Pediatric Orthopedics
|
|
- Nelson Shepherd
- 5 years ago
- Views:
Transcription
1 Pediatric Orthopedics Alexander Rogers, MD Associate Professor Emergency Medicine and Pediatrics Michigan Medicine/University of Michigan Disclosures I have no conflicts of interest to disclose I will not be talking about off label use of medications 1
2 Scope of the problem In 2010, analysis of National data showed more than 7.5 million pediatric ED visits for injuries and poisoning the top visit category (Wier LM, Yu H, Owens PL, Washington R. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); Jun) Immaturity of pediatric skeletal structures leads to different fracture patterns than adults, with different short and long term risks Learning goals Review common pediatric specific injuries Recognize when we need to intervene Cover some non-traumatic presentations 2
3 Pediatric Musculoskeletal System Pediatric skeleton less densely calcified than adult Bones are lighter and more porous More porous= more pliable less strength increase fractures Actively growing structure: long bones contain growth plates/physes end of bones contain epiphysis Pediatric Musculoskeletal System Bones of child surrounded by thick and active periosteum Ligaments and periosteum stronger than bone itself physis is weak link fractures more common than sprains in younger children Response to trauma age dependent 3
4 Salter-Harris Classification SH I fracture through physis may be displaced SH II- through physis and metaphysis SH III through physis and epiphysis SH IV through metaphysis, physis and epiphysis SH V crush to physis In general higher grade Associated with higher risk of growth abnormality 5 yo upper extremity injury (or why I work in Pediatrics ) Doctor: What brings you in today? Patient: I jumped off a chair and hurt my arm Doctor: oh, why did you jump off the chair? Patient: I was trying to fly Doctor: Did you? Patient: A little bit! 4
5 Distal Forearm fractures Common fracture type 2 view radiographs key Acute reduction can avoid the OR Reduce if > degrees angulated If not reduced acutely end up needing OR for pinning Distal Radius and Forearm fractures Orthop Rev (Pavia) Apr 22; 6(2): Multiple recommendations regarding acceptable alignment parameters Younger age have more remodeling potential Age > 9 higher risk after skeletal maturity tx as adult Distal fractures remodel better If initial reduction is not adequate these are difficult to manage in the office* *A friendly plug from my orthopedic colleagues 5
6 Forearm fracture variants 6 yo with fall from the monkey bars Pain in mid-forearm Subtle swelling/deformity Bowing fracture Plastic deformity of long bone (in this case the ulna) If > 20 degrees of deformity can prevent remodeling of the other bone Increased need to reduce if > 10 yo Reduce with either weights or slow, constant traction 6
7 Forearm fracture variants 5 yo FOOSH Still using affected arm, but decreased Pain with supination No swelling or deformity Buckle/Taurus fracture Distal Radius most common but can be any bone Can usually treat with prefabricated splints and your patients will thank you for it!* *Williams KG et al. A randomized controlled trial of cast versus splint for distal radial buckle fracture: an evaluation of satisfaction, convenience, and preference. Pediatr Emerg Care May;29(5):
8 Forearm Fracture variants 9 yo fall from a giant yoga ball that was next to a tree at family camp Monteggia Fracture Monteggia fracturedislocations consist of a fracture of the ulnar shaft with associated dislocation of the radial head. The ulnar fracture is usually obvious, whereas the radial head dislocation can be overlooked 8
9 Monteggia Fracture Monteggia Fracture Ulnar fracture + radial head dislocation Uncommon (2% all elbow fx s) but peak age 4-10 Can be easily missedmust have films of both elbow and forearm Isolated ulna fractures rare If unrecognized and not reduced, can lead to permanent disability Closed reduction possible in children, less likely with increased age Galleazzi Fracture Classic: - Fx distal 1/3 radius - dislocation of distal ulna Disruption of radioulnar joint Peak age 9-12 years Suspect in angulated distal radius fractures Difficult to recognize Requires ortho consult in ED and reduction MUGR fractures Monteggia has fractured Ulna Galeazzi has fractured Radius 9
10 Pediatric Elbow 6 ossification centers around the elbow joint C= Capitellum ( 1 yr) R = Radial head ( 3-5 yrs) I = Internal/ medial epicondyle- (4-6 yrs) on ulnar side of elbow T = Trochlea (6-8 yrs) O = Olecranon (8-10 yrs) E= External/ lateral epicondyle ( yrs) due to anatomical position lateral epicondyle on radial side of elbow Elbow Fractures and Anatomic Landmarks Anterior Fat Pad May be normal Posterior far pad Always abnormal if visible Treat a posterior fat pad as an occult fracture even if the rest of the structures are normal 10
