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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.


Peds extremity trauma

  • 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.)