Surgery Subspecialty [PEDS ORTHOPEDICS]

Adult orthopedics has a great many diseases to learn and peds This is a duplicate from the pediatrics content in
ortho is no different. For pediatrics every disease has its own case you are studying surgery only
unique presentation. Learning each constitutes strict
memorization but there’s only a few things to commit for each
disease. Keep in mind - if you’re studying for a test this makes for Dx Age Patient Dx Tx
a great extended matching set. DDH Newborn Clicky Hip U/S Harness
LCP 6 Insidious Onset XR Cast
1) Hip Pathology Antalgic Gait
Knowing the age, presentation, and treatment will help build a SCFE 13 Fat kid with XR Surgery
differential for “hip disease.” knee pain (frog-leg) (Urgent)
i. Developmental Dysplasia of the hip (nontraumatic)
The hip is insufficiently deep so the femur head constantly Septic Any Joint pain Aspirate Drain and Abx
pops out. Diagnosed during the well-baby exam (newborn), Hip (Toddler) during febrile
there’ll be a clear click sound on hip flexion (Barlow and illness
Ortolani). Confirm the diagnosis with an ultrasound at 4-6 Transient Any Joint pain after History Supportive
weeks as there can be physiologic laxity initially around Synovitis viral illness
time of birth which may resolve. Once diagnosed put the
child in a harness to keep the femur approximated to the join
as the joint grows out.
ii. Legg-Calve-Perthe Disease
When a child is around six years old they can suffer from
avascular necrosis of the hip. There’ll be an insidious onset
knee pain and an antalgic gait (spend less time on painful
leg). Diagnose by x-ray and then cast. Dx Patient Sxs Dx Tx
iii. Slipped Capital Femoral Epiphysis Osgood- Teenage Knee pain with Clinical Support
An orthopedic emergency, it can occur in adolescents who Schlatter athlete swelling
are either obese or in a growth spurt. They’ll complain of Scoliosis Teenager Adam’s Test XR Brace.
hip or knee pain of sudden onset. Get a frog-leg position (usually girl) Rods
x-ray to confirm. Surgery is required. Osteogenic Retino- Femur / Tib XR Resection
iv. Septic Hip Sarcoma blastoma pain Sunburst
The differential of pediatric hip disease could be done by age Ewing’s t(11:22) Mid-shaft pain XR Resection
alone were it not for this. It shows up in any age (though Onion-skin
usually a toddler) during a febrile illness with complaints Fractures If a plate involved do open reduction and internal fixation
of joint pain. Do an x-ray first then a joint aspiration with
Gram stain and culture. It needs to be drained and
antibiotics should be started.
v. Transient Synovitis
On the differential for septic hip. It’s synovial
inflammation up to 4 weeks after URI or GI viral illness. Kocher Criteria
Differentiate by lack of fever, no leukocytosis, and
Non-weight bearing 1: not septic joint
decreased inflammatory markers (Kocher criteria - the more
ESR > 40 2: not sure
you have, the higher risk of septic joint - see right). The X-
Fever > 38 °C 3: 93% septic joint
ray is normal. Treat supportively.
WBC > 12,000 4: 99% septic joint
2) Osgood-Schlatter Disease
Occurring in teenage athletes, it presents as a painful knee with
swelling over the tibial tubercle. The athlete has two options:
stop exercising (curative) or play through it. If they work
through, it there may be a palpable nodule. Otherwise, it causes
no permanent sequelae but it does hurt.

3) Scoliosis
A developmental disorder of the spine found in adolescents
(mainly females). Their thorax will tip to the side causing a
cosmetic deformity. More severe disease can cause respiratory
issues. Perform an Adam’s Test (patient bends forward,
asymmetric shoulders are diagnostic) and confirm with X-rays.
Treat by bracing with the goal of slowing progression (not
curing). Surgery with rod placement is reserved for severe cases.

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 Surgery Subspecialty [PEDS ORTHOPEDICS]

4) Bone Tumors
In kids, 1o tumors cause low grade focal pain and may invade
locally. Have two in mind: osteogenic sarcoma presents with a
sunburst onion skin pattern typically at the distal femur. It’s Osteogenic Sarcoma
associated with retinoblastoma. The other is a Ewing’s sarcoma
found in the mid-shaft caused by t(11:22) translocation. The test
may show you an x-ray of the bone with the lesion, or they may
just say “sunburst” or “onion-skin.” An MRI is the best
radiographic test, and, as with most cancers, biopsy is the best
diagnostic step. Resection is treatment in both cases. Ewing’s

5) Special Considerations for Fractures

Fractures are the same as for adults except when it comes to the
growth plate. If the fracture involves the growth plate an ORIF
is needed to ensure the plate is realigned. Otherwise the kid will
grow up with one leg shorter than the other.

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