11 Radiography and Anatomic Landmarks Anterior humeral line Follow anterior humeral cortex Should pass through the middle 1/3 of the capitellum Note the visible posterior fat pad! Radiography and Anatomic Landmarks Radiocapitellar line (need a good lateral film!) Should intersect the middle 1/3 of the capitellum If not think radial head dislocation/monteggia fracture Case courtesy of Dr Benoudina Samir, Radiopaedia.org, rid:
12 Supracondylar fractures Fall on outstretched arm with hyperextension Neuropraxia Absent pulse in 7-12% Volkmann contraction with brachial artery compression after repair Supracondylar types Type 1 Type 2 Type 3 Abnormal fat pad Posterior splint Pain control Outpatient ortho for casting Posterior cortex intact Posterior splint Pain control Operative repair in vs outpatient Both cortices disrupted Check pulse and nerve function! Posterior splint Pain control Urgent/emergent OR 12
13 Supracondylar Reduction If pulseless extremity and delay in transport to definite care, consider closed reduction Traction Milking of displaced portion Hyperflexion of elbow Follow by documentation of pulses and splinting Do not delay transport for reduction if pulses are thready but capillary refill is adequate closed reduction is a last resort as often slips! Heading down 13
14 Lower Extremity Injuries/Kids who won t walk Limping Teenager 14 yo male with 1 month hx of limp and progressive knee pain No known trauma 100 kg male Pain with internal rotation of hip 14
15 Slipped Capital Femoral Epiphesis 14 yo male with 1 month hx of limp and progressive knee pain No known trauma 100 kg male Pain with internal rotation of hip Slipped Capital Femoral Epiphysis (SCFE) Male>Female, African American, obese Often present as knee pain AP, Frog leg view of both hips Urgent operative repair Worsening slip can lead to AVN Family Case Study 18 month old male being swung in circle by father (me) and swings free Fall approximately 8 inches with rotational torque Won t bear weight No deformity noted Mother of child (my wife) not happy 15
16 Toddler s Fracture Nondisplaced spiral fracture of tibial shaft Ambulatory children < 3 yo Can occur with low energy mechanism Up to 40% of initial films are negative (? US dx) Pain control and casting sometimes empiric for 3 weeks Casting preferable to splinting (kids escape splints) Hip pain and fever 3 year old male with recent fall off bike URI one week ago Now with fever, unwilling to bear weight Complains of pain with movement of the right hip 16
17 Hip Septic Arthritis vs. Transient Synovitis Both can cause patients to be unwilling to bear weight and have pain with hip movement Risk factors in order of importance Fever (38.5) > CRP (>2.0) > ESR(>40) > refusal to bear weight > WBC (>12) Caird et al. The Journal of Bone & Joint Surgery. 88(6): , JUN 2006 Non-accidental trauma Close to 1% all children victims of abuse 1/3 of these kids will be reinjured 1-5% of these kids will die if returned to original environment Abuse is 2 nd leading cause of death infants and children Risk factors*: child < 4 years of age (majority are < 2) parental substance abuse young parents, single parents, large # children Nonbiological, transient caregivers in the home disability * 17
18 Orthopedic injuries and abuse Fractures associated with NAT Bucket handle and corner fractures are considered Classic Metaphyseal Lesions Torsional force applied to immature bone Highly suspicious and should prompt a skeletal survey if < 2 (NOT a babygram), 3200 and NAT workup or transfer to appropriate facility 18
19 Fractures associated with NAT Posterior rib fractures often found in contiguous ribs and different stages of healing if repetitive trauma Compressive force applied to sternum and costovertebral junction during violent shaking Highly suspicious and should prompt a skeletal survey if < 2 (NOT a babygram), 3200 and NAT workup or transfer to appropriate facility Acknowledgements Thanks to Stuart Bradin, MD Pediatric Emergency Ramon Sanchez, MD Pediatric Radiology Matthew Abbott, MD Pediatric Orthopedics Michelle Caird, MD Pediatric Orthopedics Marco Rogers my son who had the Toddler s fracture 19
20 Thank you to MCEP!!!! Questions? Fractures that only need a sling Humerus fractures with < 50 degree angulation in younger kids Clavicle fractures even with significant displacement in kids < 10 years old Kids approaching skeletal maturity can consider outpatient surgery 20
PEM GUIDE CHILDHOOD FRACTURES
PEM GUIDE CHILDHOOD FRACTURES INTRODUCTION Skeletal injuries account for 10-15% of all injuries in children; 20% of those are fractures, 3 out of 4 fractures affect the physis or growth plate. Always consider
More informationPediatric Fractures. Objectives. Epiphyseal Complex. Anatomy and Physiology. Ligaments. Bony matrix
1 Pediatric Fractures Nicholas White, MD Assistant Professor of Pediatrics Eastern Virginia Medical School Attending, Pediatric Emergency Department Children s Hospital of The King s Daughters Objectives
More informationUpper Extremity Fractures
