Pediatric and Geriatric Orthopaedic Considerations
Domain 9: Pediatric and Geriatric Orthopaedic Considerations
This domain tests age-specific anatomy, injury patterns, and safe prescribing at both ends of the lifespan.
Core rules
- Pediatric bone: open growth plates, greater remodeling potential, and Salter-Harris classification (I-V). Physeal injuries need careful reduction and follow-up because of growth arrest risk.
- Buckle (torus) fractures are stable and usually need a removable splint, not a long cast.
- Supracondylar humerus fractures: assess for neurovascular compromise; a pulseless white hand is an emergency.
- Child abuse red flags: injury inconsistent with development, delay in care, multiple fractures at different ages, and unexplained bruising.
- Geriatric fragility fractures: osteoporosis workup, fall risk, and early surgery for hip fracture when feasible, often within 48 hours.
- Polypharmacy, delirium, dehydration, and pressure injuries complicate geriatric recovery. Review medications and mobilize early.
Worked example
A 6-year-old falls and has a mildly tender distal radius with a buckle fracture on radiograph. Treat with a removable splint and analgesia, and explain that routine cast immobilization is unnecessary. This avoids stiffness and school disruption.
Traps
Missing a physeal injury by calling it a sprain; over-immobilizing a buckle fracture; and attributing an older adult's acute confusion to dementia instead of delirium.