Pediatric Orthopedics and Congenital/Developmental Disorders
Core principles
- The physis is the weak link in children; Salter–Harris classification predicts prognosis, with type III and IV crossing the physis and risking growth arrest.
- Developmental dysplasia of the hip is screened clinically and by ultrasound in at-risk infants; late diagnosis causes limping and requires reduction.
- Perthes disease causes avascular necrosis of the femoral head; age and lateral pillar involvement guide containment treatment.
- Slipped capital femoral epiphysis presents with hip or knee pain and an inability to internally rotate; urgent fixation prevents progression.
- Clubfoot is treated by the Ponseti method: serial manipulation and casting, often Achilles tenotomy, then bracing.
Worked example
A 12-year-old obese boy limps with knee pain and walks with the leg externally rotated. Reasoning: examine hip rotation, obtain AP and frog lateral pelvis radiographs, and diagnose SCFE. Urgent in situ screw fixation is needed; knee pain is referred, so treating the knee alone is a trap.
Traps
Do not dismiss knee pain without examining the hip. Do not confuse physiologic bowing with pathologic deformity. Do not ignore non-accidental injury patterns.
Key points are listed separately.