Upper Extremity Fractures Ranie Whatley, RN,FNP-C David W. Gray, MD Skeletal Trauma 10 to 15 % of all Childhood Injuries Physeal (Growth Plate) Injuries are ~ 15% of all Skeletal Injuries Orthopaedic Assessment
More informationUpper limb injuries in children. Key points, # & dislocations 7/23/2009 (MIMIC)
Upper limb injuries in children (MIMIC) Key points, # & dislocations Before the age of 16 around 50% of boys & 25% of girls will sustain a # Dislocations are very uncommon Children s bones are less brittle
More informationUpper Extremity Injury Management. Jonathan Pirie MD, Med, FRCPC, FAAP
Upper Extremity Injury Management Jonathan Pirie MD, Med, FRCPC, FAAP Learning Objectives At the end of this session, you will be able to manage common fractures of the: 1. Humerus 2. Elbow 3. Forearm
More informationCommon Orthopaedic Injuries in Children
Common Orthopaedic Injuries in Children Rakesh P. Mashru, M.D. Division of Orthopaedic Trauma Cooper University Hospital Cooper Medical School of Rowan University December 1, 2017 1 Learning Objectives
More informationPEDIATRIC UPPER EXTREMITY FRACTURE MANAGEMENT JULIA RAWLINGS, MD SPORTS MEDICINE SYMPOSIUM: THE PEDIATRIC ATHLETE 2 MARCH 2018
PEDIATRIC UPPER EXTREMITY FRACTURE MANAGEMENT JULIA RAWLINGS, MD SPORTS MEDICINE SYMPOSIUM: THE PEDIATRIC ATHLETE 2 MARCH 2018 DISCLOSURE I have nothing to disclose. 2 OBJECTIVES Discuss the diagnosis,
More informationChildhood Fractures. Incomplete fractures more common. Ligaments stronger than bone. Tendons stronger than bone. Fractures may be pathologic
Childhood Fractures Incomplete fractures more common Plastic bowing Torus / Buckle Greenstick Ligaments stronger than bone Fracture patterns different Physeal injury, not dislocation Tendons stronger than
More informationDisclosure. Learning ObjecAves. A Quick Review. Pediatric Fractures. The Developing Bone
How to Bend but not Break Managing Pediatric Orthopedic Injuries in the Emergency Department Disclosure Nothing to disclosure No conflict of interest related to this topic Adam Cheng, MD, FRCPC Division
More informationPediatric Elbow Radiology. Seema Awatramani, MD Friday, April 5, 2018 ACOEP Spring Seminar
Pediatric Elbow Radiology Seema Awatramani, MD Friday, April 5, 2018 ACOEP Spring Seminar Disclosure I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or
More informationOBJECTIVES: Define basic assessments skills needed to identify orthopedic injuries. Differentiate when an orthopedic injury is a medical emergency
1 2 How to Triage Orthopaedic Care David W. Gray, M.D. OBJECTIVES: Define basic assessments skills needed to identify orthopedic injuries Differentiate when an orthopedic injury is a medical emergency
More information1/19/2018. Winter injuries to the shoulder and elbow. Highgate Private Hospital (Whittington Health NHS Trust)
Winter injuries to the shoulder and elbow Omar Haddo Consultant Orthopaedic Surgeon, Shoulder, Elbow, Hand & Wrist Specialist MBBS, BmedSci, FRCS(Orth) Highgate Private Hospital (Whittington Health NHS
More informationTrauma-related Pediatric Orthopedic Emergencies. Javier Gonzalez del Rey, M.D. Professor Pediatrics Cincinnati Children s Hospital Medical Center
Trauma-related Pediatric Orthopedic Emergencies Javier Gonzalez del Rey, M.D. Professor Pediatrics Cincinnati Children s Hospital Medical Center Room # 10 7 month old sick since birth Room # 11 5 y/o Fell
More informationSurgical Care at the District Hospital. EMERGENCY & ESSENTIAL SURGICAL CARE
Surgical Care at the District Hospital 1 18 Orthopedic Trauma Key Points 2 18.1 Upper Extremity Injuries Clavicle Fractures Diagnose fractures from the history and by physical examination Treat with a
More informationOuch, That s Gotta Hurt! Pediatric Fractures & Injuries
Ouch, That s Gotta Hurt! Pediatric Fractures & Injuries Greg Canty, MD Medical Director, Sports Medicine Center Attending Physician, Emergency Medicine Children s Mercy Kansas City 2011 Children s Mercy
More informationPEDIATRIC ELBOW FRACTURES.
PEDIATRIC ELBOW FRACTURES www.fisiokinesiterapia.biz INCIDENCE SECOND MOST COMMON PEDIATRIC INJURY OSSIFICATION 1. CAPITELLUM (6 mo. - 2 yrs.) 2. MED. EPICONDYLE (5-9 yrs.) 3. TROCHLEA (7-13 yrs.) 4. LAT.
More informationFOOSH It sounded like a fun thing at the time!
FOOSH It sounded like a fun thing at the time! Evaluating acute hand and wrist injuries Larry Collins, MPAS, PA-C, ATC, DFAAPA Assistant Professor, Physician Assistant Program Assistant Professor, Department
More information4/28/2010. Fractures. Normal Bone and Normal Ossification Bone Terms. Epiphysis Epiphyseal Plate (physis) Metaphysis
Fractures Normal Bone and Normal Ossification Bone Terms Epiphysis Epiphyseal Plate (physis) Metaphysis Diaphysis 1 Fracture Classifications A. Longitudinal B. Transverse C. Oblique D. Spiral E. Incomplete
More informationDisclosure. Pediatric Orthopedic Emergencies. I have no actual or potential conflict of interest in relation to this program or presentation.
