Children`s Orthopaedics

General guideline according to age

< 6 months

Palvik harness
Angulation & overlapping will remodel and overgrowth
Rotation will not self correct

< 5 years

Immediate hip spica cast in 90 degrees knee and hip flexion

5 - 10 years

Skin traction followed by hip spica cast

10 - 15 years

Screw & plate or elastic titanium nail

> 15 years

Intramedullary nail ( ILN or K nail )

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Distal humeral physeal separation
In newborn & young children ( around 2-4 years old )
Less common > 6 year old
Need to rule out child abuse in newborn

Clinical
Grossly swollen elbow

Radiology
Distal fragment is posteromedially displaced
Radiocapitullar relationship is maintained

Treatment
Closed reduction and pinning
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Osteonecrosis of femoral head in growing child
Unknown etiology
Males more common (4:1)
Age between 4 - 7 years old
Bilateral in 10 % of cases
Variable outcome
Higher risk in

• Caucasian
• Positive family history
• Coagulopathy / Thrombopilia

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Approach to benign bone tumours

Characteristic

History

Slow growing
Painless / less pain
No constitutional symptoms
Trivial injury prior to pathological fracture
Small swelling

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Due to embryonic failure of segmentation of tarsal bones. Forming connecting bar between tarsal bones commonly calcaneonavicular and talocalcaneum. Less common in talonavicular and calcaneocuboidal. 70 % bilateral in calcaneonavicular and 50 % bilateral in talocalcaneal.

Tarsal coalition can be in form of

• Fibrous bar
• Cartilage bar
• Bone bar

Genetically inherited as autosomal dominant

Associated congenital abnormalities

• Fibular hemimelia

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