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Mandatory Reporting of Suspected Child Abuse in Orthopaedic Trauma Cases

This document highlights the importance of mandatory reporting for suspected child abuse in orthopaedic trauma cases. It emphasizes that orthopaedic surgeons are protected from litigation when they report suspected abuse, which is critical for child safety. The risks of failing to report are alarming, with a 50% chance of repeat abuse and a 10% risk of fatality. The text also covers guidelines for initial treatment of injuries, recognizing compartment syndrome, and managing specific fractures in children, including tibial and femoral injuries.

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Mandatory Reporting of Suspected Child Abuse in Orthopaedic Trauma Cases

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  1. Peds Extremity Trauma Jeremy Onnen M.D.

  2. Reporting of suspected child abuse is mandatory. • The orthopaedic surgeon is protected from litigation when reporting cases of suspected abuse. • Failure to report suspected abuse puts the abused child at a 50% risk of repeat abuse and up to a 10% risk of being killed.

  3. Initial Treatment • Appropriate diagnostics and evaluation • Stop blood loss • Reduction of dislocations/Severely displaced fractures • Repair of soft tissue lacerations if appropriate • IMMOBILIZATION

  4. 10 yo male with a non displaced tibial shaft fracture

  5. Splinting Goals

  6. Splinting Goals

  7. Splinting Goals • STOP FURTHER DAMAGE!!!!

  8. 10 yo male with a non displaced tibial shaft fracture

  9. Compartment syndrome • Signs and Symptoms • pain out of proportion to injury • pain with passive stretching • paresthesia • decreased sensation or functional loss • tense swelling • weakness or paralysis and loss of pulse are late signs

  10. Compartment syndrome • Signs and Symptoms • pain out of proportion to injury • pain with passive stretching • paresthesia • decreased sensation or functional loss • tense swelling • weakness or paralysis and loss of pulse are late signs WRONG

  11. Compartment Syndrome in KIDS • Anxiety • Agitation • Increased Analgesia

  12. Distal Femoral Epiphysis Fx S A L T R I II III IV V

  13. Distal Femoral Physeal Fractures • direct blow mechanism • Salter I or II common • check neurologic / vascular status • Less common than w/ tibial injury

  14. Distal Femoral Physeal Fractures • closed reduction and pinning for displaced fractures • long leg cast

  15. Be Wary of Fixation Only in Thurston-Holland Fragment Loss of reduction at 2 weeks

  16. Salter IV Distal Femur Fracture

  17. Distal Femoral Physeal Fractures • high rate of premature growth arrest rare < 2 yo 80%2 - 11 yo 50% > 11 yo • angular deformity • leg length discrepancy • F/U 6 mo – XR other side; & reg intervals until maturity

  18. Distal Femur Physeal Bar

  19. Diaphyseal Femur Fractures

  20. SCFE

  21. OSSIFICATION • 1. CAPITELLUM (6 mo. - 2 yrs.) • 2. MED. EPICONDYLE (5 - 9 yrs.) • 3. TROCHLEA (7 -13 yrs.) • 4. LAT. EPICONDYLE (8 - 13 YRS.)

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