Pediatric Orthopedic Emergencies Robin Pearce MSN, RN-BC Trauma Performance Improvement Manager Henrico Doctors Hospital, Forest Disclosure I have no actual or potential conflict of interest in relation
More informationEMERGENCY PITFALLS IN ORTHOPAEDIC TRAUMA. Thierry E. Benaroch, MD, FRCS MCH Trauma Rounds February 9, 2009
EMERGENCY PITFALLS IN ORTHOPAEDIC TRAUMA Thierry E. Benaroch, MD, FRCS MCH Trauma Rounds February 9, 2009 MORAL OF THE STORY Fracture distal radius and intact ulna W/O radius fracture will most likely
More informationTraumatic injuries of the paediatric elbow: A pictorial review
Traumatic injuries of the paediatric elbow: A pictorial review Poster No.: C-750 Congress: ECR 2009 Type: Educational Exhibit Topic: Pediatric Authors: A. M. Veitch, J. Harington, K. Franklin ; Plymouth/UK,
More informationOther Upper Extremity Trauma. Inje University Sanggye Paik Hospital Yong-Woon Shin
Other Upper Extremity Trauma Inje University Sanggye Paik Hospital Yong-Woon Shin Forearm Fractures Forearm fractures - the most common orthopaedic injuries in children - 30-50% of all pediatric fractures
More informationChapter XIX.1. Fractures May 2002
Case Based Pediatrics For Medical Students and Residents Department of Pediatrics, University of Hawaii John A. Burns School of Medicine Chapter XIX.1. Fractures May 2002 Annemarie Uliasz The skeletal
More informationTop 10 Ortho Urgent Care Injuries. J.C. Clark, M.D. ORA Orthopedics
Top 10 Ortho Urgent Care Injuries J.C. Clark, M.D. ORA Orthopedics 10. Proximal Humerus Fractures Treatment Simple sling ICE, pain meds Button-down shirts Recliner to sleep in It will be up to the surgeon
More informationFOOSH It sounded like a fun thing at the time!
FOOSH It sounded like a fun thing at the time! Evaluating acute hand and wrist injuries Larry Collins, MPAS, PA-C, ATC, DFAAPA Assistant Professor, Physician Assistant Program Assistant Professor, Department
More informationOrthopedic Emergencies. Peter Gutierrez, MD Pediatric Emergency Medicine Children s Healthcare of Atlanta
Orthopedic Emergencies Peter Gutierrez, MD Pediatric Emergency Medicine Children s Healthcare of Atlanta Disclosures I have no relevant financial relationships to disclose I do not intend to discuss unapproved
More informationFractures of the shoulder girdle, elbow and fractures of the humerus. H. Sithebe 2012
Fractures of the shoulder girdle, elbow and fractures of the humerus H. Sithebe 2012 Fractures of the Clavicle (mid-shaft). Fractures of the clavicle Fractures of the clavicle Treatment- conservative.
More informationFractures and dislocations around elbow in adult
Lec: 3 Fractures and dislocations around elbow in adult These include fractures of distal humerus, fracture of the capitulum, fracture of the radial head, fracture of the olecranon & dislocation of the
More informationGALEAZZI FRACTURE. Galeazzi fracture-dislocations can be difficult to recognize and are often not initially appreciated.
GALEAZZI FRACTURE Introduction In the Galeazzi fracture-dislocation there is a fracture of the distal third of the shaft of the radius in association with a subluxation or dislocation of the distal radio-ulna
More informationPediatric Orthopedics in Your Office. Laurel Saliman, MD Pediatric Orthopedic Surgeon Swedish Pediatric Specialty Care
Pediatric Orthopedics in Your Office Laurel Saliman, MD Pediatric Orthopedic Surgeon Swedish Pediatric Specialty Care Overview for 20 minute whirlwind Clavicle Distal radius fractures Finger fractures
More informationHand and wrist emergencies
Chapter1 Hand and wrist emergencies Carl A. Germann Distal radius and ulnar injuries PEARL: Fractures of the distal radius and ulna are the most common type of fractures in patients younger than 75 years.
More informationTHE ELBOW. The elbow is a commonly injured joint in both children and adults.
ABC of Emergency Radiology FIG i-lateral radiograph of elbow and line THE ELBOW D A Nicholson, P A Driscoll The elbow is a commonly injured joint in both children and adults. Interpretation of elbow radiographs
More informationBasic Radiographic Principles Part II
Basic Radiographic Principles Part II Kristopher Avant, D.O. October 19 th, 2016 I have no disclosures relevant to the material presented in this discussion. Good Stuff!!! 1 Really? Really! Musculoskeletal
More informationRADIAL HEAD FRACTURES. It is far more common in adults than in children, (who more commonly fracture their neck of radius).
