Pediatric orthopaedic

Common Pediatric Fracture and Dislocations

Club foot

Developmental dysplasia of the hip (DDH)

-       Incomplete fracture

• plastic deformation 
• Buckle (Torus) fracture

• Greenstick fracture

-       Growth plate injury

• Salter-Harris classification
  • Type I-V
• 5-6 years
• Mechanism of injury
  • Fall on outstretch hand
• Clinical feature
  • Anterior pucker sign
• Investigation
  • Plain X-ray(AP, Lat)
• Classification
  • Gartland classification
    •  Type I : Non-displaced fracture
    • Type II: Partially-displaced fracture
    • Type III: Totally-displaced fracture
• Treatment
  • Type I : Long arm cast
  • Type II: CRIF with K-wire
  • Type III: ORIF with K-wire

Fractures & dislocations around the elbow

Supracondylar fracture of the distal humerus

-       Complication

• Malunion
• Neurovascular injury
• compartment syndrome

Fractures of the lateral condyle

-                    Mechanism of injury

• varus force
• ECRL,ECRB

-                    Classification

• Milch classification
  • Type I: Salter-Harris type IV
  • Type II: Salter-Harris type II 

-                     Clinical features

-                          Pain,Swelling

-                     Investigation

• Plain X-ray (elbow ท่าAP ,lateral)

-                    Treatment

• Non-displace fracture (< 2 mms. )
• Displaced fracture : open reduction fixation withK-wire

-                    Complications

• non-union
• malunion
• cubitus valgus
• deformity
• delayed ulnar nerve palsy

Forearm fracture

-                    Mechanism of injury

•  Direct force
• Indirect force

-                    Clinical features

• Pain swelling

-                    Investigation 

•  Plain X-ray forearm (AP,lateral)

-                    Treatment

• Close reduction with long arm cast
• Open reduction & internal fixation
  • irreducible fracture
  • multiple fractures

Fracture of the distal radius

-                    metaphysic

-                    Mechanism of injury

-                    Clinical features

• dinner-fork deformity
• DRUJ
• scaphoid

-                   

-                    Investigation : Plain X-ray

-                    Treatment

-                    non-operative treatment

• Physeal fractures
  • close reduction with long arm cast
  • Buckle fractures
    • short arm splint 
    • Green stick fractures
      • closed reduction with long arm cast

-                   

• Complete fractures
  • closed reduction with long arm cast

-                     Complications

• Malunion
• radio-ulnar discrepancy
• physeal arrest

 Femoral shaft fracture 

-                    Clinical featuress

• multiple organs injury

-                    Investigation

• Plain X-ray

-                    Treatment

•  Infant : hip spica cast
• Aldolescent : open reduction & plate screw fixation

Club foot

-                   Cause

-                   Pathology

• soft tissue
• Bone

-                   Clinical presentation

-                   Investigation

•  X ray : Kite’s angle

-                   Differential Diagnosis

• physiologic clubfoot

-                   Treatment

•  Serial casting (Ponseti technique)
• Plaster taping (functional method)
• Surgery

Developmental dysplasia of the hip (DDH)

-            -      Cause

-            -       Pathology

-            -       Clinical presentation

• Otolarni test , Barlow test
• Galeazzi sign
• limited of hip abduction

-            -       Investigation

• X ray
• Ultrasound

-            -       Treatment

• 0-6 months: Pavlik harness
• 6-18 months: close, open reduction
• More than 18 monthe: open reduction(with  Osteotomy)