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PAEDIATRIC PAEDIATRIC ORTHOPAEDICSORTHOPAEDICS
ORTHO - PAEDICSORTHO - PAEDICS
Children are not small AdultsChildren are not small Adults
Anatomic differencesAnatomic differences
Centers of ossificationRadiolucent growth plateThicker and stronger periosteum
Biomechanic differencesBiomechanic differences
Osteoid of a child’s bone is not significantly less calcified,but the density of a young’s bone is certainly less
Pores prevent the extension of a fracture line
Porous nature allows failure in compressionGrowth remodeling based in asymmetric
growth of physis and periosteum
Clinical examination-The grate Clinical examination-The grate ArtArt
Children never lie
Children cry
Listen to the mother
Congenital deformities
Family history
Abused child
Congenital deformitiesCongenital deformities
Infantile hip Dysplasia or Congenital dislocation of the Hip
Coxa Vara-Coxa Valga Paediatric Foot
C.D.H-IncidenceC.D.H-Incidence
1-6\1000 birthsLeft hip is affected about twice as
frequently as the rightHighest risk for first born girlsFamily historyScoliosis[10 times grater incidence]
EtiologyEtiology
Familiar tendencyJoint laxityAcetabular dysplasiaMechanical factorsDeficiency in growth of the labrum[limbus]Hormonal abnormalities
Physical AssessmentPhysical Assessment
Apparent limb’s shorteningOrtolani’s testBarlow’s testLimited abduction[no more than half way]Assymetrical skin creasesPerineal gapLate walking,waddling gait
Radiologic assessmentRadiologic assessment
XraysUltrasonographyComputed tomographyMagnetic Resonance Imaging
TreatmentTreatment
Closed treatment:Pavlik harness,Von Rosen harness,Frejka pillow
Surgical procedures:Salter acetabular osteotomy,Chiari acetabular osteotomy,femoral osteotomies
Slipped Capital Femoral Slipped Capital Femoral EpiphysisEpiphysis
IncidenceIncidence
Boys age 12 to14, girls age 10 to 12Caucasian children 1 to 3 per 100.000Black males,higher incidence[7 to 8 per
100.000]
Etiologic factorsEtiologic factors
ObesityRapid growth spurtsEndocrinopathies[hypothyroidism,renal
rickets,hypogonadism]Mechanical factors
Clinical PresentationClinical Presentation
PreslipAcute slipChronic slip[3 weeks]Acute on chronic slip
Diagnostic ImagingDiagnostic Imaging
Lateral Head-shaft Angle[Southwick’ method] >60, 30-60,30>
Klein’s line Epiphyseal height Physeal widening One third uncovered metaphysis,grade 1 Two thirds,grade 2 More than two thirds,grade 3
TreatmentTreatment
ManipulationPinningOsteotomies
Legg-Calve-Perthes’ Legg-Calve-Perthes’ DeaseaseDeasease
IncidenceIncidence
1 in 10.000Particularly rare in black childrenUsually 4-8 years oldBoys are affected 4 times as often as girlsHigher incidence in underprivileged
communities
PathogenesisPathogenesis
Blood supply of femoral head:1/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
PathologyPathology
Stage 1: Ischaemia and bone deathStage 2:Revascularizasion and repairStage 3: Distorsion and remodeling
TreatmentTreatment
Analgesia-? Skin tractionSupervised neglectContainment:1/Hips widely abducted,in
plasteror in removable splint 2/Varus osteotomy of femur or pelvis
FracturesFractures
Greenstick fracturesInjuries of physis
Thank youThank you