RADIAL HEAD FRACTURES Introduction Fractures of the head of the radius are relatively common. The injury can be subtle unless specifically looked for. It is far more common in adults than in children,
More information11/5/14. I will try to make this painless. Great, a Fracture, Now What? Objectives. Basics for Fracture Workup. Basics for Fracture Workup
Great, a Fracture, Now What? I will try to make this painless Mary Greve MS, PA-C Department of Orthopedic Surgery Trauma Team University of Iowa Hospitals and Clinics Mary-Greve@uiowa.edu Pager 2121 Objectives
More informationPaediatric fractures in the Emergency Department. October 2012
Paediatric fractures in the Emergency Department October 2012 Victorian Paediatric Orthopaedic Network What this presentation covers Paediatric bone anatomy Buckle injury of distal radius Supracondylar
More informationBasic Care of Common Fractures Utku Kandemir, MD
Basic Care of Common Fractures Utku Kandemir, MD Assistant Clinical Professor Trauma & Sports Medicine Dept. of Orthopaedic Surgery UCSF / SFGH History Physical Exam Radiology Treatment History Acute trauma
More informationSports Medicine Unit 16 Elbow
Sports Medicine Unit 16 Elbow I. Bones a. b. c. II. What movements does the elbow perform? a. Flexion b. c. Pronation d. III. Muscles in motion a. FLEXION (supinated) i Brachialis (pronated) ii (neutral)
More informationPractice Changes I Hope You Make
Is that Bad? What PCPs (& Parents) Need to Know about Fractures Aharon Z. Gladstein, MD Pediatric Orthopaedics & Sports Medicine Texas Children s Hospital Assistant Professor, Orthopaedics Baylor College
More informationHow to Triage Orthopaedic Care. David W. Gray, M.D.
How to Triage Orthopaedic Care David W. Gray, M.D. OBJECTIVES: Define basic assessments skills needed to identify orthopedic injuries Differentiate when an orthopedic injury is a medical emergency Determine
More information10/8/17. I have no disclosures. What are they? Upper extremity fractures Lower extremity fractures Non accidental trauma
I have no disclosures Upper extremity fractures Lower extremity fractures Non accidental trauma What are they? Fractures of the radius, ulna and/or humerus Who gets them? Active children usually after
More informationMontreal Children s Hospital McGill University Health Center Emergency Department Fracture Guideline
Montreal Children s Hospital McGill University Health Center Emergency Department Guideline Disclaimers This document is designed to assist physicians working in our emergency department in caring for
More informationRADIOGRAPHY OF THE ELBOW & HUMERUS
RADIOGRAPHY OF THE ELBOW & HUMERUS Patient Position: ELBOW AP Projection in same plane Part Position: Hand in ; patient Centered to Humeral epicondyles Central Ray: Structures Shown: AP Elbow Criteria
More informationIndex. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A Abscess, epidural, 822 824 Achilles tendon rupture, 894 895, 981 982 Acromioclavicular separations, shoulder pain in, 751 753 Adhesive capsulitis,
More informationCASE ONE CASE ONE. RADIAL HEAD FRACTURE Mason Classification. RADIAL HEAD FRACTURE Mechanism of Injury. RADIAL HEAD FRACTURE Imaging
CASE ONE An eighteen year old female falls during a basketball game, striking her elbow on the court. She presents to your office that day with a painful, swollen elbow that she is unable to flex or extend
More informationIntroduction to Fractures. Traumatology RHS 231 Dr. Einas Al-Eisa Lecture 3
Introduction to Fractures Traumatology RHS 231 Dr. Einas Al-Eisa Lecture 3 Definitions A fracture is an interruption in the continuity of bone Fracture = Break Fracture: mechanical damage produced in a
More informationTrauma Films for Upper Body. LCDR. Naruebade Rungrattanawilai RTN M.D., LL.B. FRCOST, DMOC
Trauma Films for Upper Body LCDR. Naruebade Rungrattanawilai RTN M.D., LL.B. FRCOST, DMOC Objective A 42 year-old housekeeper with history of motorcycle accident. There was no external wound but she have
More informationMEDIAL EPICONDYLE FRACTURES
MEDIAL EPICONDYLE FRACTURES Demographic 20% of elbow fractures 60% of which are associated with elbow dislocation. 75% in boys between 6-12 years 20% of elbow dislocation with ME fracture, the ME is incarcerated
More information---Start of Pediatric and Adolescent Upper Extremity Fractures---
Presented by: Mary Lloyd Ireland Professor Dept. of Orthopaedic Surgery and Sports Medicine University of Kentucky Lexington KY www.marylloydireland.com ---Start of Pediatric and Adolescent Upper Extremity
More informationHUMERAL SHAFT FRACTURES. Fractures of the shaft of the humerus are common, especially in the elderly.
HUMERAL SHAFT FRACTURES Introduction Fractures of the shaft of the humerus are common, especially in the elderly. The majority can be treated conservatively but patient coping issues may be significant.
