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Fractures and Dislocations about the Hip and Pelvis

Fractures and Dislocations of the Pelvis and Acetabulum Introduction/Pathology Incidence The overall incidence of pediatric pelvic fractures is 1 per 100,000 children per year. Although rare, these fractures are identified in pediatric trauma patients at a reported rate between 2.4% and 7.5%. This rate increases to nearly 20% in polytraumatized patients. There is a male predominance with a male-to-female ratio of 1.4:1 and an average age…

Fractures of the Spine

Spine injuries in children are fortunately rare, involving only 1% to 4% of children admitted to trauma centers. Treating pediatric patients with spine injuries can be challenging. Clinical evaluation is often hampered by an inability to obtain accurate historical information and unreliability of the physical examination. Children are often frightened, usually unable to describe pain, and either unable (altered mental status, age) or unwilling to cooperate…

Outcomes Assessment of Fractures in Children

Introduction How do we know that our interventions have been successful? The success or effectiveness of an intervention is best defined in terms of whether or not it consistently achieves the goal(s) for which the intervention is intended. Outcomes research is the science of measuring effectiveness. Wennberg, one of the pioneers of the outcomes research movement, defined the imperative to “sort out what works in medicine…

Nerve Injury and Repair in Children

The following videos are included with this chapter and may be viewed at ExpertConsult: Video 8.1 Tinel sign. Video 8.2 Desensitization. Video 8.3 Follow-up clinical examination. Introduction Nerve injuries in children are relatively uncommon; however, children tend to put their hands in all sorts of unexpected places with sharp objects. Garbage disposals, conveyer belts, and dishwashers are uninteresting to adults but are a fascinating source of…

Complications of Fractures in Children

Acknowledgment The authors would like to acknowledge and thank Dr. Anthony A. Stans and Dr. Robert N. Hensinger, MD, for their contributions to the previous versions of this chapter. Vascular Injuries Overall, vascular trauma is relatively uncommon in pediatric patients. One study reviewed all pediatric patients who presented to a level 1 trauma institution over a 6-year period and found that only 23 presented with a…

Fractures with Soft Tissue Injuries

Acknowledgment The author would like to acknowledge Fred F. Behrens, MD (deceased), for his contributions to earlier versions of this chapter. Characteristics It is generally accepted that open fractures among children have better clinical outcomes than similar injuries in adults, but high-level comparative studies are lacking. Although skeletal maturity and preexisting conditions (such as osteogenesis imperfecta) influence the injury patterns of open fractures, it is primarily…

The Multiply Injured Child

Introduction Children who are victims of severe trauma often sustain musculoskeletal injuries but may also have injuries to other body areas that can be severe and even life-threatening. Early morbidity and mortality are related to injuries to the nervous system, genitourinary system, abdomen, and thorax, whereas long-term morbidity or disability is caused predominantly by injuries to the central nervous system (CNS) and musculoskeletal system. Therefore, careful,…

Pathologic Fractures in Children

Introduction Pathologic fractures occur in diseased bone, and, in children, such fractures are caused by a spectrum of conditions different from those in adults. Children’s diseases frequently associated with pathologic fractures include noncancerous benign bone tumors and congenital or genetic abnormalities affecting the skeleton. Polyostotic disease with fractures affecting the immature skeleton is often caused by osteomyelitis, histiocytosis, vascular neoplasms, and metastases (neuroblastoma and Wilms tumor).…

Casting Techniques

Introduction Immobilization in a cast has been the standard of care for spinal and upper and lower extremity injuries and fractures in children. Techniques were first described in antiquity, and they used a variety of hardening agents. Until the 1900s, plaster-impregnated bandages were used. Today’s more common casting material is fiberglass in various forms; it shares some of the same properties of plaster of Paris but…

Physeal Injuries

Introduction Preservation of the structure and function of the growth plate, or physis, is essential for normal growth. Physes are composed of cartilage. They may be weaker than surrounding bone and ligaments and therefore are prone to injuries in tension or shear. Different physes respond differently to injury, and each must be approached as a distinct entity; careful attention should be paid to the child’s age,…

