Pearls for Practitioners

Chapter 197

Orthopedics Assessment

• Orthopedic rough guide to developmental milestones

  • Sit independently at 6 months

  • Pull to stand at 10 months

  • Cruising at 12 months

  • Walk at 18 months

• Lower extremity angular profile

  • Genu varum (bowlegs) at birth and begin to straighten out by 18 months

  • Genu valgum (knock knees)—maximum at 4 years old and resolves by 5–8 years of age

  • Pathologic genu verum: Blount disease (tibia vara) and rickets

• The limping child differential diagnosis

  • Painful

    • Septic arthritis, osteomyelitis, diskitis

    • Transient monoarticular synovitis

    • Toddler’s fracture or trauma

    • Malignancy

    • Rheumatologic disorders in older children

    • Acute slipped capital femoral epiphysis (SCFE) in adolescents

• Painless

  • Development dysplasia of the hip

  • Neuromuscular disorder

  • Leg length inequality

  • Legg-Calve-Perthes disease in older children

  • Muscular dystrophy in older children

  • Chronic, stable SCFE in adolescents

Chapter 198

Fractures

• Features unique to pediatric skeleton

  • Bone has higher collagen content (tend to undergo plastic deformation before complete fracture)

  • Thicker periosteum (aids healing and can stabilize fracture after reduction)

  • Ability to remodel some deformity

  • Possible overgrowth following long-bone fractures (especially femur)

• Salter-Harris (physeal) fracture types

  • I—transverse through physis

  • II—through physis into metaphysis

  • III—through physis into epiphysis (joint)

  • IV—through both metaphysis and epiphysis

  • V—crush to the physis

• Signs/symptoms of acute compartment syndrome producing neurovascular injury:

  • Early findings: Pain out of proportion to the injury, pain with passive stretch or muscle contraction

  • Later findings: pallor, pulselessness, paresthesia, poikilothermy (cold)

  • Most common sites at risk: supracondylar humerus and tibia fractures

Chapter 199