More informationIndex. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A Acetabular fractures, 462 464 Achilles tendon rupture, 389 Acromioclavicular dislocations, 302 Acromion fractures, 301 Ankle, anatomy of, 376
More informationDisclosures. Fracture vs. Break: Is There a Difference? Jennifer Weiner, MS, RN, CPNP AC/PC March 21, Fracture vs. Break. Learning Objectives
39 th National Conference on Pediatric Health Care Fracture vs. Break: Is There a Difference? Jennifer Weiner, MS, RN, CPNP AC/PC March 21, 2018 March 19-22, 2018 CHICAGO Disclosures I have no conflicts
More informationRehabilitation after Total Elbow Arthroplasty
Rehabilitation after Total Elbow Arthroplasty Total Elbow Atrthroplasty Total elbow arthroplasty (TEA) Replacement of the ulnohumeral articulation with a prosthetic device. Goal of TEA is to provide pain
More informationPediatric Injuries/Fractures. Rena Heathcote
Pediatric Injuries/Fractures Rena Heathcote INTRODUCTION Incidence Anatomy of the Growing Bone Injury Patterns What can we X-ray PEDIATRIC FRACTURES INCIDENCE What makes children susceptible to fractures?
More informationBones 101: Introduction to Emergency Orthopedics
Bones 101: Introduction to Emergency Orthopedics Claire Plautz, MD (with special thanks to) Andrew D. Perron, MD University of Virginia Health System Intro to ortho: Overview General Terms & Principles
More informationConflict of Interest. Learner Outcome. Management of Pediatric Upper and Lower Extremity Fractures. Pediatric Fractures: Unique Challenges 7/12/2016
Conflict of Interest Management of Pediatric Upper and Lower Extremity Fractures I hereby certify that, to the best of my knowledge, no aspect of my current personal or professional situation might reasonably
More informationCLINICAL PRESENTATION AND RADIOLOGY QUIZ QUESTION
Donald L. Renfrew, MD Radiology Associates of the Fox Valley, 333 N. Commercial Street, Suite 100, Neenah, WI 54956 10/13/2012 Radiology Quiz of the Week # 94 Page 1 CLINICAL PRESENTATION AND RADIOLOGY
More information1. Discuss some common pediatric problems seen in the clinic. Diagnosis Clinical examination (at birth and subsequent well-baby examinations)
1 Pediatric Orthopaedics for Primary Care Providers 2 Disclosure Statement No conflicts related to this presentation 3 4 Goals 1. Discuss some common pediatric problems seen in the clinic 2. Examination
More informationAustin Hill MD MPH. Assistant Professor Dell Medical School Dept of Surgery and Perioperative Care Orthopaedic Trauma
Austin Hill MD MPH Assistant Professor Dell Medical School Dept of Surgery and Perioperative Care Orthopaedic Trauma Disclosures Orthopedic Implant Company ownership, stock, or options Increasing volume
More information1 Chapter 29 Orthopaedic Injuries Principles of Splinting 2 Types of Muscles. Striated Skeletal. Smooth
1 Chapter 29 Orthopaedic Injuries Principles of Splinting 2 Types of Muscles Striated Skeletal Smooth 3 Anatomy and Physiology of the Musculoskeletal System 4 Skeletal System 5 Skeletal System Functions
More informationChapter 29 Orthopaedic Injuries Principles of Splinting Types of Muscles
1 2 3 4 5 6 7 Chapter 29 Orthopaedic Injuries Principles of Splinting Types of Muscles Striated Skeletal Smooth Anatomy and Physiology of the Musculoskeletal System Skeletal System Skeletal System Functions
More informationPediatric Orthopedics
Pediatric Orthopedics Paul Allegretti, DO, FACOEP Program Director, Associate Professor of Emergency Medicine, Midwestern University, Chicago College of Osteopathic Medicine, Downers Grove Notes I. INTRODUCTION
More informationGoals. Initial management skeletal trauma. Physical Exam ABC OF PRIMARY CARE MEDICINE FRACTURE MANAGEMENT 12/4/2010
ABC OF PRIMARY CARE MEDICINE FRACTURE MANAGEMENT Brian Feeley, MD UCSF Sports Medicine and Shoulder Surgery Goals Discuss common fractures and initial management, treatment guidelines Let your patients
More informationDisclosures Head to Toe: Common Sports Injuries in Kids
Disclosures Head to Toe: Common Sports Injuries in Kids None R. Jay Lee MD Director Pediatric Orthopaedic Fellowship Assistant Professor Pediatric Orthopaedics Johns Hopkins / Bloomberg Children s Objectives
More informationUpper Extremity Trauma.
Upper Extremity Trauma www.fisiokinesiterapia.biz Topics Clavicle Shoulder Dislocation Humerus Elbow Forearm Distal Radius Clavicle Fractures Clavicle Fractures Mechanism Fall onto shoulder (87%) Direct
More informationCommonly Missed Injuries of the Extremities
Commonly Missed Injuries of the Extremities Dr. Tudor H. Hughes M.D., FRCR Department of Radiology University of California School of Medicine San Diego, California 1. Base of skull 2. Odontoid process
More informationEpisode 121 Elbow Injuries Pitfalls in Diagnosis and Management
Radial head fracture mechanism of injury Episode 121 Elbow Injuries Pitfalls in Diagnosis and Management With Arun Sayal & Dale Dantzer Prepared by Lorraine Lau & Shaun Mehta, February 2019 Key concepts
More informationTranscapsular Buttonholing of the Proximal Ulna as a Cause for Irreducible Pediatric Anterior Elbow Dislocation.
