Pediatric Orthopedics in Your Office. Laurel Saliman, MD Pediatric Orthopedic Surgeon Swedish Pediatric Specialty Care

Transcription

1 Pediatric Orthopedics in Your Office Laurel Saliman, MD Pediatric Orthopedic Surgeon Swedish Pediatric Specialty Care

2 Overview for 20 minute whirlwind Clavicle Distal radius fractures Finger fractures Toddler fractures Toe fractures Slipped capital femoral epiphysis

3 Treat in office vs Refer? Depends: on your comfort level Stability of the fracture or acuity of the injury Splint/brace capability of your practice Potential for remodeling

4 Stable fractures of the upper extremity Clavicle Distal forearm/ Wrist

5 Clavicle Under 12 years old surgery is never performed 13 and older surgery sometimes Surgical criteria Dominant arm Overhead athlete Shortening of clavicle by 17 mm or more Wide displacement more likely to have nonunion

6 10 yo clavicle fracture

7 4 yo injury 6 weeks

8 Clavicle fracture office management Sling for 4 weeks figure 8 brace if displaced, older than 12 years and they tolerate it Pendulum exercises after a few days Weeks 4-8 no sling except for PE, recess Week 9 may return to sports Be careful about collision Obtain x-rays at week 4, week 8 In patients 6 or younger may resume normal activities at 6 w

9 Distal radius buckle or something more?

10 Buckle fracture of distal radius stable = brace, unstable = referral 2 yo injury films and healing 6 weeks after injury

11 Use pain with pronation and supination as a guide no pain =velcro brace

12 Use pain with pronation and supination as a guide no pain =velcro brace

13 5 yo

14 5 yo 1 week 4 weeks

15 5 yo 1 week 4 weeks 8 weeks

16 12 yo distal radius angulation of physis - refer

17 Treatment stable distal radius fractures Removable wrist brace for all out of bed activities for 4 weeks if kid is a crazy monster or less than 10. >10 for PE, recess and sports. Week 4-8 may have brace off except for risky activities such as competitive sports, PE, skateboarding, snowboarding No repeat x-rays needed

18 Treatment stable distal radius fractures Removable wrist brace for full time including sleeping until 1 week from injury Then use it for all out of bed activities for 3 weeks. Week 4-8 may have brace off except for PE, recess and sports I get x-rays at 4 weeks and 8 weeks

19 Fractures look worse before they look better injury 4 weeks 8 weeks

20 Finger fractures- extra octave, volar plate

21 Finger fractures- extra octave, volar plate Physeal fracture <10 degrees of angulation Non displaced volar plate avulsion

22 Finger fractures- extra octave, volar plate Splint for no more than 5 days Begin motion 5 minutes 3 times a day pressing each joint and holding 10 seconds Buddy tape to adjacent finger full time for 2 weeks and then for sports, PE until 4 weeks Repeat x-rays at 4 weeks Hand PT if motion not full at 4 week

23 Get x-rays at 6 month if physis involved to monitor for any physeal arrest injury 4 weeks 6 months

24 Toddler s fracture

25 May not even need to be splinted if child does not have to go to daycare Little kids <3 often do not like walking boots Risk of pressure sore high in non verbal kids May walk as tolerated Avoid jumping from a height for 6 weeks Toddler s fracture

26 Proximal tibia fracture often needs casting, has potential for valgus overgrowth, called Cozen s Phenomenon

27 1 st Metatarsal Buckle fracture Cast or walking boot depending on child for 4 weeks May walk as tolerated Avoid jumping from a height for 6 weeks after injury

28 Toe Fractures- lesser toes Needs reduction

29 Lesser toe

30 Lesser toe fractures Walking boot if really, really sore Buddy tape for 2 weeks full time Then buddy tape for another 2 weeks when barefoot, but don t have to tape when in shoes if it bothers them Be careful around the house may want to have slippers or house shoes for up to 8 weeks If displaced physeal fracture 6 month x-rays

31 Great toe fractures

32 Great toe fractures

33 Treated same way chevron taping

34 Chevron taping 16,000 steps at Disneyland with this

35 Great toe fractures Chevron taping for 4 weeks Begin motion exercises of toe X-rays at 4 weeks Release to sports at 4 weeks Be careful in house for 8 weeks slippers 6 month x-rays to evaluate physis growth if physeal fracture

36 Slipped capital femoral epiphysis No limping child should ever be diagnosed with a groin strain without AP and frog pelvis x-rays unless: Full motion of hip in prone position- especially internal rotation And you can touch the area that hurts and reproduce the pain

37 Prone internal rotation

38 Treated for a groin strain for months

39 Right Severe SCFE

40 Right severe SCFE

41 Post op surgical hip dislocation

42 Different patient with mild left slip

43 Thanks!