PAEDIATRIC ORTHOPAEDICS

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PAEDIATRIC ORTHOPAEDICS
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ORTHO - PAEDICS
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Children are not small Adults
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Anatomic differences

• Centers of ossification
• Radiolucent growth plate
• Thicker and stronger periosteum

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Biomechanic differences

• Osteoid of a childs bone is not significantly
  less calcified,but the density of a youngs bone
  is certainly less
• Pores prevent the extension of a fracture line
• Porous nature allows failure in compression
• Growth remodeling based in asymmetric growth of
  physis and periosteum

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Clinical examination-The grate Art

• Children never lie
• Children cry
• Listen to the mother
• Congenital deformities
• Family history
• Abused child

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Congenital deformities

• Infantile hip Dysplasia or Congenital dislocation
  of the Hip
• Coxa Vara-Coxa Valga
• Paediatric Foot

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C.D.H-Incidence

• 1-6\1000 births
• Left hip is affected about twice as frequently as
  the right
• Highest risk for first born girls
• Family history
• Scoliosis10 times grater incidence

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Etiology

• Familiar tendency
• Joint laxity
• Acetabular dysplasia
• Mechanical factors
• Deficiency in growth of the labrumlimbus
• Hormonal abnormalities

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Physical Assessment

• Apparent limbs shortening
• Ortolanis test
• Barlows test
• Limited abductionno more than half way
• Assymetrical skin creases
• Perineal gap
• Late walking,waddling gait

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Radiologic assessment

• Xrays
• Ultrasonography
• Computed tomography
• Magnetic Resonance Imaging

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Treatment

• Closed treatmentPavlik harness,Von Rosen
  harness,Frejka pillow
• Surgical proceduresSalter acetabular
  osteotomy,Chiari acetabular osteotomy,femoral
  osteotomies

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Slipped Capital Femoral Epiphysis
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Incidence

• Boys age 12 to14, girls age 10 to 12
• Caucasian children 1 to 3 per 100.000
• Black males,higher incidence7 to 8 per 100.000

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Etiologic factors

• Obesity
• Rapid growth spurts
• Endocrinopathieshypothyroidism,renal
  rickets,hypogonadism
• Mechanical factors

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Clinical Presentation

• Preslip
• Acute slip
• Chronic slip3 weeks
• Acute on chronic slip

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Diagnostic Imaging

• Lateral Head-shaft AngleSouthwick method gt60,
  30-60,30gt
• Kleins line
• Epiphyseal height
• Physeal widening
• One third uncovered metaphysis,grade 1
• Two thirds,grade 2
• More than two thirds,grade 3

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Treatment

• Manipulation
• Pinning
• Osteotomies

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Legg-Calve-Perthes Deasease
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Incidence

• 1 in 10.000
• Particularly rare in black children
• Usually 4-8 years old
• Boys are affected 4 times as often as girls
• Higher incidence in underprivileged communities

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Pathogenesis

• Blood supply of femoral head1/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

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Pathology

• Stage 1 Ischaemia and bone death
• Stage 2Revascularizasion and repair
• Stage 3 Distorsion and remodeling

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Treatment

• Analgesia-? Skin traction
• Supervised neglect
• Containment1/Hips widely abducted,in plasteror
  in removable splint
  2/Varus osteotomy of femur or pelvis

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Fractures

• Greenstick fractures
• Injuries of physis

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Thank you