Episode 35: Pediatric Orthopedics Pearls and Pitfalls

Pediatric orthopedic emergencies are explored, emphasizing the importance of recognizing often-missed injuries due to challenges in history-taking, physical exams, and x-ray interpretation. Drs. Pirie and Mehta share insights on approaching pediatric orthopedics, including ACL tears, tibial spine fractures, and knee injuries, highlighting the Ottawa Knee Rules' applicability in children. The discussion covers septic arthritis, transient synovitis, and occult fractures in limping children, stressing the significance of distinguishing between these conditions and avoiding over-investigation. Management strategies for common injuries like distal radius fractures, greenstick fractures, and nursemaid's elbow are reviewed, advocating for removable splints and symptom-guided care.

Outlines

Part 1: Introduction and General Principles

Part 2: Knee Injuries and ACL Assessment

Part 3: The Limping Child and Hip Pathology

Part 4: Occult Fractures and Lower Extremity Issues

Part 5: Ankle and Growth Plate Injuries

Part 6: Upper Extremity and Wrist Fractures

Part 7: Pain Management Strategies

Part 8: Elbow Injuries and Neurological Assessment

Part 9: Specialized Elbow Conditions

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Emergency Medicine Cases

Part 1: Introduction and General Principles

00:01Introduction to Pediatric Orthopedic Emergencies: Common Missed Diagnoses and Management

Introduction to Pediatric Orthopedic Emergencies: Common Missed Diagnoses and Management

Part 2: Knee Injuries and ACL Assessment

02:08ACL Injuries vs. Tibial Spine Fractures: Diagnosing Knee Injuries in Children

ACL Injuries vs. Tibial Spine Fractures: Diagnosing Knee Injuries in Children

04:51Physical Examination Techniques for ACL Tears and Tibial Spine Fractures

Physical Examination Techniques for ACL Tears and Tibial Spine Fractures

08:31Ottawa Knee Rules in Pediatric ACL Tear Assessment and X-Ray Considerations

Ottawa Knee Rules in Pediatric ACL Tear Assessment and X-Ray Considerations

11:25X-Ray Findings, ED Management, and Surgical Considerations for ACL Tears

X-Ray Findings, ED Management, and Surgical Considerations for ACL Tears

15:21Additional X-Ray Views, Patellar Injuries, and Management in the ED

Additional X-Ray Views, Patellar Injuries, and Management in the ED

Part 3: The Limping Child and Hip Pathology

18:52Hip Source Consideration and Introduction to Limping Child Cases

Hip Source Consideration and Introduction to Limping Child Cases

21:36Septic Arthritis vs. Trauma vs. Systemic Illness: Approaching the Limping Child

Septic Arthritis vs. Trauma vs. Systemic Illness: Approaching the Limping Child

25:44History and Physical Exam Pearls for Diagnosing the Cause of a Limp

History and Physical Exam Pearls for Diagnosing the Cause of a Limp

29:37Physical Exam Techniques and Differentiating Septic Arthritis from Synovitis

Physical Exam Techniques and Differentiating Septic Arthritis from Synovitis

33:34Risk and Severity: Determining Pre-Test Probability for Septic Arthritis

Risk and Severity: Determining Pre-Test Probability for Septic Arthritis

36:15Kocher's Criteria and CRP/ESR Utility in Septic Arthritis Diagnosis

Kocher's Criteria and CRP/ESR Utility in Septic Arthritis Diagnosis

42:41Ultrasound's Role and Discharge Instructions for Suspected Transient Synovitis

Ultrasound's Role and Discharge Instructions for Suspected Transient Synovitis

47:00Follow-Up Care, Avascular Necrosis Risk, and Antibiotic Use in Septic Arthritis

Follow-Up Care, Avascular Necrosis Risk, and Antibiotic Use in Septic Arthritis

Part 4: Occult Fractures and Lower Extremity Issues

50:35Occult Fractures: Recognizing and Addressing Missed Diagnoses in Toddlers

Occult Fractures: Recognizing and Addressing Missed Diagnoses in Toddlers

53:54Toddler's Fractures: Diagnosis, Presentation, and Management Strategies

Toddler's Fractures: Diagnosis, Presentation, and Management Strategies

57:33Ultrasound Utility, Parental Communication, and Slipped Capital Femoral Epiphysis

Ultrasound Utility, Parental Communication, and Slipped Capital Femoral Epiphysis

1:01:11Diagnosing Slipped Capital Femoral Epiphysis: Key Features and X-Ray Interpretation

Diagnosing Slipped Capital Femoral Epiphysis: Key Features and X-Ray Interpretation

1:04:36Non-Accidental Trauma: Recognizing and Addressing Child Maltreatment in Fractures

Non-Accidental Trauma: Recognizing and Addressing Child Maltreatment in Fractures

Part 5: Ankle and Growth Plate Injuries

1:09:15Ottawa Ankle Rules in Children: Applicability and Significance of Salter-Harris Fractures

Ottawa Ankle Rules in Children: Applicability and Significance of Salter-Harris Fractures

1:12:46Salter-Harris Fractures: Significance and Reclassification as Sprains

Salter-Harris Fractures: Significance and Reclassification as Sprains

1:17:07Clinical Outcomes and Management of Salter-Harris I and II Fractures

Clinical Outcomes and Management of Salter-Harris I and II Fractures

1:22:23Anterior Ankle Pain and the Importance of Examining the Joint Line

Anterior Ankle Pain and the Importance of Examining the Joint Line

1:25:21Tillaux and Triplane Fractures: Age-Specific Ankle Injuries and Management

Tillaux and Triplane Fractures: Age-Specific Ankle Injuries and Management

Part 6: Upper Extremity and Wrist Fractures

1:29:52Distal Radius Fractures: Physical Exam and Management of Buckle Fractures

Distal Radius Fractures: Physical Exam and Management of Buckle Fractures

1:33:54Greenstick Fractures: Angulation, Remodeling, and Removable Splints

Greenstick Fractures: Angulation, Remodeling, and Removable Splints

1:37:52Distal Radius Fractures: Acceptable Angulation and Splinting Techniques

Distal Radius Fractures: Acceptable Angulation and Splinting Techniques

Part 7: Pain Management Strategies

1:40:40Pain Management in Pediatric Fractures: ED and Discharge Strategies

Pain Management in Pediatric Fractures: ED and Discharge Strategies

1:44:56Advanced Pain Management and Health Canada Warning on Codeine

Advanced Pain Management and Health Canada Warning on Codeine

Part 8: Elbow Injuries and Neurological Assessment

1:47:07Supracondylar Fractures: Mechanism, Clinical Findings, and Elbow Extension

Supracondylar Fractures: Mechanism, Clinical Findings, and Elbow Extension

1:50:07Pediatric Elbow X-Ray Interpretation: Fat Pads, Lines, and Ossification Centers

Pediatric Elbow X-Ray Interpretation: Fat Pads, Lines, and Ossification Centers

1:53:15Ossification Centers, Keats' Books, and Clinical Examination

Ossification Centers, Keats' Books, and Clinical Examination

1:57:31Neurologic Examination in Pediatric Upper Extremity Injuries

Neurologic Examination in Pediatric Upper Extremity Injuries

2:00:52Sensory and Circulatory Examination in Pediatric Upper Extremity Injuries

Sensory and Circulatory Examination in Pediatric Upper Extremity Injuries

2:04:30Supracondylar Fractures: Immobilization and Orthopedic Consultation

Supracondylar Fractures: Immobilization and Orthopedic Consultation