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Osgood-Schlatter Diagnosis

• Exam
• TTP tibial tuberosity
• Tight quads
• You KNOW when
• Everything fits
• No pain at rest
• Xrays?

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Osgood Schlater Final Thoughts

• Treatment
• Rest
• Stretch Quads
• Strengthen Quads
• Watch Out for
• Same symptoms in heel?
• Pain at rest
• Night pain

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Objectives

• What are Growth Plates and Why do I care?
• Osgood-Schlatter Disease
• Slipped Capital Femoral Epiphysis
• Radial Head Subluxation
• Toddlers Fracture

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Slipped Capital Femoral Epiphysis Presentation

• Who?
• 7 14 yo
• Growing FAST (or about to)
• Obese or active more likely

• What c/o?
• ANY hip/thigh/knee pain
• Limp
• Sits/runs/walks funny

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Slipped Capital Femoral EpiphysisDiagnosis
Kleins Line on AP

• Exam
• Limited/painful IR Hip
• Obligate IR with flexion
• You KNOW when
• Kleins line
• Radiologist frantic page
• What Next?

Normal
Abnormal
Frog Leg
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Slipped Capital Femoral EpiphysisFinal Thoughts

• Treatment
• Non-weight Bearing!
• Ortho Consult within 72 hours
• This can be bad!
• Watch Out for
• Legg-Calve-Perthes
• Septic/Toxic Synovitis

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Objectives

• What are Growth Plates and Why do I care?
• Osgood-Schlatter Disease
• Slipped Capital Femoral Epiphysis
• Radial Head Subluxation
• Toddlers Fracture

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Young Kids Are Messy
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Radial Head Subluxation Presentation

• Who?
• 2 7 year old
• Pulled by the arm
• What c/o?
• Crying
• Wont use arm

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Radial Head Subluxation Diagnosis

• Exam
• Typical posture My Arm
• Maybe some swelling
• You KNOW when
• You reduce AND
• Child begins to use arm
• Xrays?

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Radial Head Subluxation Final Thoughts

• Treatment
• Reduction
• Psychotherapy for mom
• Watch Out for
• Supracondylar Fractures
• Compartment Syndrome

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Objectives

• What are Growth Plates and Why do I care?
• Osgood-Schlatter Disease
• Slipped Capital Femoral Epiphysis
• Radial Head Subluxation
• Toddlers Fracture

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Toddlers Fracture Presentation

• Who?
• 1 5 year old
• Minimal trauma
• What c/o?
• Wont walk
• Antalgic gait

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Toddlers Fracture Diagnosis

• Exam
• TTP tibia (good luck!)
• Trouble running back to mom
• You KNOW when
• Xray --- maybe

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Toddlers FractureFinal Thoughts

• Treatment
• Casting 3-4 weeks LLC
• Heal VERY fast
• Watch Out for
• Fractures of Abuse

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Objectives

• What are Growth Plates and Why do I care?
• Osgood-Schlatter Disease
• Slipped Capital Femoral Epiphysis
• Radial Head Subluxation
• Toddlers Fracture

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Review Question

• 11 yo soccer player complains of knee pain
  whenever she plays 2 games in 1 day. Exam shows
  no joint swelling, no erythema, but TTP over
  tibial tuberosity.
• The preferred treatment for this athlete is
• MRI and orthopedic referral
• X-ray of affected knee, NSAIDs, rest until pain
  subsides, and then return to sports
• Rest from aggravating activities, quadriceps
  stretching and strengthening program, then return
  to sports
• Knee brace, NSAIDs, return to play in 2 weeks

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Review Question

• 13 yo boy complains of medial right knee pain
  worse with going up and down stairs or when
  running in P.E. class. Motrin helps the pain a
  little. On exam his knee appears completely
  normal.
• The next step in treatment for this patient is
• MRI and orthopedic referral
• X-ray of affected knee, NSAIDs, rest until pain
  subsides, and then return to sports
• Rest from aggravating activities, quadriceps
  stretching and strengthening program, then return
  to sports
• Examination of the hip

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Final Review Question
Is this a safe position to teach a child how to
hit?