Peds Extremity Trauma

1. Peds Extremity Trauma Jeremy Onnen M.D.

9. 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.

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

11. 10 yo male with a non displaced tibial shaft fracture

13. Splinting Goals

14. Splinting Goals

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

16. 10 yo male with a non displaced tibial shaft fracture

17. 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

18. 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

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

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

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

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

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

28. Salter IV Distal Femur Fracture

29. 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

30. Distal Femur Physeal Bar

31. Diaphyseal Femur Fractures

37. SCFE

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