1. PAEDIATRIC ORTHOPAEDICS

2. ORTHO - PAEDICS

3. Children are not small Adults

4. Anatomic differences Centers of ossification Radiolucent growth plate Thicker and stronger periosteum

5. Biomechanic differences Osteoid of a child’s bone is not significantly less calcified,but the density of a young’s bone is certainly less Pores prevent the extension of a fracture line Porous nature allows failure in compression Growth remodeling based in asymmetric growth of physis and periosteum

6. Clinical examination-The grate Art Children never lie Children cry Listen to the mother Congenital deformities Family history Abused child

7. Congenital deformities Infantile hip Dysplasia or Congenital dislocation of the Hip Coxa Vara-Coxa Valga Paediatric Foot

8. C.D.H-Incidence 1-6\1000 births Left hip is affected about twice as frequently as the right Highest risk for first born girls Family history Scoliosis[10 times grater incidence]

9. Etiology Familiar tendency Joint laxity Acetabular dysplasia Mechanical factors Deficiency in growth of the labrum[limbus] Hormonal abnormalities

10. Physical Assessment Apparent limb’s shortening Ortolani’s test Barlow’s test Limited abduction[no more than half way] Assymetrical skin creases Perineal gap Late walking,waddling gait

11. Radiologic assessment Xrays Ultrasonography Computed tomography Magnetic Resonance Imaging

13. Treatment Closed treatment:Pavlik harness,Von Rosen harness,Frejka pillow Surgical procedures:Salter acetabular osteotomy,Chiari acetabular osteotomy,femoral osteotomies

14. Slipped Capital Femoral Epiphysis

15. Incidence Boys age 12 to14, girls age 10 to 12 Caucasian children 1 to 3 per 100.000 Black males,higher incidence[7 to 8 per 100.000]

16. Etiologic factors Obesity Rapid growth spurts Endocrinopathies[hypothyroidism,renal rickets,hypogonadism] Mechanical factors

17. Clinical Presentation Preslip Acute slip Chronic slip[3 weeks] Acute on chronic slip

18. Diagnostic Imaging Lateral Head-shaft Angle[Southwick’ method] >60, 30-60,30> Klein’s line Epiphyseal height Physeal widening One third uncovered metaphysis,grade 1 Two thirds,grade 2 More than two thirds,grade 3

20. Treatment Manipulation Pinning Osteotomies

21. Legg-Calve-Perthes’ Deasease

22. Incidence 1 in 10.000 Particularly rare in black children Usually 4-8 years old Boys are affected 4 times as often as girls Higher incidence in underprivileged communities

23. Pathogenesis Blood supply of femoral head:1/metaphyseal vessels which penetrate the growth disc 2/lateral epiphyseal vessels running in the retinacula 3/scanty vessels in the ligamentum teres Between 4 and 7 years of age blood supply and venous drainage depends almost entirely on the lateral epiphyseal vessels

24. Pathology Stage 1: Ischaemia and bone death Stage 2:Revascularizasion and repair Stage 3: Distorsion and remodeling

28. Treatment Analgesia-? Skin traction Supervised neglect Containment:1/Hips widely abducted,in plasteror in removable splint 2/Varus osteotomy of femur or pelvis

29. Fractures Greenstick fractures Injuries of physis

32. Thank you