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Arab Board Orthopedic Surgery Clinical study materials
Arab Board Orthopedic Surgery Clinical study resources

Arab Board Orthopedic Surgery Clinical: Pediatric Orthopedics

Arab Board Orthopedic Surgery Clinical · Work through your exam, one topic at a time.

All guide sections

Pediatric Orthopedics

Principles of Pediatric Orthopedics

Candidates must understand growth and development, physeal injuries (Salter-Harris classification), congenital anomalies, developmental dysplasia of the hip (DDH), limb length discrepancy, and pediatric fractures (plastic deformation, greenstick, torus). Know age-specific conditions (e.g., Legg-Calvé-Perthes, slipped capital femoral epiphysis (SCFE), Osgood-Schlatter).

Key Concepts

  • Salter-Harris classification: I (through physis), II (through physis and metaphysis), III (through physis and epiphysis), IV (through metaphysis, physis, epiphysis), V (crush injury). Types III and IV are intra-articular and require anatomic reduction.
  • DDH: Risk factors (breech, female, firstborn). Screening: Ortolani and Barlow tests in neonates; ultrasound for high risk. Treatment: Pavlik harness for <6 months; closed reduction and spica cast for older; surgery for failed closed treatment.
  • SCFE: Obese adolescent, hip/knee pain, limited internal rotation. Radiographs: frog-leg lateral shows slip. Treatment: in situ screw fixation; avoid reduction to prevent AVN.
  • Legg-Calvé-Perthes: Idiopathic AVN of femoral head, ages 4-8, more common in boys. Treatment: containment (brace, osteotomy) for severe cases.
  • Pediatric fractures: Remodeling potential high in young children; accept angulation within limits. Supracondylar humerus fracture: Gartland classification; type III requires pinning.

Traps

  • SCFE: Must rule out bilateral involvement (20-40% have bilateral). Delay in treatment increases risk of AVN.
  • Salter-Harris: Type V may be missed initially; high index of suspicion.
  • DDH: Ortolani and Barlow tests may become negative after 3 months; ultrasound is best before ossification.
  • Supracondylar fracture: Assess for compartment syndrome and nerve injury (anterior interosseous nerve most common).

Worked Example

A 12-year-old obese boy presents with limping and vague knee pain. Exam shows limited internal rotation of the hip. Radiographs show a slipped capital femoral epiphysis. Rule of thumb: SCFE is a surgical emergency; perform in situ screw fixation. Do not attempt forceful reduction; risk of avascular necrosis. Also, counsel on weight reduction and screen contralateral hip.