Pediatric Orthopedics and Deformity
What this domain tests
Developmental dysplasia of the hip, clubfoot, limb deformity, pediatric fracture patterns, and growth-plate behavior.
Core rules
- DDH: Ortolani and Barlow maneuvers in the neonate, ultrasound using Graf classification before ossification of the femoral head, and plain films afterward. Pavlik harness for infants under about six months; closed reduction and spica casting between six and eighteen months; pelvic and femoral osteotomy for older or failed cases.
- Clubfoot: Ponseti sequential casting, percutaneous Achilles tenotomy in most cases, then boots and bar. Avoid extensive soft-tissue release, which causes stiffness.
- Slipped capital femoral epiphysis: in situ screw fixation without forceful reduction to protect the blood supply. Consider prophylactic fixation of the contralateral hip in very young or endocrinopathic patients.
- Salter-Harris classification runs from I (physis only) to V (crush). Types III and IV cross the physis and need anatomic reduction.
- Supracondylar humerus fractures use Gartland staging; a pulseless but pink hand is treated by reduction and pinning.
Worked example
A 13-year-old obese boy with three weeks of knee pain and an antalgic gait. The knee is normal; hip radiographs show a widened physis and Klein's line fails to intersect the epiphysis. Diagnosis: stable slipped capital femoral epiphysis. Answer: urgent in situ single-screw fixation, restricted weight bearing until comfortable, and counseling about the contralateral hip.
Traps that cost marks
- Examining only the knee in a limping child and missing hip pathology.
- Attempting forceful reduction of a slipped epiphysis and causing avascular necrosis.
- Treating a Salter-Harris IV fracture nonoperatively and producing a physeal bar and angular deformity.