Pediatric Orthopedics for Primary Healthcare: Evidence-Based Practice

Description

This book provides a comprehensive, evidence-based guide on how to manage pediatric orthopedic problems safely and confidently. The format allows the reader to identify key points whilst working in their busy clinical practice. Each chapter is co-written by an orthopedic surgeon and general practitioner to ensure the content is relevant to primary care, but also sufficiently detailed to meet the needs of those in specialist training. The book is divided into two parts; general topics including assessment, normal variants, infections and specific disorders; followed by a section based on specific anatomical regions. Pediatric Orthopedics for Primary Healthcare: Evidence-Based Practice will be an essential resource for a wide audience including but not limited to general practitioners and trainees, pediatric orthopedic surgeons, trauma surgeons, orthopedic residents, emergency department doctors, physiotherapists, podiatrists and medical students who are seeking a concise, yet comprehensive evidence-based resource for this important specialty. Foreword Foreword Foreword Preface Contents Contributors Part I: General Orthopaedic Terminology 1 Introduction 1.1 Backslab 1.2 Cast 1.3 Fractures References Normal Development 1 Introduction 2 Understanding Normality 3 Growth Charts 4 Bone Development and Growth 5 Developmental Milestones 6 Sexual Development 7 Summary References General Assessment 1 Introduction 2 History 2.1 Antenatal History 2.2 Birth History 2.3 Neonatal and Infant History 3 Childhood History 3.1 Family History 3.2 Social History 3.3 History of Present Illness 4 Physical Exam 4.1 Musculoskeletal Exam Basics 4.2 Infant Exam 4.3 Toddler/Elementary Exam 4.4 Adolescent Exam 5 Summary References Normal Variants 1 Background 2 Flexible Flat Feet (Pes Planus) 2.1 In-Toeing (Pigeon Gait) 2.2 Metatarsus Adductus 2.3 Internal Tibial Torsion 2.4 Femoral in-Torsion (Persistent Femoral Anteversion) 3 Bowed Legs (Genu Varum) and Knock Knees (Genu Valgum) References Musculoskeletal Infection 1 Introduction 1.1 Acute Phase Response to Musculoskeletal Infection- Double Edged Sword 2 Musculoskeletal Infection Epidemiology 2.1 Osteomyelitis 2.2 Septic Arthritis 2.3 Pyomyositis 2.4 Cellulitis 2.5 Necrotizing Fasciitis 3 Clinical Presentation of Musculoskeletal Infections 3.1 General Presentation 3.1.1 Differentiating Between Inflammatory and Infectious Pathology 3.1.2 Tools for Evaluation 4 Imaging 4.1 Radiographs 4.2 Ultrasound 4.3 Magnetic Resonance Imaging (MRI) 5 Laboratory Tests 5.1 IL-6 5.2 CRP 5.3 ESR and Fibrinogen 5.4 Utilizing Laboratory Values to Differentiate Inflammatory Conditions from Musculoskeletal Infections 6 Treatment and Pathology Management 6.1 Antibiotics 6.2 Indications for Operative Management 6.3 Operative Techniques 6.4 Post-Operative Care 7 Putting it all Together References Musculoskeletal Tumors 1 Introduction 1.1 Definition of a Tumor 1.2 Bone and Soft Tissue Tumors 1.3 Tumor Staging 2 Clinical Presentation 2.1 The History 2.1.1 Pain 2.1.2 Swelling 2.1.3 Age at Presentation 2.1.4 Gender 2.1.5 Special Presentation 2.2 Clinical Assessment 2.2.1 