Achondroplasia
Achondroplasia is the most common form of skeletal dysplasia, with a prevalence of approximately 1 in 40,000 persons. Although it is transmitted as an autosomal dominant condition, at least 80% of patients with…
Orthopaedics
Paediatric orthopaedics
Paediatric orthopaedics resources from the Orthopaedics Hyperguide.
79 resourcesAlphabetical A–Z
Anatomy of Child's Lower Extremity
The hip is the most structurally stable joint in the body. Acetabular stability is enhanced by three thickenings in the hip capsule, the iliofemoral, ischial-femoral and pubo-femoral ligaments. The iliofemoral ligament…
Ankylosing Spondylitis
Ankylosing spondylitis (AS) is a painful and progressive arthritis of the sacroiliac joints and spine that typically presents in patients between 20 and 40 years of age.1,2 The disease is an enthesopathy. The enthesis…
Arthrogryposis Multiplex Congenita
Arthrogryposis multiplex congenita is a nonprogressive disease that consists of two or more different joint contractures present at birth. There are more than 150 different conditions that are classified under the term…
Atlanto-Axial Instability
Non-traumatic subluxation at the C1-C2 junction is rare, but most commonly seen in children with Down syndrome, skeletal dysplasia, or after a pharyngeal inflammation. It has been reported that as many as 20% of trisomy…
Atlanto-Axial Instability
Anterior knee pain can result from many pathological conditions involving not only the knee, but also the hip. Most are related to overuse injuries. The exception is referred pain from a condition like Legg-Calv-Perthes…
Atlantoaxial Rotatory Displacement
In 1930, Grisel described a syndrome in which rotatory displacement of C1 on C2 resulted from inflammation of adjacent neck tissues after acute upper respiratory infection. He proposed that lymphatic and venous…
Blount Disease
Bowing of the lower extremities is a normal stage in the musculoskeletal development of infants. Physiologic bowing may occur in infants <2 years of age. As a result of growth, bowing naturally decreases when children…
Bone Tumors
Bone and soft tissue tumors are uncommon in the general population and are even more uncommon in the upper extremity in children. Although not often seen, it is helpful for the practicing orthopedic surgeon to have a…
Cavus Foot
Cavus foot presents as a neuromuscular disorder in 2/3 of patients; 1/2 have Charcot-Marie-Tooth-Disease.
Cervical Kyphosis in Children
Cervical alignment varies with positioning of the patient. This is especially important in young children. The head has been shown to be disproportionately large in children, so if they are placed supine, the neck will…
Charcot-Marie-Tooth Disease
The diagnosis of CMT is made by physical exam, family history, and ancillary tests. The tests include electromyography (EMG), nerve conduction velocity (NCV), and muscle and peripheral nerve biopsy. The patient may…
Closed Reduction with Percutaneous Stabilization of Supracondylar Humerus Fractures in Children
Supracondylar humeral fractures are among the most frequent skeletal injuries in children. Treatment is often challenging, particularly with completely displaced fractures. Surgeons must be aware of anatomical…
Clubfoot
Clubfoot is a common and controversial foot deformity. Clubfoot is classified as congenital depending upon neuromuscular aspects, hereditary factors and arrested fetal development. Teratologic classification is the…
Congenital Kyphosis
Congenital Kyphosis (CK) is uncommon. It is frequently severe and can produce deformity, reduced pulmonary function and paraplegia. Unfortunately, few physicians are aware of its devastating potential. Early treatment…
Congenital Pseudarthrosis of the Clavicle
Congenital pseudarthrosis of the clavicle is a rare condition in which part of the middle portion of the clavicle has a discontinuity. Signs or symptoms of fracture are absent.1 The pseudarthrosis is typically on the…
Congenital synotosis
Congenital synostosis of the proximal radius and ulna represents a failure of longitudinal segmentation during intrauterine development. Present at birth, the deformity becomes obvious in early adolescence as the…
Coxa Vara
Developmental coxa vara is characterized by an ossification defect in the inferior portion of the femoral neck adjacent to the subcapital growth plate. There is an associated decrease in the angle between the…
Developmental Dysplasia of the Hip
As a generic term, developmental dysplasia of the hip (DDH) includes varying degrees of subluxation and dislocation. Acetabular dysplasia indicates a shallow socket that tends to have a more vertical orientation than…
Diastrophic Dysplasia
Diastrophic dysplasia has more numerous and severe skeletal abnormalities than other dysplasias. The word diastrophic comes from Greek and means distorted, which aptly describes the ears, spine, joints, and feet of…
