Paediatric Fractures

• Paediatric orthopaedics is a subspecialty focused on the musculoskeletal problems of children

Paediatric Fractures

• Paediatric fractures differ from adult fractures due to the presence of growth plates (physes), thicker periosteum, and greater bone remodeling potential
• Growth plate fractures can lead to growth disturbances if not managed properly
• Common fracture types in children include greenstick, buckle (torus), and complete fractures
• Diagnosis involves physical examination and radiographic imaging
• The Salter-Harris classification is used for growth plate fractures, with types I-V describing the location and severity of the fracture
• Type I: Fracture through the physis
• Type II: Fracture through the physis and metaphysis
• Type III: Fracture through the physis and epiphysis
• Type IV: Fracture through the metaphysis, physis, and epiphysis
• Type V: Crush injury to the physis
• Treatment options include closed reduction and casting, open reduction and internal fixation (ORIF), or percutaneous pinning
• Remodeling potential is greater in younger children and fractures closer to the joint

Skeletal Dysplasia

• Skeletal dysplasias are a heterogeneous group of genetic disorders affecting bone and cartilage growth
• These conditions result in abnormal skeletal development, leading to variations in limb length, body proportions, and stature
• Achondroplasia is the most common skeletal dysplasia, characterized by rhizomelic shortening of the limbs, macrocephaly, and midface hypoplasia
• Osteogenesis imperfecta (OI) is another skeletal dysplasia, characterized by fragile bones and increased susceptibility to fractures
• OI is caused by mutations in genes related to type I collagen
• Diagnosis involves clinical evaluation, radiographic imaging, and genetic testing
• Management includes orthopedic interventions to correct deformities and prevent fractures, physical therapy, and medical management of related complications

Clubfoot Treatment

• Clubfoot (talipes equinovarus) is a congenital deformity characterized by plantarflexion, inversion, and adduction of the foot
• The Ponseti method is the gold standard treatment for clubfoot, involving serial casting to gradually correct the deformity
• The Ponseti method consists of gentle manipulation of the foot followed by application of a long leg cast, repeated weekly
• After achieving full correction, a tenotomy of the Achilles tendon may be necessary to correct equinus
• Following tenotomy, a foot abduction brace is worn full-time for 3 months, then at night until 4 years of age to prevent recurrence
• Surgical treatment may be considered for resistant or recurrent clubfoot, involving soft tissue releases and/or bony procedures

Hip Dysplasia Management

• Developmental dysplasia of the hip (DDH) refers to a spectrum of abnormalities in the hip joint, ranging from mild instability to complete dislocation
• Risk factors for DDH include breech presentation, family history, and oligohydramnios
• Clinical examination involves assessing hip stability using the Ortolani and Barlow maneuvers in infants
• The Ortolani test reduces a dislocated hip
• The Barlow test dislocates an unstable hip
• Ultrasound is used to evaluate hip anatomy in infants younger than 6 months
• Radiographs are used for older children to assess the acetabular development and femoral head position
• Treatment options include the Pavlik harness for infants, closed reduction and spica casting, or open reduction with or without pelvic osteotomies
• Early diagnosis and treatment are essential to prevent long-term complications such as hip pain and arthritis

Spinal Deformities

• Spinal deformities in children include scoliosis, kyphosis, and spondylolisthesis
• Scoliosis is a lateral curvature of the spine, often accompanied by vertebral rotation
• Idiopathic scoliosis is the most common type, usually diagnosed during adolescence
• Kyphosis is an excessive rounding of the upper back
• Scheuermann's disease is a common cause of kyphosis in adolescents, characterized by vertebral wedging
• Spondylolisthesis is the forward slippage of one vertebra over another
• Diagnosis involves physical examination, radiographic imaging, and assessment of neurological function
• Treatment options for scoliosis include observation, bracing, and surgical correction with spinal fusion
• Bracing is used for moderate curves to prevent progression during growth
• Surgical correction is considered for severe curves or curves that progress despite bracing
• Treatment for kyphosis and spondylolisthesis depends on the severity of the deformity and associated symptoms