Pediatric Orthopedics
What you must understand
Know normal growth and development, physeal anatomy (Salter–Harris classification), and common pediatric conditions: developmental dysplasia of the hip (DDH), Legg–Calvé–Perthes, slipped capital femoral epiphysis (SCFE), clubfoot, scoliosis, and limb-length discrepancy. Understand the differences between pediatric and adult bone - more elasticity, thicker periosteum, remodeling potential, and open physes. Be fluent in osteomyelitis and septic arthritis in children, and in non-accidental trauma patterns.
Traps in questions
- SCFE presents with hip or knee pain and limited internal rotation in an obese adolescent; urgent fixation prevents avascular necrosis.
- DDH screening: Ortolani (reduces dislocated hip) and Barlow (dislocates reducible hip); ultrasound for infants under 6 months, radiographs after.
- Salter–Harris types I–V: I through physis, II through physis and metaphysis (most common), III through physis and epiphysis, IV through both, V crush.
- Clubfoot (talipes equinovarus) is treated with the Ponseti method - serial casting, often Achilles tenotomy.
- A limp in a child with fever is septic arthritis until proven otherwise - urgent aspiration and drainage.
Worked example
A 12-year-old with knee pain and inability to bear weight: examine the hip. Limited internal rotation and obligate external rotation suggest SCFE - obtain frog-leg lateral radiographs and fix urgently.
Exam strategy
Always consider age-specific differentials and remember that pediatric conditions may present with referred pain.