5Unicameral bone cyst Next to growth plate Active vs Inactive Falling leaf sign
6ABCAneurysmal bone cysts may occur in patients aged years, with a peak incidence in those aged 16 years.About 75% of patients are younger than 20 years.Four phases of pathogenesis are recognized, as follows:Osteolytic initial phaseActive growth phase, which is characterized by rapid destruction of bone and a subperiosteal blow-out patternMature stage, also known as stage of stabilization, which is manifested by formation of a distinct peripheral bony shell and internal bony septae and trabeculae that produce the classic soap-bubble appearance.Healing phase with progressive calcification and ossification of the cyst and its eventual transformation into a dense bony mass with an irregular structure.
13Osteochondromas or Multiple Exostoses Cartilaginous cap covered by a bursaImpinge on local structuresCT shows cap < 1cm in thicknessCan be excised due to structural problemsSMALL incidence (<1% per lesion) of transformation to Chondro sarcoma (or Osteogenic less common)
14Multiple Exostoses Found in areas around growth plates Can occur in multiple locations or singularlyUsually not NeoplasticBone with cartilaginous capGrows normally with growth of the rest of the skeleton
15OsteochondromasB9Cartilaginous capImpinges on local structures
28Twisty Bendy Feet Most common is metatarsus adductus FPS fetal packaging syndromeNormal rotation of feet in uteroShould respond to gentle massage and SWNShoes could be worn in reverse (r-l l-r) if there is any “last” in the shoe
29Metatarsus adductus/clubfoot (tell tale medial crease)
30Twisty Bendy Feet Clubfeet “talipes equino-varus” Metatarsus adductus, heel equinus and varus and talus adductusTell tale crease on lat underneath malleolusThinning and atrophy of lower legNeeds attention based on severity of deformity, START TREATMENT AT BIRTH !!! Refer early
37Twisty Bendy Legs Internal Tibial Torsion Normal adult rotation is degrees externalNormal unwinding of child's lower legsNot significantly affected by orthotics or treatment !!!Sight along tibial crest and look at malleoliReassure (look for other conditions)
38Twisty Bendy Legs Bendy knees/legs 2-4-6 years Genu varus / genu valgusNormal variantsRadiographs for Blount’s DiseaseVitaminsOrthotics (?)
64Causes of Hip Pain in Children CDH0-2 years1:4 m:f20%bilatLCP4-8 years5:1 m:f10% bilatSCFE10-15 years1.5:1 m:f25-40%bilat
65Idiopathic Adolescent Scoliosis Not a painful conditionIf there is pain…look for another cause!OBJECTIVE OF TREATMENT:To prevent deformity as adultSkeletal maturityOnset of menses, Risser signCriteria for referral relates to progressionBracesSurgery runs the gamut
104Neuromuscular Category Cerebral PalsySpastic or FlaccidBirth injuryPerinatal cerebral anoxiaHyperactive stretch receptorsContracturesReleases, Transfers, Braces etc.
105Infections Joints Pyarthrosis Infants and young children Endemic Otitis MediaNo good lab testX-rays normalPatho-anatomy growth plate vasculatureDrain and decompress because of potential damage to cartilageMay lead to Osteomyelitis