Transcapsular Buttonholing of the Proximal Ulna as a Cause for Irreducible Pediatric Anterior Elbow Dislocation. Nick N. Patel, Emory University Robert W. Bruce, Emory University Journal Title: Case report
More informationBCCH Emergency Department UPPER LIMB INJURIES Resource pack Developed by: RENA HEATHCOTE RN
- 1 - BCCH Emergency Department UPPER LIMB INJURIES Resource pack Developed by: RENA HEATHCOTE RN - 2 - FRACTURES The shoulder Dislocation +/_ fracture of humeral head A dislocated shoulder generally follows
More information7/1/2012. Repetitive valgus stresses cause microfractures in the apophyseal cartilage (weak link) Common in year olds
1 2 3 4 5 6 7 When growing pains are not growing pains David W. Gray,M.D. Medical Director Orthopedics Differential Diagnosis Fracture Ligament Injury Disloclation Cartilage Injury Apophysitis Inflammation
More informationRecurrent subluxation or dislocation after surgical
)263( COPYRIGHT 2017 BY THE ARCHIVES OF BONE AND JOINT SURGERY CASE REPORT Persistent Medial Subluxation of the Ulna with Radiotrochlear Articulation Amir R. Kachooei, MD; David Ring, MD, PhD Research
More informationSt Mary Orthopaedic Conference. Steven A. Caruso, MD Trenton Orthopaedic Group Trauma and Complex Fracture Surgeon October 25, 2014
St Mary Orthopaedic Conference Steven A. Caruso, MD Trenton Orthopaedic Group Trauma and Complex Fracture Surgeon October 25, 2014 Nothing to disclose Goals To discuss common orthopaedic pathologies and
More informationElbow Effusions in Trauma in Adults and Children: Is There an Occult Fracture?
Downloaded from www.ajronline.org by 46.3.193.109 on 01/20/18 from IP address 46.3.193.109. Copyright RRS. For personal use only; all rights reserved Nancy M. Major 1 Steven T. Crawford 1,2 Received July
More informationNE Nebraska Trauma Conference Tristan Hartzell, MD November 8, 2017
NE Nebraska Trauma Conference 2017 Tristan Hartzell, MD November 8, 2017 Traumatic arm injuries in the elderly Fractures Hand Wrist Elbow Shoulder Soft tissue injuries Definitions Elderly? old or aging
More informationElbow Joint Anatomy ELBOW ANATOMY, BIOMECHANICS. Bone Anatomy. Bone Anatomy. Property of VOMPTI, LLC
ELBOW ANATOMY, BIOMECHANICS AND PATHOLOGY Kristin Kelley, DPT, OCS, FAAOMPT Elbow Joint Anatomy Joint articulations Humeroulnar Radiohumeral Radioulnar (proximal and distal) Orthopaedic Manual Physical
More informationTHE Salter-Harris classification is a radiologic
Advanced Emergency Nursing Journal Vol. 29, No. 1, pp. 10 19 Copyright c 2007 Wolters Kluwer Health Lippincott Williams & Wilkins Radiology R O U N D S Column Editor: Jonathan Lee Salter-Harris Fractures
More informationA Patient s Guide to Nursemaid's Elbow in Children. PHYSIO.coza
A Patient s Guide to Nursemaid's Elbow in Children SANDTON MEDICLINIC 011 706 7495 FAIRWAYS LIFE HOSPITAL 011 875 1827 ST STITHIANS 082 378 9642 JEPPE BOYS HIGH SCHOOL 084 816 5457 JOHANNESBURG, SANDTON@PHYSIO.CO.ZA
More informationCOURSE TITLE: Skeletal Anatomy and Fractures of the Lower Arm, Wrist, and Hand
COURSE DESCRIPTION Few parts of the human body are required to pivot, rotate, abduct, and adduct like the wrist and hand. The intricate and complicated movements of the arm, wrist, and hand exist partly
More informationWill She Still Make the WNBA? Sports Injuries & Fractures
Will She Still Make the WNBA? Sports Injuries & Fractures Aharon Z. Gladstein MD Pediatric Orthopaedic Surgery Pediatric Sports Medicine Sports Injuries Chronic (overuse) Acute Who can be treated in PCP
More informationDisclosures / Conflicts
Management of Pediatric Orthopaedic Trauma Urgencies/Emergencies David A. Podeszwa, M.D. Christine A. Ho, M.D. Anthony I. Riccio, M.D. Lane Wimberly, M.D. OTA Annual Meeting 2013 Disclosures / Conflicts
More informationOn the Field Management of Pediatric Trauma
On the Field Management of Pediatric Trauma Kyle Nagle, MD MPH University of Colorado Department of Orthopedics Children s Hospital Colorado Orthopedics Institute Disclosures I have no conflicts of interest
More informationProximal radioulnar translocation associated with elbow dislocation and radial neck fracture in child: a case report and review of literature
DOI 10.1007/s00402-013-1820-8 TRAUMA SURGERY Proximal radioulnar translocation associated with elbow dislocation and radial neck fracture in child: a case report and review of literature Hong Kee Yoon
More informationLower Extremity Alignment: Genu Varum / Valgum
Lower Extremity Alignment: Genu Varum / Valgum Arthur B Meyers, MD Nemours Children s Hospital & Health System Associate Professor of Radiology, University of Central Florida Clinical Associate Professor
