Chapter 139 - Pediatric Pelvic and Lower Extremity Fractures

Question 1

Pelvic avulsion sites and their avulsed structures

Answer 1

ASIS: sartoius
AIIS: recuts
Iliac wing: obliques
Ischium: hamstrings
Symphysis: adductors
GT: glute medius
LT: Illiopsoas

Question 2

complications of non-op management of pedi hip fractures

Answer 2

coxa vara
nonunion

Question 3

complication of surgically treated hip fractures in kids

Answer 3

osteonecrosis
related to type of fracture
type I: 90-100%
type II: 50%
type III: 25%
type IV: 10%

Question 4

after closed reduction of a pedi hip dislocation what imaging is indicated?

Answer 4

MRI to eval for chondrolabral separation
(MRI shown to be superior to CT)

Question 5

Indications for spica casting in pedi femur fracture

Answer 5

<6yo
shortening <3cm
+/- polytrauma
single leg spica = both leg spica in terms of fracture outcomes, and single leg has greater parent satisfaction

Question 6

LLD following femur fracture

Answer 6

injured leg actually overgrows 7-10mm in kids age 2-10 at time of injury

Question 7

most common malunion following non-op femur fx

Answer 7

varus and procurvatum

Question 8

flexinails for pedi femurs

Answer 8

age >6, weight <55kg
contraindications
- very proximal
- very distal
- comminuted
- length unstable

Question 9

submuscular bridge plating for femur fractures

Answer 9

comminution
length unstable patterns

complications:
- fracture following hardware removal
- distal femur valgus deformity 2/2 injury to the distal physis (plate should be >20mm from physis)

Question 10

rigid nails for pedi patients

Answer 10

> age 8-10
50kg

can result in narrow neck from disruption of the proximal femur growth plate

must use lateral entry start point (point c on the diagram)

Question 11

distal femur physeal fractures

Answer 11

closed reduction internal fixation preferred if able to get anatomic reduction closed
- avoid the physis with fixation if possible
- if you cant, use smooth pins and remove at 3-4 weeks

** some surgeons advocate for antegrade pins when you have to cross the physis - allows pins to be placed extra-articular and lowers the risk of septic arthritis 2/2 pin tract infection

Question 12

growth arrest following distal femur physeal fx

Answer 12

occurs in 30-50% of fx
angular deformity more common than LLD
the angular deformity occurs OPPOSITE the displaced physeal region
- ie for the below fracture, the most likely angular deformity is valgus

Question 13

what structure is most commonly the issue if you cannot get a tibial eminence fracture to reduce?

Answer 13

anterior horn of the medial meniscus

Question 14

complications of tibial eminence fracture?

Answer 14

ACL laxity - but not of clinical significance
arthrofibrosis is common and early ROM can help prevent it

Question 15

complications of tibial tubercle fractures

Answer 15

recurvatum
rarely compartment syndrome:
- injury to the anterior recurrent tibial artery

Question 16

proximal tibial physeal separation can result in what vascular injury

Answer 16

popliteal artery injury in hyperextension injuries

Question 17

cozen phenomena

Answer 17

valgus tibial malunion following a proximal tibial metaphyseal fracure with an intact fibula
no treatment needed immediately - often has spontaneous resolution

Question 18

how long does fracture healing take in pedi tibia shaft fractures?

Answer 18

3-4 weeks for toddler’s fractures
6-8 weeks for other tibial shaft fractures

Question 19

indications for surgical treatment of tibial shaft fracture

Answer 19

> 10 degrees angulation post reduction
1cm shortening

Question 20

when closed reduction of tibial shaft fracture is lost what is the most common malalignment?

Answer 20

varus if only tibial shaft involved
valgus if both tibia and fibula involved

Question 21

order of closure for the distal tibial physis

Answer 21

• central
• medial
• lateral

this is how transitional ankle injuries happen

Question 22

tillaux fractures

Answer 22

only involved the physis and the epiphysis

occur via supination external rotation

SHIII

Question 23

triplane fractures

Answer 23

involve the epiphysis, the physis, and the. metaphysis and have a posterior malleolar component
SHIII in the sagittal plant
SHII in the coronal plane
physis split in the axial plane

Question 24

treatment of choice for pedi calc fractures

Answer 24

most are non-op

only operative if displaced articular fragment

Question 25

treatment of avulsion fx of navicular, cuneiform, or cuboid

Answer 25

walking cast x 2-3 weeks

Question 26

tx of almost all metatarsal fx

Answer 26

weight bearing in a hard soled shoe

exception is a base of the 5th met at or distal to the articualtion (these need to be non-weightbearing)