Pediatric and Adolescent Orthopaedic Care
Growth plate injuries
Salter–Harris classification: I slipped (physis only), II above (physis plus metaphyseal fragment, most common), III lower (physis plus epiphysis), IV through (metaphysis, physis, epiphysis), V crush (often radiographically silent). Higher grades carry greater growth-arrest risk. The mnemonic SALTR preserves the order.
Pediatric fracture patterns
Children's bone bends and buckles: torus/buckle fractures, greenstick fractures, plastic deformation, and complete fractures all occur. Remodeling is powerful in young children and in the plane of joint motion, so not every pediatric fracture needs adult-style fixation.
Conditions to distinguish
Developmental dysplasia of the hip: Ortolani reduces, Barlow dislocates in the neonate; asymmetric thigh folds and limited abduction; Pavlik harness in infancy. Legg–Calvé–Perthes: avascular necrosis of the femoral head in a young child with a limp. Slipped capital femoral epiphysis: obese adolescent with hip, groin, or knee pain and limited internal rotation - keep non-weight-bearing and pin surgically, never manipulate forcefully. Supracondylar humerus fracture: swelling, refusal to move the arm, high risk of brachial artery and median nerve injury and compartment syndrome.
Abuse and safety
Fractures in non-ambulatory infants, posterior rib fractures, metaphyseal corner fractures, and injuries inconsistent with the stated history or developmental stage require reporting. Document objectively and factually.
Rule of thumb
Knee or thigh pain in a child can be a hip problem - always examine the hip when the knee is symptomatic.