Skeletal Growth, Development, and Healing as Related to Pediatric Trauma

Acknowledgment We would like to acknowledge and thank Dr. Eric T. Jones for his contributions to the previous versions of this chapter. Introduction Consideration of growth potential is the major difference in treating injuries in children as compared with adults. Pediatric skeletal trauma can result in enhanced or diminished growth. Future growth is usually helpful because some angular and length deformities can correct themselves as the…

Vascular Disorders of the Hand

Vascular disorders of the hand are relatively uncommon but can pose significant problems for patients suffering from them. Ischemic pain, ulceration, and decreasing hand function are just some of the problems that can occur. Proper management of patients can improve their quality of life dramatically and on occasion prevent loss of tissue and potentially even the limb. Anatomy Arterial blood is supplied to the hand through…

Bone and Soft Tissue Tumors

Acknowledgment: I would like to acknowledge the excellent work of earlier authors who wrote and revised portions of this chapter in previous editions: Alexander C. Angeledes, Gordon B. McFarland, Jr., Waldo E. Floyd III, Richard J. Smith, Clayton A. Peimer, Harold M. Dick, and Owen J. Moy. The principles of management of aggressive and malignant tumors as described in great detail by these authors have evolved…

Skin Tumors of the Hand and Upper Extremity

Anatomy and Clinical Examination Skin is divided into the epidermis, dermis, and subcutaneous layers ( Fig. 58.1 ). The epidermis possesses the following appendages , : 1. Eccrine glands 2. Apocrine glands 3. Sebaceous glands 4. Hair follicles 5. Nails Glands and hair follicles arise as down growths from the epidermis and project into the dermis. The two types of sweat glands are eccrine and apocrine.…

The Burned Hand

Hands are involved in more than 80% of all severe burns. Each hand represents less than 3% of the total body surface area; nonetheless, the American Burn Association categorizes burns of the hand as major injuries. Even small burns of the hand may result in severely limited function. When burns of the hand occur as part of a major thermal injury, treatment of the hands receives…

Tendinopathy

Tendinopathy is defined as painful conditions affecting tendons and includes both inflammatory and degenerative processes. True acute inflammation of a tendon is termed tendinitis, with associated inflammatory cells and proteins. Tendinosis is thought to be a chronic and degenerative tendon lesion with disorganization of collagen bundles, increased tenocyte nuclei, and lipid vacuoles. Several factors are thought to contribute to tendon pathology. Increased age has been shown…

Rheumatoid Arthritis and Other Inflammatory Arthropathies

Acknowledgments: The authors would like to acknowledge Nathalie Baxter for her help in revising this chapter. We thank the authors of the seventh edition chapter: Paul Feldon, Andrew L. Terrono, Edward A. Nalebuff, and Lewis H. Millender. Parts of their work have been incorporated into this text. Etiology And Differential Diagnosis Of Inflammatory Disease In The Hand Among the different inflammatory diseases, rheumatoid arthritis (RA) is…

Factitious Disorders

Occasionally, a patient will have symptoms or physical findings that do not coincide with recognizable disease patterns. The symptoms may be out of proportion to the physical findings, or the physical findings may not make sense based on the historical record or compared with previous experience. When this happens, the examining physician should consider the possibility that the patient’s agenda may be something other than wellness.…

A Practical Guide for Complex Regional Pain Syndrome in the Acute Stage and Late Stage

The classification of abnormal, posttraumatic pain is complicated and is encompassed in the term complex regional pain syndrome (CRPS). The term reflex sympathetic dystrophy (RSD), a descriptor of posttraumatic pain, is established in the lay, medical, and legal literature despite the absence of defined pathophysiologic findings and consistent clinical symptoms and signs. RSD is a condition considered to be present in a subset of patients contained…

Management of Venomous Injuries

Many venomous animals can cause injuries to humans. The injuries are induced by substances called toxins that are produced or stored in the body of these animals and inoculated (i.e., injected) into victims by their venom apparatus, as seen in snakes, spiders, and scorpions. Toxins can also cause lesions from contact when the animal is handled or crushed, as happens with some species of beetles. ,…