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Peds Extremity Trauma. Jeremy Onnen M.D. Reporting of suspected child abuse is mandatory. The orthopaedic surgeon is protected from litigation when reporting cases of suspected abuse.

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peds extremity trauma

Peds Extremity Trauma

Jeremy Onnen M.D.

slide9

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.
initial treatment
Initial Treatment
  • Appropriate diagnostics and evaluation
  • Stop blood loss
  • Reduction of dislocations/Severely displaced fractures
  • Repair of soft tissue lacerations if appropriate
  • IMMOBILIZATION
splinting goals2
Splinting Goals
  • STOP FURTHER DAMAGE!!!!
compartment syndrome
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
compartment syndrome1
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

compartment syndrome in kids
Compartment Syndrome in KIDS
  • Anxiety
  • Agitation
  • Increased Analgesia
distal femoral epiphysis fx
Distal Femoral Epiphysis Fx

S A L T R

I II III IV V

distal femoral physeal fractures
Distal Femoral Physeal Fractures
  • direct blow mechanism
  • Salter I or II common
  • check neurologic / vascular status
    • Less common than w/ tibial injury
distal femoral physeal fractures1
Distal Femoral Physeal Fractures
  • closed reduction and pinning for displaced fractures
  • long leg cast
distal femoral physeal fractures2
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
ossification
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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