Look 2.2.2 Feel 2.2.3 Move 2.2.4 Special Tests 3 Investigations 3.1 Laboratory Investigations 3.2 Plain Radiographs 3.3 Ultrasound 3.4 Computer Tomography Scan 3.5 Magnetic Resonance Imaging 3.6 Positron Emission Tomography 3.7 Tissue Histopathology 4 Pathoanatomy 5 Benign Bone Tumors 5.1 Osteochondroma 5.2 Simple Bone Cyst (Unicameral Bone Cyst) 5.3 Aneurysmal Bone Cyst 5.4 Non-Ossifying Fibroma & Fibrous Cortical Defects 5.5 Fibrous Dysplasia 5.6 Osteoid Osteoma 5.7 Chondroblastoma 6 Malignant Bone Tumors 6.1 Osteosarcoma 6.2 Ewing Sarcoma 6.3 Bone Metastases References Metabolic Bone Disease 1 Introduction 2 Bone Remodelling and Biochemistry 3 Bone Biochemistry 4 Rickets 4.1 Vitamin D Deficiency 4.2 Vitamin D Dependent Rickets (VDDR) 4.3 Calcium Deficiency Rickets 4.4 Hypophosphataemic Rickets 5 Renal Osteodystrophy 6 Metabolic Bone Disease of Prematurity (MBDP) 7 Osteoporosis 7.1 Clinical Presentation 7.2 Diagnosis 7.3 Medical Treatment 7.3.1 Prevention 7.3.2 Management 7.3.3 Future Therapies 8 Evaluation of Recurrent Fractures 9 Osteogenesis Imperfecta 9.1 Genetic Studies 9.2 The Multidisciplinary Team in OI References Neuromuscular Conditions 1 Introduction 2 Cerebral Palsy 2.1 Topographical (Anatomical) Classification (Fig. 1) 2.2 Clinical (Physiological) Classification 2.3 Functional Classification 2.4 Pathology 2.4.1 Primary Pathological Changes 2.4.2 Secondary Pathological Changes Limbs as Levers 2.4.3 Compensatory Mechanisms 3 Diagnosis and Evaluation 3.1 History 3.2 Examination 3.3 Investigations 4 Management 4.1 Physiotherapy 4.2 Orthoses 4.3 Assistive Devices 4.4 Serial Casting 4.5 Treatment of Spasticity 4.6 Botulinum Toxin a 5 Selective Dorsal Rhizotomy (SDR) 5.1 Surgery 5.2 Prevention 6 Soft Tissue Release for Displacement or a Hip at Risk 7 Reduction and Reconstruction of the Displaced or Dislocated Hip 7.1 Salvage Surgery for Long-Standing Painful Dislocations References Relevant Syndromes 1 Introduction References Musculoskeletal Dysplasias 1 Introduction 2 Achondroplasia 2.1 Management 3 Skeletal Dysplasias in General 3.1 Clinical Presentation 3.2 Investigations 3.3 Referral 3.4 Treatment Principles and Follow-Up 3.5 Genetic Influences on the Pathophysiology 4 Specific Skeletal Dysplasias 4.1 Hypochondroplasia 4.2 Pseudoachondroplasia (PSACH) 4.3 Multiple Epiphyseal Dysplasia (MED) 4.4 Spondyloepiphyseal Dysplasia Congenita (SEDC) 4.5 Spondyloepiphyseal Dysplasia Tarda (SEDT) 4.6 Stickler Syndrome 4.7 Osteogenesis Imperfecta 4.7.1 Clinical Features 4.7.2 Investigations 4.7.3 Imaging Antenatal Ultrasound 4.7.4 Treatment 4.8 Osteopetrosis 4.9 Diastrophic Dysplasia 4.10 Larsen Syndrome 4.11 Metaphyseal Dysplasias 4.12 Cleidocranial Dysostosis 5 Clinically Localised Dysplasias 5.1 Leri-Weill Dyschondrosteosis 5.2 Trevor’s Disease 5.3 Infantile Cortical Hyperostosis (Caffey’s Disease) 6 Lethal Skeletal Dysplasias 7 The Masqueraders 8 Conclusion References Limb Deformity 1 Introduction 2 Clinical Assessment of Limb Deformities 3 Radiologic Assessment 4 Deformity Planning and Correction 4.1 Identify the Source of Malalignment (Deformity) 4.2 Identify the Level of the CORA (Mechanical Axis Planning) 4.3 Corrective Osteotomies 5 