Ehlers-Danlos Syndrome
Ehlers-Danlos syndrome (EDS) is a family of disorders caused by a variety of defects in collagen metabolism (Slide 1). The cardinal feature, common through all subtypes of this syndrome, is hyperelasticity of the skin.…
Elastic Stable Intramedullary Fixation in Femur and Tibia Fractures in Adolescents
Diaphysis fractures of the femur and tibia constitute approximately 18% of all fractures in adolescents. These fractures result from high-energy injuries - the most common are motor vehicle accidents (transport-related…
Elbow
Introduction The elbow is made up of three articulations in one common synovial cavity: the ulnohumeral (ulnotrochlear) joint, the radiohumeral (radiocapitellar) joint and the proximal radioulnar joint. The ulnohumeral…
Elbow Dislocations
Elbow dislocations occur most commonly in children >6 years of age. They are not nearly as common in children as supracondylar fractures of the humerus, which occur by the same mechanism: hyperextension of the elbow…
Elbow Septic Arthritis
Infections of the upper extremity are common in children (Slide 10). These problems are challenging to diagnose. The history is often unreliable and physical examination is sometimes difficult to interpret, especially…
Fibular Hemimelia
Congenital absence of the fibula is the most common deficiency of long bones; it is often sporadic and can be described as complete or incomplete. The condition is referred to as a terminal deficiency if the foot is…
Flatfoot
Flatfoot, or calcaneovalgus deformity, is the most common neonatal foot deformity. The foot is positional and flexible, but has limited plantarflexion secondary to contracted dorsiflexors. Most treatments for flatfoot…
Forearm
Anatomy and Biomechanics The radial head articulates with the capitellum. Both surfaces are covered by articular cartilage, but the diameter of the radial head is always greater than that of the capitellum. The radial…
Fractures of the Proximal Humerus
Injuries to the upper end of the humerus usually heal and remodel well with observation because of the great amount of growth and remodeling potential. Deformity in this region is much less evident or functionally…
Fractures of the Proximal Radius
The proximal radial epiphysis is the second ossification center to appear about the elbow. It ossifies as a small wafer-like structure beginning at approximately 4 years of age. Normally, the articular surface of the…
Gene Therapy in Orthopedics
Gene therapy involves the transfer of genes to individuals for therapeutic purposes. Apart from the use of gene therapy in genetic diseases to compensate for abnormal or deficient gene products, it may also be used to…
Hallux Valgus
A study of juvenile hallux valgus¹ found the foot deformity of 9 out of 10 females (average age 11.8 years; 40% < 10 years old). Maternal transmission was noted in 75% of the cases. One-half of the population had an…
Hand
A mechanism contributing to the growth and development of the hand is that pluripotent mesenchymal cells differentiate. The cell population size increases by mitosis and the intracellular structural protein is…
Hand Infections
Animal bites are one of the most common sources of infection in the child's hand. These wounds are treated by a combination of antibiotic therapy, irrigation, debridement and open-wound management. Pasteurella multocida…
Herniated Disks in the Pediatric Population
In contrast to the adult population, lumbar intervertebral disk herniation is a relatively rare cause of low-back complaints in the pediatric population. Twelve years after Mixter and Barr in 1934 showed that herniated…
Homocystinuria
Homocystinuria is an inborn error of metabolism in which the enzyme cystathionine -synthase is deficient.1,2 As in the majority of enzyme deficiencies, homocystinuria is an autosomal recessive disorder because even half…
Idiopathic Scoliosis
Scoliosis is defined empirically as a lateral trunk rotation of over 10°, and has a prevalence of 2% to 3%. The incidence of idiopathic scoliosis associated with using a Cobb angle of 20° or greater is 0.3%. There is an…
Juvenile Rheumatoid Arthritis
Juvenile rheumatoid arthritis (JRA) is a disease of variable onset and course. The primary diagnostic criterion is swelling in one or more joints that persists for at least 6 weeks. Based upon the manifestations of the…
Juvenile Rheumatoid Arthritis & The Cervical Spine
In the United States the reported incidence of juvenile rheumatoid arthritis (JRA) ranges from 9.2 to 13.9 per 100,000 people.¹ A more recent follow-up study by Peterson et al.² examined medical records of 1240…
Klippel-Feil Syndrome
