6/10/2019

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Orthopedic Emergencies

Peter Gutierrez, MD

Pediatric Emergency Medicine

Children’s Healthcare of Atlanta

Children’s Healthcare of Atlanta | Emory University

Disclosures

• I have no relevant financial relationships to disclose

• I do not intend to discuss unapproved uses for commercial products

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Children’s Healthcare of Atlanta | Emory University

Objectives

• Upon completion of this educational activity, participants will be able to– Identify common pediatric orthopedic emergencies,

including fractures, dislocations, infection, and overuse injuries

– Choose the correct evaluation tools and initial management for common pediatric orthopedic emergencies

– Recognize pediatric orthopedic emergencies that should be transferred to a pediatric facility

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Children’s Healthcare of Atlanta | Emory University

Topics

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Fractures Dislocations InfectionOveruse Injuries/

Misc

Buckle FracturesNursemaid’s

ElbowSeptic Arthritis

Osgood-Schlatter Disease

Clavicular Fracture

Patellar Dislocations

OsteomyelitisSinding-Larsen-

Johansson Disease

Supracondylar Fractures

Sever Disease

Scaphoid Fracture Slipped Capital Femoral Epiphysis

Salter-Harris Fractures

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Children’s Healthcare of Atlanta | Emory University

Buckle Fractures- Mechanism and Presentation

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Children’s Healthcare of Atlanta | Emory University

Buckle Fracture- Radiographic Findings and Management

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Children’s Healthcare of Atlanta | Emory University

Clavicular Fractures- Mechanism and Presentation

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Children’s Healthcare of Atlanta | Emory University

Clavicular Fracture- Radiographic Findings and Management

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Children’s Healthcare of Atlanta | Emory University

Supracondylar Fractures- Mechanism and Presentation

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Children’s Healthcare of Atlanta | Emory University

Supracondylar Fracture- Type 1

• Both cortices appear intact

• Soft signs present– Anterior humeral line

– Posterior fat pad

– Anterior fat pad

• Management– Posterior long arm splint

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Children’s Healthcare of Atlanta | Emory University

Supracondylar Fracture- Type 2

• Anterior Cortex Disrupted

• Management– Depends on degree of

angulation

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Children’s Healthcare of Atlanta | Emory University

Supracondylar Fracture- Type 3

• Disruption of anterior and posterior cortices

• Management– Almost exclusively

operative management

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Children’s Healthcare of Atlanta | Emory University

Supracondylar Fractures- Neurovascular Status

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Children’s Healthcare of Atlanta | Emory University

Supracondylar Fracture- Management

• Type 1– Need only splint

• Type 2 and 3– Splint for comfort and

refer to emergency department

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Children’s Healthcare of Atlanta | Emory University

Scaphoid Fractures- Mechanism and Presentation

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Children’s Healthcare of Atlanta | Emory University

Scaphoid Fracture- Radiographic Findings and Management

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Children’s Healthcare of Atlanta | Emory University

Salter Harris (SH) Fractures- Mechanism and Presentation

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Children’s Healthcare of Atlanta | Emory University

SH Fractures- Types

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SH Fractures- Management

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Children’s Healthcare of Atlanta | Emory University

Nursemaid’s Elbow- Mechanism and Presentation

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Nursemaid’s Elbow- Radiographic Findings

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Nursemaid’s Elbow- Reduction

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Patellar Dislocation- Mechanism and Presentation

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Children’s Healthcare of Atlanta | Emory University

Patellar Dislocation- Radiographic Findings

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Patellar Dislocation- Management

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Septic Arthritis- Mechanism and Presentation

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Children’s Healthcare of Atlanta | Emory University

Septic Arthritis- Management

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Children’s Healthcare of Atlanta | Emory University

Septic Arthritis- Management

• IF– Feeling cavalier

– Have access to labs

– Hip is the joint involved

• Kocher Criteria– Non-weight bearing

– Fever of 38.5 or higher

– WBC >12

– ESR >40

• Septic arthritis of the hip– 99% chance with 4/4

– 92% chance with 3/4

– 40% chance with 2/4

– 3% chance with 1/4

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Osteomyelitis- Mechanism and Presentation

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Osteomyelitis- Management

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Osgood-Schlatter Disease (OSD)-Mechanism and Presentation

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OSD- Radiographic Findings

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OSD- Management

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Sinding-Larsen-Johansson (SLJ) Disease

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SLJ- Radiographic Findings

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SLJ- Management

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Sever Disease- Mechanism and Presentation

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Sever Disease- Management

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Slipped Capital Femoral Epiphysis (SCFE)-Mechanism and Presentation

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SCFE- Radiograph Findings

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SCFE- Management

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Children’s Healthcare of Atlanta | Emory University

References

• Fleischer and Ludwig’s Textbook of Pediatric Emergency Medicine. 7th Edition

• Yang S, Andras L. “Clavicle Shaft Fractures in Adolescents.” Orthop Clin N Am 48 (2017) 47–58

• Wheeless’s Textbook of Orthopedics. www.wheelessonline.com- multiple topics

• Emedicine- Sever Disease, SCFE

• Medcomic.com

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