Techniques of Deformity Correction 5.1 Acute Correction 5.2 Gradual Correction 5.2.1 Growth modulation techniques (hemi-epiphysiodesis) 6 Gradual Deformity Correction and Limb Lengthening Using Distraction Osteogenesis References Child Safeguarding 1 Introduction 2 Clinical Presentation 3 Management References Chronic Pain in Children 1 Background 2 Benign Idiopathic Nocturnal Limb Pain of Childhood (Growing Pains) 3 Joint Hypermobility Syndrome (JHS) (Also known as Hypermobility Ehlers Danlos Syndrome Type III) 4 Central Sensitisation Disorder 5 Growth Related Joint Pain in Teenagers 6 Chronic Apophyseal Injuries (CAI) 7 Complex Regional Pain Syndrome (CRPS) 8 Conclusions References Part II: Region Specific Topics Paediatric Hips 1 Introduction 2 Hip Growth 3 Physical Examination of the Hip 3.1 Hip Rotation and Flexion 3.2 Hip Abduction 3.2.1 Trendelenburg Test 3.2.2 Leg Length Discrepancy 4 Evaluation of Hip Pain 5 Preferred Imaging Modalities 6 Developmental Dysplasia of the Hip 6.1 Overview 6.2 Etiology 6.3 Physical Examination 6.3.1 Hip Instability/Abduction 6.3.2 Hip Click 6.3.3 Hip Instability/Barlow 6.3.4 Hip Instability/Ortolani 6.3.5 Gross Morphology 6.3.6 Version 6.4 Imaging 6.4.1 Ultrasound Radiograph 6.5 Treatment Algorithms (by Age) 6.5.1 Overall Goal of Management Treatment for Newborn Hips Type A & B 6.5.2 Treatment for Newborn Hips Type C & D 6.5.3 Follow Up 7 Legg-Calve-Perthe’s Disease 7.1 Overview 7.2 Differential Diagnoses 7.3 Presentation 7.4 Imaging 7.5 Treatment 7.5.1 Residual Disease 7.6 Prognosis 8 Slipped Capital Femoral Epiphysis 8.1 Overview 8.2 Differential Diagnosis 8.3 Presentation 8.4 Physical Examination 8.5 Imaging 8.6 Treatment 8.7 Prognosis/Complications 9 Snapping Hip 9.1 Assessment 9.2 Imaging 9.3 Treatment 10 Labral Tears 10.1 Treatment 11 Femoroacetabular Impingement 11.1 Presentation/Examination 11.2 Treatment 12 Protrusio 13 Transient Synovitis 13.1 Physical Examination 13.2 Imaging and Lab Tests 13.3 Treatment 13.4 Prognosis/Complications 14 In-Toeing and Femoral Anteversion 14.1 Overview 14.2 Presentation 14.3 Physical Examination 14.4 Imaging 14.5 Treatment 14.6 Prognosis 15 Coxa Vara/Valga 15.1 Presentation 15.2 Imaging 15.3 Treatment 16 Summary References Paediatric Knee Disorders 1 Introduction 2 Stress-Related Pain 2.1 Osgood-Schlatter’s Disease 2.1.1 Diagnosis and Evaluation 2.1.2 Treatment 2.2 Sinding-Larsen-Johansson Disease 2.2.1 Diagnosis and Evaluation 2.2.2 Treatment 3 Patella 3.1 Bipartite Patella 3.1.1 Epidemiology 3.1.2 Diagnosis and Evaluation 3.1.3 Treatment 3.2 Patella Dislocation, Instability and Maltracking 3.2.1 Diagnosis and Evaluation 3.2.2 Treatment 3.3 Anterior Knee Pain 3.3.1 Epidemiology 3.3.2 Aetiology 3.3.3 Diagnosis and Evaluation 3.3.4 Management 4 Intra-Articular Conditions 4.1 Osteochondritis Dissecans 4.1.1 Clinical Findings 4.1.2 Diagnosis and Evaluation 4.1.3 Treatment 4.2 Discoid Meniscus 4.2.1 Clinical Features 4.2.2 Treatment 5 Tumours 5.1 Popliteal Cyst 5.1.1 Diagnosis 5.1.2 Treatment 5.2 Pigmented Villonodular Synovitis 5.3 Other Tumours 6 Other Disorders 6.1 Tibial Bowing 6.1.1 Posteromedial Bow 6.1.2 Anteromedial Bow 6.1.3 Anterolateral Bow 6.2 Tibial Hemimelia 