Also known as congenital cervical synostosis, Klippel-Feil syndrome is a rare syndrome characterized by cervical fusion and multiple congenital malformations. One of the major clinically apparent deformities of this…
Lateral Humeral Condyle Fractures
Lateral condyle fractures are some of the more problematic fractures seen in children. This may be because the lateral condyle is mostly cartilaginous and the innocuous initial appearance of the injury may lead to late…
Legg-Calvé-Perthes Disease
Legg-Calvé-Perthes disease begins with idiopathic ischemia of part or all of the femoral capital epiphysis. Osteonecrosis leads to multiple overriding fractures of trabeculae within the epiphysis and coxa plana.…
Little League Elbow
Anatomy and Biomechanics Repetitive forces applied to the growing elbow may adversely affect the normal development of the elbow joint at multiple sites medially, laterally or posteriorly. The primary factor in the…
Lyme Disease
Lyme disease is a tick-borne spirochetal infection that is most prevalent in the northeastern part of the United States, as well as Wisconsin and California. It is caused by the spirochete Borrelia burgdorferi. The…
Madelung Deformity of the Forearm
Tutorial Madelung deformity is a skeletal abnormality of the forearm and wrist characterized by prominence of the distal ulna, shortening and lateral bowing of the forearm, and volar and ulnar tilt of the wrist and…
Marfan Syndrome
Marfan syndrome is a well-defined clinical disorder with extensive phenotypic variability. Marfan syndrome affects approximately 1 in 5,000-10,000 persons. In addition, many persons show some of the manifestations of…
Medial Epicondyle Fractures
Introduction The medial epicondyle is the last secondary ossification center to fuse with the distal humerus. This fusion occurs at approximately 15 years of age.1 The epicondyle is posteromedially placed on the distal…
Metatarsus Adductus
Metatarsus adductus is a forefoot adduction with a normal mid and hindfoot. It occurs in 1 in every 1000 live births and is bilateral in 50% of the cases. There is a low incidence of hip dysplasia associated with…
Monteggia Fracture-Dislocations
The Monteggia fracture-dislocation is a great "fooler" in orthopedic surgery. A Monteggia fracture consists of a radial head dislocation in conjunction with an ulnar fracture. The radial head dislocates in the direction…
Neurofibromatosis
Neurofibromatosis exists in two forms that are both characterized by disordered growth of nervous tissue. The central form, NF2, is transmitted autosomal dominantly from defects on chromosome 22 and occurs in…
Olecranon Fractures in Children
Introduction Fractures of the olecranon process are uncommon in children. When they do occur, it is usually the result of a fall. Olecranon fractures occur at a slightly older age than supracondylar fractures (9 years)…
Osteochondritis Dissecans
Osteochondritis dissecans (OCD), first described by Konig1 in 1988, is an avascular necrosis involving a bone at the osteochondral junction in the epiphysis. The subchondral bone becomes avascular. The overlying…
Osteogenesis Imperfecta
Osteogenesis imperfecta (OI) is a disorder of type I collagen, a structural protein that comprises bones, dentin, cornea, sclera, dermis, tendons, fascia, meninges, and organ capsules. Manifestations depend on the…
Osteomyelitis
Hematogenous bacterial osteomyelitis occurs in the metaphysis of the long bones. The humerus is most commonly involved in the upper extremity. Bacterial precipitation in the metaphysis leads to septic infarction of bone…
Pediatric Analgesia and Conscious Sedation
Conscious sedation is a controlled lessening of a patient's awareness of the environment and pain perception while maintaining stable vital signs, an independent airway, and adequate spontaneous respirations. With…
Physeal Fractures of the Distal Humerus
Distal humeral physeal fractures are most common when the epiphysis is largely cartilaginous. Therefore they occur most often in the very young child but may be seen in children up to 6 years of age. Physeal fractures…
Physeal Injuries and Growth Arrest
Fractures involving the physes are common in the pediatric population. Most of these injuries can adequately be treated with closed reduction and immobilization. Some, however, require operative management to limit the…
Proximal Femoral Focal Deficiency
Proximal femoral focal deficiency (PFFD) is a congenital absence of the proximal femur. The absence of the proximal femur is evident both clinically and radiographically. The cause of the deficiency in the majority of…
Radiography of the Elbow in Children
A proper diagnosis is essential to deliver precise treatment to children with elbow injuries. The distal humerus is largely cartilaginous in the first 2 years of life, but ossification centers appear thereafter in a…
Rheumatic Fever
