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PAEDIATRIC ORTHOPAEDICS

PAEDIATRIC ORTHOPAEDICS. ORTHO - PAEDICS. Children are not small Adults. Anatomic differences. Centers of ossification Radiolucent growth plate Thicker and stronger periosteum. Biomechanic differences.

christophergramirez
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PAEDIATRIC ORTHOPAEDICS

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  1. PAEDIATRIC ORTHOPAEDICS

  2. ORTHO - PAEDICS

  3. Children are not small Adults

  4. Anatomic differences • Centers of ossification • Radiolucent growth plate • Thicker and stronger periosteum

  5. Biomechanic 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 compression • Growth remodeling based in asymmetric growth of physis and periosteum

  6. Clinical examination-The grate Art Children never lie Children cry Listen to the mother Congenital deformities Family history Abused child

  7. Congenital deformities • Infantile hip Dysplasia or Congenital dislocation of the Hip • Coxa Vara-Coxa Valga • Paediatric Foot

  8. C.D.H-Incidence • 1-6\1000 births • Left hip is affected about twice as frequently as the right • Highest risk for first born girls • Family history • Scoliosis[10 times grater incidence]

  9. Etiology • Familiar tendency • Joint laxity • Acetabular dysplasia • Mechanical factors • Deficiency in growth of the labrum[limbus] • Hormonal abnormalities

  10. Physical Assessment • Apparent limb’s shortening • Ortolani’s test • Barlow’s test • Limited abduction[no more than half way] • Assymetrical skin creases • Perineal gap • Late walking,waddling gait

  11. Radiologic assessment • Xrays • Ultrasonography • Computed tomography • Magnetic Resonance Imaging

  12. Treatment • Closed treatment:Pavlik harness,Von Rosen harness,Frejka pillow • Surgical procedures:Salter acetabular osteotomy,Chiari acetabular osteotomy,femoral osteotomies

  13. Slipped Capital Femoral Epiphysis

  14. Incidence • Boys age 12 to14, girls age 10 to 12 • Caucasian children 1 to 3 per 100.000 • Black males,higher incidence[7 to 8 per 100.000]

  15. Etiologic factors • Obesity • Rapid growth spurts • Endocrinopathies[hypothyroidism,renal rickets,hypogonadism] • Mechanical factors

  16. Clinical Presentation • Preslip • Acute slip • Chronic slip[3 weeks] • Acute on chronic slip

  17. Diagnostic 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

  18. Treatment • Manipulation • Pinning • Osteotomies

  19. Legg-Calve-Perthes’ Deasease

  20. Incidence • 1 in 10.000 • Particularly rare in black children • Usually 4-8 years old • Boys are affected 4 times as often as girls • Higher incidence in underprivileged communities

  21. Pathogenesis • 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

  22. Pathology • Stage 1: Ischaemia and bone death • Stage 2:Revascularizasion and repair • Stage 3: Distorsion and remodeling

  23. Treatment • Analgesia-? Skin traction • Supervised neglect • Containment:1/Hips widely abducted,in plasteror in removable splint 2/Varus osteotomy of femur or pelvis

  24. Fractures • Greenstick fractures • Injuries of physis

  25. Thank you

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