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Fractures About the Knee

Introduction Fractures about the knee in pediatric patients account for a small percentage of childhood injuries. However, their associated complications have some of the most significant potential for patient morbidity. Acute complications such as compartment syndrome and vascular injury can be limb-threatening. Appropriate awareness followed by early and accurate diagnosis is key to limiting long-term sequalae. In addition, prolonged follow-up must be performed in order to…

Complications in the Treatment of Pediatric Femoral Shaft Fractures

Introduction Diaphyseal femur fractures are one of the most common orthopedic injuries requiring hospitalization in children and account for 2% of all bony injuries. Historically, femoral shaft fractures were managed nonoperatively in children and young adults, typically with spica casting without or without traction. Nonoperative management remains the standard of care for children with stable fractures, using a Pavlik harness for infants less than 6 months…

Complications in Pediatric Pelvic and Proximal Femur Fractures

Pediatric Pelvic Fractures Pediatric pelvic bone fractures are quite uncommon, except for avulsion fractures. Pelvic fractures in these age groups are mainly seen after high-energy traumatic injuries like motor vehicle accidents. A study by Banerjee et al. from a level 1 trauma center in the United Kingdom mentioned that pelvic injuries are most commonly associated with extremity injuries followed by head injuries. A systematic review by…

Complications in Thoracolumbar Spine Trauma

Introduction Although thoracolumbar spine trauma is rare in children, complications are common and may be catastrophic if diligent care is not taken in the management of such injuries. The immature, developing spine has unique features that make its injury patterns different compared to the mature skeleton. The pediatric spine is more elastic and compressible compared to the mature spine, which results in a lower incidence of…

Complications in Pediatric Cervical Spine Trauma

Introduction Pediatric cervical spine trauma often presents after high-energy level 1 trauma, but it can also occur from sports or other lower energy injuries, particularly in a child with congenital or syndromic differences that might put them at risk. Cervical spine injury accounts for only 1.6% of all pediatric trauma cases. Pediatric injuries differ from adult cervical spine injuries by having a higher likelihood of C1…

Hand/Finger Fractures

Introduction Finger and hand injuries are frequently encountered in children. Although lacerations and soft tissue injuries predominate, fractures represent 11.4% to 19.3% of pediatric hand injuries. In studies of pediatric fractures presenting to the emergency department, the hand is reported as the second most common site of fracture in children, with the fingers and carpals/metacarpals representing 14% to 15% and 7% to 13%, respectively, of fractures…

Forearm Fractures

Introduction Pediatric forearm fractures account for 6% to 18% of all pediatric fractures. Much debate exists regarding the most appropriate management of these injuries. Although a number of “acceptable” angulation and displacement parameters for pediatric forearm fractures have been proposed, there is no universally agreed-upon set of criteria for acceptable deformity subsequent remodeling potential. Some authors have even questioned the need for a formal reduction at…

Medial Condyle and Medial Epicondyle Fractures

Introduction Fractures of the medial condyle of the elbow in children are rare, even described as “once in a lifetime” for providers. They constitute approximately 1% of pediatric elbow injuries. Unlike the medial epicondyle avulsion fracture, this is an intra-articular Salter-Harris IV fracture involving the epiphysis (trochlea), physis, and metaphysis. These injuries predominantly involve a fracture through the unossified cartilaginous portion of the medial condyle, and…

Lateral Condyle Fractures

Introduction Lateral condyle fractures of the distal humerus represent the second most common fracture about the elbow in children, with the first being the supracondylar humerus fracture. These fractures represent approximately 10% to 20% of pediatric upper extremity fractures and occur at a mean age of 6 years. There are two distinctive features of the lateral condyle fractures that add complexity to the diagnosis, treatment, and…

Supracondylar Humerus Fractures

Introduction Supracondylar humerus (SCH) fractures are common injuries that account for 15% of all pediatric fractures. These injuries most commonly occur in children 5 to 7 years of age. The fractures are divided into extension- and flexion-type injuries, of which extension-type injuries make up 95% to 99%. Extension-type injuries occur after a fall onto an outstretched arm that drives the olecranon into the distal humerus and…

