Pediatric Orthopedics and Musculoskeletal Oncology
Concepts
Pediatric orthopedics is organized by age and growth plate. Know Salter–Harris I–V (I through the physis, II above with a Thurston–Holland fragment, III below, IV through both, V crush) and that type V carries the highest growth-arrest risk. Developmental dysplasia of the hip: Ortolani and Barlow in the newborn, limited abduction and Galeazzi later, ultrasound before ossification and radiographs after about 4–6 months. Legg–Calvé–Perthes affects ages 4–8; SCFE affects older, heavier children around 10–14 with a limp and externally rotated leg - the trap is treating hip or knee pain as a muscle strain. Clubfoot is managed with the Ponseti method.
Musculoskeletal oncology: separate benign from malignant by age, location and margins. Osteosarcoma is metaphyseal, in the second decade, with sunburst periosteal reaction and a Codman triangle. Ewing sarcoma is diaphyseal, in younger patients, with onion-skin periosteal reaction and a characteristic translocation. Osteochondroma is a benign metaphyseal lesion with cortical continuity. Red flags are night pain, unintentional weight loss, a deep or growing mass, and pain that wakes the child.
Rule of thumb: a child with hip or knee pain and inability to bear weight gets hip imaging, not just knee imaging.
Worked example: a 12-year-old with months of vague thigh pain, night pain and a sunburst distal femur lesion - osteosarcoma until proven otherwise; refer for staging, not observation.