Orthopedic Eponyms - Emory Department of Pediatrics

Orthopedic Eponyms - Emory Department of Pediatrics

Pediatric Orthopedic Fractures Dafina Good, MD Pediatric Emergency Medicine

Fellow Emory University School of Medicine Objectives

Review unique structural and physiologic

differences between children and adult skeletal systems Review fracture patterns unique to children Review the Salter-Harris classification of pediatric physeal fractures

Review common presentations and EPONYMS of common pediatric and adult fractures Review Ottawa ankle and knee criteria

Epidemiology

Orthopedic trauma accounts for 1015% of ED visits in urban pediatric hospitals It is estimated that over 40% of boys

and over 25% of girls will sustain a fracture during childhood Rapid growth of organized sports

Skeletal Differences between Children and Adults Presence of Growth Plates (Physis)

Presence of Secondary Ossification Centers (Epiphysis) Rapid healing

Growth plate injuries constitute up to 25% of all skeletal

injuries in children More metabolically active periosteum in children Greater Potential to Remodel

More porous and more pliable bones Fracture patterns unique to children Fractures are more common than sprains in young children

Ligaments and tendons attaching one bone to another have greater strength than immature bones Normal Bone Anatomy

Normal Bone Anatomy Describing Fractures

Open vs. Closed

Location (shaft, through growth plate etc.) Displacement in mm Shortening in mm Impaction if present Angulation, degree and direction

(midshaft-direction of terminal fragment) Salter Harris Classification Neurovascular status Describing Fractures

Describing Fractures Salter Harris Classification

Fractures Unique to Children Buckle or Torus Fractures

Fractures Unique to Children Greenstick

Fractures Unique to Children Greenstick

Fractures Fractures Unique to Children

Bowing Fractures Fractures unique to children

Fractures unique to children Toddlers Fracture

Common Fracture Eponyms Who Named It? From the neck down to the toes!

Jefferson Fracture Hangmans Fracture

Teardrop Fracture Chance Fracture Boxers Fracture

Hand Anatomy Bennetts Fracture

Colles Fracture Smiths Fracture Nightstick Fracture

Monteggia Fracture Monteggia Fracture

Galeazzi Fracture Supracondylar Fracture Ossification Centers C-R-I-TO-E

Approximate age of appearance Capitellum - 1 year Radial head - 3 years Internal epicondyle

(Medial epicondyle)-5 years Trochlea - 7 years Olecranon - 9 years External epicondyle (Lateral epicondyle)-11 years

Proximal Humeral Fracture Slipped Capital Femoral

Epiphysis SCFEs Kleins Line Kleins Line

Pelvic Avulsion Fractures Common Locations of Pelvic Avulsion Fractures

Spiral Femur Fracture Osgood Slater Disease vs Sinding Larsen-Johansson

Patellar Fracture Knee Anatomy

Knee Anatomy Ottawa Knee Rules Characteristics of Patients Who Should Undergo Radiography After Knee Trauma

Ottawa knee rules Age 55 years or older Tenderness at head of fibula Isolated tenderness of patella

Inability to flex knee to 90 degrees Inability to walk four weight-bearing steps immediately after the injury and in the emergency department Pittsburgh decision rules

Blunt trauma or a fall as mechanism of injury plus either of the following: Age younger than 12 years or older than 50 years Inability to walk four weight-bearing steps in the emergency department

Corner Fracture Bucket Handle Fractures

Maisonneuve Fracture Tillaux Fracture Tillaux Fracture

CT Scan of Tillaux Fracture Triplane Fracture

Triplane Fracture Whats the Difference?

Anatomy of the Fifth Metatarsal Ottawa Ankle Rules

Reasons to Refer to Orthopedics

Open Fractures Unacceptably displaced fractures Fractures with associated neurovascular compromise Significant growth plate or joint injuries

Pelvic/Femur fractures (other than minor avulstions) Spinal Fractures Dislocations of major joints other than shoulder/knee

Clavicle (distal third) Fractures prone to Nonunion/Malunion Why do we do it?

Prevent Growth arrest Prevent malunion or nonunion

Restore function as close to physiologic

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