Antibiotics and Cement

Introduction The use of antibiotics in cement predates the widespread use of systemic intravenous antibiotics for perioperative prophylaxis. In the 1950s, published data recommended avoiding administration of systemic antibiotics with the fear that they may actually increase infection rates. , The debate over utilization of antibiotics perioperatively continued into the 1970s. Intriguingly, while controversy about systemic perioperative antibiotic prophylaxis continued, local antibiotic mixture into the cement…

Proximal Humerus and Clavicle Complications

Proximal Humerus Complications Proximal humerus fractures in the pediatric and adolescent population are relatively rare, constituting less than 3% of all children’s fractures and accounting for 3% to 7% of physeal fractures. Nonoperative treatment is the standard of care in most skeletally immature patients, given the significant remodeling potential of the proximal humeral physis, but depends on the degree of displacement and angulation, so treatment must…

Management of Chronic Periprosthetic Joint Infection

Introduction Chronic periprosthetic joint infection (PJI) is a devastating complication of hip and knee arthroplasty that leads to a significant increase in joint loss of function, morbidity, and mortality. The traditional assumption is that chronic PJI can be defined as an infection in a prosthetic joint that occurs greater than 4 weeks from the index procedure or, according to the Centers for Disease Control and Prevention…

Management of Acute Periprosthetic Joint Infections

Introduction Periprosthetic joint infection (PJI) is a challenging and increasingly common complication after total joint arthroplasty (TJA). In 2009, 2.18% of both total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients were treated for PJI, with an associated annual cost of $566 million. The definition of acute has been controversial. The Musculoskeletal Infection Society (MSIS) defines acute postoperative PJI as cases with symptoms presenting within…

Diagnosis and Definitions of Periprosthetic Joint Infections

Introduction While total joint arthroplasty (TJA) is considered a relatively safe procedure, complications may arise. Periprosthetic joint infection (PJI) continues to be the leading cause of failure for primary total knee and revision total hip arthroplasty. , The number of TJAs performed in the United States is anticipated to increase significantly by the year 2030 and exceed 3.8 million annually. Consequently, associated PJIs are projected to…

Hip Preservation—Complications of Periacetabular Osteotomy

Introduction Acetabular dysplasia is a major cause of hip pain and dysfunction in young patients. Moderate to severe dysplasia, when left untreated, is an established cause of arthritis requiring total hip arthroplasty (THA) at an early age. , Congenital malformation of the acetabulum and femoral head results in malalignment and increased joint reactive forces that disrupt the labrochondral junction and cartilage, which may eventually result in…

Workup of the Painful Total Hip Arthroplasty

Preoperative Considerations Differentiating Hip Versus Spine Pathology When a patient presents with pain following total hip arthroplasty (THA), it is essential to remember that pain patterns from lumbar spine disorders and hip pathology overlap. Overlapping pain patterns, coupled with the coexistence of lumbar spine disorders in 18% of patients undergoing THA, pose a challenge in the diagnosis of pain following THA. A thorough clinical history, physical…

Postoperative Periprosthetic Fractures in Total Hip Arthroplasty

Introduction Periprosthetic hip fractures include injuries along the proximal femur and surrounding the acetabulum. They may range from relatively simple fractures with a stable implant to major injuries with components that require revision. Management of such fractures requires a surgeon to borrow and blend principles for fracture treatment with concepts and “rules” of hip arthroplasty. These two disciplines often have conflicting ideas for treating a postoperative…

Troubleshooting the Direct Anterior Approach

Introduction The only true intermuscular and internervous approach in total hip arthroplasty (THA), the direct anterior approach (DAA) continues to increase in popularity. Several proposed advantages have been attributed to DAA utilization, including lower dislocation rates, more accurate cup position, quicker patient mobilization, less early postoperative pain, and shorter length of stay. Over the past 2 decades, the DAA has been facilitated by the development and…