Pediatrics
Core concepts
Pediatric orthopaedics tests growth, development, and physeal behavior. Master the Salter-Harris classification and its prognosis (type I-IV, with type V being worst). Know developmental dysplasia of the hip (DDH): risk factors, Ortolani/Barlow, ultrasound screening, and treatment by age (Pavlik harness, closed reduction, open reduction, osteotomy). Understand Legg-Calvé-Perthes and slipped capital femoral epiphysis (SCFE), including the stable vs unstable classification and the risk of avascular necrosis. Review scoliosis: idiopathic vs congenital vs neuromuscular, the Cobb angle, and bracing indications. Also know clubfoot (Ponseti method), limb-length discrepancy, and common fractures (supracondylar humerus, both-bone forearm). Recognize the difference between physiologic and pathologic bowing.
Traps
A common trap is missing a SCFE in an obese adolescent with knee pain; the pain may be referred to the knee. Another is assuming all physeal fractures are benign; Salter-Harris type III and IV often need anatomic reduction to prevent growth arrest. Do not forget that DDH screening relies on ultrasound in infants and radiographs in older children.
Rule of thumb
In a child with hip or knee pain and a limp, get a hip film; SCFE and Perthes can present with referred knee pain.
Worked example
A 12-year-old with obesity and a limp, knee pain, and limited internal rotation of the hip: obtain frog-leg and AP pelvis films; treat SCFE with in situ pinning to prevent further slip and AVN.