More informationEffects of Immobilization. N24 Pedi Musculoskeletal Spring 2012, Week 14. Cabrillo ADN/C. Madsen RN, MSN 1. Physical effects on other systems
Common Orthopedic Problems of Children Congenital Acquired Bones Neuromuscular Physical effects on other systems Pulmonary Cardiac Skin integrity Elimination GI GU 1 4 General Nursing Considerations any
More informationTibia metaphysis fracture icd 9
Tibia metaphysis fracture icd 9 The Borg System is 100 % Tibia metaphysis fracture icd 9 S82.244F is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
More informationUpper Extremity Trauma
Upper Extremity Trauma Wesley Eilbert, MD, FACEP (August Course & Webcast Course Lecturer) Clinical Associate Professor, Department of Emergency Medicine, University of Illinois at Chicago, College of
More informationAppendicular Skeletal Trauma
Appendicular Skeletal Trauma Dr. Tudor H. Hughes M.D., FRCR Department of Radiology University of California School of Medicine San Diego, California Types of cognitive error Satisfaction of search; Once
More informationElbow. Chapter 2 LISTEN. Mechanism of Injury (If Applicable) Pain
Chapter 2 Elbow LISTEN Mechanism of Injury (If Applicable) Patient usually remembers their position at the time of injury Certain mechanisms of injury result in characteristic patterns Fall on outstretched
More informationFractures of the Ankle Region in the Skeletally Immature Patient. The Salter Classification is Worthless!!
Fractures of the Ankle Region in the Skeletally Immature Patient. The Salter Classification is Worthless!! Kaye E Wilkins D.V.M,M.D. President's Council/Dielmann Chair in Pediatric Orthopedics Professor
More informationOrthopedics in Motion Tristan Hartzell, MD January 27, 2016
Orthopedics in Motion 2016 Tristan Hartzell, MD January 27, 2016 Humerus fractures Proximal Shaft Distal Objectives 1) Understand the anatomy 2) Epidemiology and mechanisms of injury 3) Types of fractures
More informationCOMMON CARPAL INJURIES IN ATHLETES Nicholas A. Bontempo, MD Orthopedic Associates of Hartford I HAVE NO CONFLICTS OR DISCLOSURES TO REPORT OUTLINE
COMMON CARPAL INJURIES IN ATHLETES Nicholas A. Bontempo, MD Orthopedic Associates of Hartford I HAVE NO CONFLICTS OR DISCLOSURES TO REPORT OUTLINE The carpus Scaphoid fracture Scapholunate ligament tear
More information6/23/2017. What do you see? skull fracture
What do you see? skull fracture 1 Head CT On soft tissue windows, posterior soft tissues swelling and hemorrhage, no definite evidence of fracture Head CT On bone windows, fracture now seen subjacent to
More informationCase Presentation: Comminuted Fractures of the Proximal Ulna 11/28/2017. Disclosures. Surgical Strategy. Implant Choice. Melvin P.
Current Solutions in Orthopaedic Trauma Case Presentation: Comminuted Fracture of the Proximal Ulna Melvin P. Rosenwasser, MD Robert E. Carroll Professor of Surgery of the Hand Chief, Orthopaedic Hand
More informationFractures of the Hand in Children Which are simple? And Which have pitfalls??
Fractures of the Hand in Children Which are simple? And Which have pitfalls?? Kaye E Wilkins DVM, MD Professor of Orthopedics and Pediatrics Departments of Orthopedics and Pediatrics University of Texas
More informationCase Report An Undescribed Monteggia Type 3 Equivalent Lesion: Lateral Dislocation of Radial Head with Both-Bone Forearm Fracture
Case Reports in Orthopedics Volume 2016, Article ID 8598139, 5 pages http://dx.doi.org/10.1155/2016/8598139 Case Report An Undescribed Monteggia Type 3 Equivalent Lesion: Lateral Dislocation of Radial
More informationAnatomy of the Musculoskeletal System
Anatomy of the Musculoskeletal System Kyle E. Rarey, Ph.D. Department of Anatomy & Cell Biology and Otolaryngology University of Florida College of Medicine Outline of Presentation Vertebral Column Upper
More informationFriday Teaching. Bones
Friday Teaching Bones Regarding slipped femoral capital epiphysis It represents Salter Harris type V injury 20% are bilateral There is slight widening of the joint space Slip is typically posteromedial
More informationThe Elbow Scanning Protocol
The Elbow Scanning Protocol Diagnostic Imaging of the Elbow: Introduction The elbow maybe considered as consisting of four quadrants, anterior, medial, lateral and posterior. Ultrasound would normally
More informationBone Up on Pediatric Fractures & Dislocations!
Disclosures Bone Up on Pediatric Fractures & Dislocations! Greg Canty, MD Medical Director, The Center for Sports Medicine A:ending Physician, Emergency Medicine Children s Mercy Hospitals & Clinics I
More information