Acute rheumatic fever is an autoimmune process that occurs a few weeks following streptococcal pharyngitis. It complicates approximately 1%-5% of streptococcal throat infections, and it rarely occurs after skin…
Scheuermann Kyphosis
Estimates of the incidence of Scheuermann disease in the general population range from 0.5% to nearly 10%, and are dependent on the diagnostic criterion used. Most studies have reported a higher incidence in males and a…
Septic Arthritis
Hematogenous bacterial infection of the hip joint in children is an emergency because proteolytic enzymes in the purulent exudate will destroy articular cartilage if appropriate treatment is delayed. Timely diagnosis by…
Shoulder
Anatomy and Biomechanics Development The shoulder joint forms as a single cartilaginous anlage at 5 weeks gestation. Between 6 and 7 weeks of gestation, a cleft forms in the anlage creating the glenohumeral joint. The…
Slipped Upper Femoral Epiphysis
Slipped upper femoral epiphysis (SUFE) is the posterior displacement of the femoral capital epiphysis on the femoral neck through sudden or gradual deformation of the subcapital growth plate. Body habitus and structural…
Soccer-Related Injuries in Adolescents
Generally, adolescent soccer is considered to be less injury-intensive than other sports. In fact, it is a relatively safe sport.1 In this sense, damage to the locomotor system is not necessarily expected as a result of…
Soft Tissue Tumors
Lipomas are the most common benign soft tissue tumor, but are rare during the first two decades of life. Lipomas frequently occur around the shoulder area and usually present as an asymptomatic, slowly growing mass.…
Spina Bifida
Spina bifida is a defect in neural tube formation and closure that occurs for unknown reasons. Supplementation of dietary folate at the time of conception has been strongly linked to a decreased incidence of…
Spondyloepiphyseal Dysplasia
Spondyloepiphyseal dysplasia congenita has a prevalence of approximately 3 to 4 per 1 million. Its central features include significant spinal and epiphyseal involvement without metaphyseal enlargement. Although…
Spondylolysis and Spondylolisthesis
Spondylolysis refers to a defect of the pars interarticularis of the lumbar vertebrae. It is usually bilateral, although unilateral cases occur in 20% of cases. Separation of a spondylolysis leads to subluxation of the…
Sprengel’s Deformity
The scapula develops as a mesenchymal condensation at the level of the fourth cervical somite and migrates to the upper thoracic spine by the 12th fetal week. The failure of normal caudal migration of the scapula…
Stickler Syndrome
Stickler syndrome was first described by Gunnar Stickler and colleagues at the Mayo Clinic in 1965.1 They reported a unique autosomal dominant condition in a family with midface hypoplasia, hearing loss, retinal…
Supracondylar Humerus Fractures
Fractures of the supracondylar portion of the distal humerus are among the most common elbow injuries seen in children. The fractures mainly occur within the first decade of life, have a peak incidence in children 5 to…
T-condylar Fractures of the Distal Humerus
As children pass the typical age for supracondylar fracture of the elbow, which is the first decade of life, fractures of the elbow become less common. T- or Y-condylar fractures of the distal humerus are the most…
Tarsal Coalition
Tarsal coalition presents as painful hindfoot, with limited motion, usually in valgus position, and often with protective peroneal spasm. Differential diagnosis includes: tarsal coalition, inflammation (osteochondroses,…
The Child's Foot
In the early walking phase of normal gait development, the child has a wide base with flexion at the hips and knees. Children in this stage are flatfooted and walk with a drop foot gait in short stride lengths. .
The Use Of Homogenic Bone Graft in the Treatment Of Neurogenic Valgus Feet with Combined Grice and Evans Procedures
Performing subtalar arthrodeses was advocated primarily for treating foot deformities and secondarily for treating injuries and paralysis (poliomyelitis). In 1943, Leavitt performed subtalar arthrodeses on patients with…
Thoracic Diskitis
Spine infections are usually a result of a hematogenous spread from other body sources. Diskitis is most common among children 1 to 9 years of age. Due to the widespread, early use of antibiotics, fulminant…
Tibial Hemimelia
For partial TH, such as type 2, it may be possible to fuse the proximal tibia and fibula and perform a Syme's amputation for an unstable foot and ankle.
Transient Synovitis of the Hip
Temporary hip joint distension with attendant pain, limp, and limitation of motion characterize transient synovitis of the hip in children. Other, more serious conditions with similar presentation need to be ruled out:…
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