6.3 Blount’s Disease 6.4 Treatment References Paediatric Foot and Ankle 1 Background 1.1 Growth 1.2 Clinical Assessment 1.3 Flat Feet 1.3.1 Rigid Flat Foot Tight Tendo Achillis or Gastrocnemius Muscles Tarsal Coalition Accessary Navicular Bone 1.4 High Arches 1.5 Toe Walking 1.6 Painful Ankle 1.6.1 Sprained Ankle 1.6.2 Talus Bone Osteochondritis Dissecans 1.6.3 Miscellaneous Causes of Painful Ankle 1.7 Painful Foot 1.7.1 Bunions and Curly Toes 1.7.2 Ingrown Toe Nail 1.7.3 Ganglion 1.8 Foot Disorders in the Newborn 1.8.1 Packaging or Positional Deformities Calcaneovalgus Foot Positional Talipes 1.8.2 Structural (Rigid) Deformities Clubfoot (Congenital Talipes Equino Varus- CTEV) Metatarsus Adductus Congenital Vertical Talus Toe Abnormalities References Paediatric Spine 1 Spinal Deformity 1.1 Scoliosis 1.2 Classification of Scoliosis 1.2.1 Congenital Scoliosis 1.2.2 Idiopathic Scoliosis Infantile Idiopathic Scoliosis (IIS) Juvenile Idiopathic Scoliosis (JIS) Adolescent Idiopathic Scoliosis (AIS) Observation Bracing Surgery 1.3 Neuromuscular Scoliosis 1.4 Syndromic (Dystrophic) Scoliosis 1.5 Miscellaneous Types of Scoliosis 2 Kyphosis 2.1 Congenital Kyphosis 2.2 Developmental Kyphosis 2.3 Neuromuscular Kyphosis 2.4 Syndromic Kyphosis 3 Spondylolysis/Spondylolisthesis 4 Infection References Paediatric Shoulder Disorders 1 Introduction 2 Obstetric Brachial Plexus Injuries 2.1 Background 2.2 Clinical Assessment 2.3 Investigations 2.4 Management 2.4.1 Management in Primary Care 2.4.2 Management in Secondary Care Primary Neurosurgical Reconstruction Secondary Shoulder Reduction and Rebalancing 3 Sprengel Deformity 3.1 Background 3.2 Clinical Assessment 3.3 Investigations 3.4 Management 3.4.1 Management in Primary Care 3.4.2 Management in Secondary Care 4 Congenital Clavicle Pseudoarthrosis 4.1 Background 4.2 Clinical Assessment 4.3 Investigations 4.4 Management 4.4.1 Management in Primary Care 4.4.2 Management in Secondary Care 5 Little Leaguer’s Shoulder 5.1 Background 5.2 Clinical Assessment 5.3 Investigations 5.4 Management References Paediatric Elbow 1 Anatomy of the Paediatric Elbow 2 Traumatic Disorders of the Paediatric Elbow 2.1 Pulled Elbow (Nursemaid’s Elbow) 2.2 Supracondylar Fracture of the Humerus 2.3 Elbow Dislocation 2.4 Lateral Condyle Humeral Fracture 2.5 Medial Epicondyle Fracture 2.6 Radial Neck Fracture 2.7 Olecranon Injury 2.8 Monteggia Lesion 2.8.1 Congenital Elbow Conditions 3 Osteochondrosis and Osteochondritis Dissecans 4 Chronic Paediatric Elbow Conditions 4.1 Ulnar Collateral Ligament (UCL) Injuries 4.2 Medial Epicondyle Apophysis 4.3 Olecranon Impingement Syndrome (Valgus Extension Overload) References Paediatric Hand and Wrist 1 Congenital Hand Deformities 1.1 Polydactyly 1.2 Post Axial Polydactyly 1.3 Central Polydactyly 1.4 Pre-axial Polydactyly 1.5 Syndactyly 1.6 Constriction Ring Syndrome 1.7 Thumb Hypoplasia 1.8 Macrodactyly 1.9 Arthrogryposis 1.10 Transverse Arrest and Phocomelia 1.11 Brachydactyly 1.12 Symbrachydactyly 1.13 Radial Longitudinal Deficiency 1.14 Ulnar Longitudinal Deficiency 1.15 Central Longitudinal Deficiency 1.16 Camptodactyly 1.17 Clinodactyly 1.18 Trigger Thumb 1.19 Congenital Clasped Thumb References