Tachdjian’s Pediatric Orthopaedics

Title Volume One
Title Volume Two
Copyright
Contributors
Preface
Section I: Disciplines
Chapter 1: Growth and Development
Normal Growth and Development
Disorders of Normal Growth and Development
Malformations
Deformations
Disruptions
Dysplasias
Evolution of Proportionate Body Size
Physical Growth
Head Circumference
Height and Weight
Epiphyseal Growth and Closure
Tanner Stages of Development
Developmental Milestones
Gross Motor Skills
Fine Motor Skills
Personal, Social, and Verbal Skills
References
Chapter 2: The Orthopaedic History
Chief Complaint
History of Present Illness
Family History
Birth History
Prenatal History
Natal History
Neonatal History
Growth and Development: Key Questions
Chapter 3: The Orthopaedic Examination: A Comprehensive Overview
Recognizing Deformities
Angular Deformity
Range of Motion
The Shoulder
The Elbow
The Forearm
The Cervical Spine
Motion of the Spine
The Hip
Trendelenburg Test
The Knee
The Ankle
The Foot
Muscle Strength
Neurologic Assessment
Developmental Reflexes
The Moro Reflex
Palmar (Hand) Grasp Reflex
Tonic Neck Reflexes
Neck-Righting Reflex
References
Chapter 4: The Orthopaedic Examination: Clinical Application
Screening Examinations
Hip Examination
Other Newborn Screening Examinations
Scoliosis Examination
General Childhood Screening Examination
The Focused Examination
Intoeing
Flatfoot
Leg Length Discrepancy
Spinal Deformity
The Art of Examining the Pediatric Patient
References
Chapter 5: Gait Analysis
Phases of Gait
Stance Phase
Swing Phase
Time Spent in Each Phase
Temporal (Cadence) Parameters
Neurologic Control of Gait
Function of Gait
Gait Energy
Kinematics
Sagittal Plane
Coronal Plane
Transverse Plane
Muscle Activity
Types of Muscle Contraction
Concentric Contractions
Eccentric Contractions
Muscle Activity During Stance and Swing Phases
Kinetics
Pedobarography
Pathologic Gait
Gait Analysis Laboratories
References
Chapter 6: The Limping Child
Abnormal Gait Patterns in Children
Antalgic Gait
Trendelenburg Gait
Proximal Muscle Weakness Gait
Spastic Gait
Short-Limb
Special Considerations Based on Age Group
Toddler (Ages 1 to 3 Years)
Child (Ages 4 to 10 Years)
Adolescent (Ages 11 to 15 Years)
References
Chapter 7: Back Pain
History
Nature of the Pain
Constitutional Symptoms
Aggravating and Alleviating Factors
Age-Related Conditions
Assessment of General Symptoms
Physical Examination
General Inspection
Assessment of the Spine
Neurologic Assessment
General Physical Assessment
Diagnostic Studies
Radiography
Bone Scan
Computed Tomography
Single-Photon Emission Computed Tomography
Magnetic Resonance Imaging
Laboratory Tests
Differential Diagnosis
Mechanical Disorders
Disk Herniation
Apophyseal Ring Fracture/Slipped Vertebral Apophysis
Spinal Fracture
Developmental Disorders
Spondylolysis and Spondylolisthesis
Scheuermann Kyphosis
Lumbar Scheuermann Disease
Idiopathic Scoliosis
Syringomyelia
Tethered Spinal Cord
Idiopathic Juvenile Osteoporosis
Infectious and Inflammatory Conditions
Infectious Spondylitis
Ankylosing Spondylitis
Juvenile Rheumatoid Arthritis
Neoplasms
Osteoid Osteoma
Osteoblastoma
Eosinophilic Granuloma (Histiocytosis X)
Aneurysmal Bone Cysts
Malignancies
Acute Lymphocytic Leukemia
Spinal Tumors
Spinal Metastases
Spinal Cord Tumors
Malignant Neurofibrosarcoma
Intraabdominal and Intrathoracic Causes of Back Pain
Nonspecific Back Pain and Psychosomatic Back Pain (Conversion Reaction)
References
Section II: Anatomic Disorders
Chapter 8: Disorders of the Neck
Overview
Developmental Anatomy
Atlas
Axis
Subaxial Cervical Spine
Unique Characteristics
Cervical Deformity: Torticollis
Deformity Without Pain—Congenital Torticollis
Congenital Muscular Torticollis
Treatment
Nonsurgical
Surgical
Congenital Osseous Torticollis/Klippel­Feil Syndrome
Clinical Features
Radiographic Findings
Treatment
Halo Fixation
Surgical Treatment
Indications
Techniques for Occipitocervical Fusion
Techniques for Atlantoaxial Fusion
Deformity With Pain
Acquired Torticollis
Atlantoaxial Rotatory Displacement
Radiographic Finding
Treatment
Neurogenic Torticollis
Inflammatory and Septic Causes
Pharyngeal or Lymphatic Abscess
Vertebral Osteomyelitis and Diskitis
Tumor-Like Conditions
Intervertebral Disk Calcification
Juvenile Arthritis
Sandifer Syndrome
Ocular Torticollis (Lateral Gaze Palsy)
Cervical Deformity: Kyphosis
Congenital or Developmental Kyphosis
Clinical Features
Radiographic Findings
Treatment
Orthotic Management
Surgical Stabilization: Posterior Versus Anterior Cervical Fusion
Acquired Postlaminectomy Kyphosis
Treatment
Cervical Hyperlordosis
Cervical Instability
Os Odontoideum
Down Syndrome
Atlantooccipital Anomalies
Odontoid Anomalies and Ligamentous Instability in Skeletal Dysplasia
Nontraumatic Atlantooccipital Instability
Subaxial Instability
References
Chapter 9: Scoliosis
Definition
Classification of Scoliotic Curves
Idiopathic Scoliosis
Adolescent Idiopathic Scoliosis
Prevalence
Natural History
Natural History Before Skeletal Maturity
Gender
Remaining Growth
Curve Magnitude
Prognostic Testing
Natural History After Skeletal Maturity
Scoliosis Screening
Screening Programs
Screening Methods
Etiology
Neurologic Dysfunction
Connective Tissue Abnormalities
Genetic Factors
Pathophysiology
Clinical Features
Initial Signs and Symptoms
Physical Examination
Neurologic Examination
Patient Maturity
Radiographic Findings
Plain Radiography
Measurement of Curve Magnitude
Measurement of Vertebral Rotation
Measurement of Spinal Balance
Measurement of Kyphosis and Lordosis on Lateral Radiographs
Surface Imaging
Magnetic Resonance Imaging
Computed Tomography
Treatment
Observation
Nonsurgical Treatment
Orthotic (Brace) Treatment
Indications for Brace Treatment
Contraindications to Brace Treatment
Comparison of Orthoses
Boston Brace
Wilmington Brace
Providence Brace
Charleston Brace
Spine-Cor Brace
Milwaukee Brace
Brace Treatment Protocols
Electrical Stimulation
Physical Therapy and Biofeedback
Surgical Treatment
Indications for Surgery
Preoperative Planning
Curve Patterns
Lenke Classification System
Construct Selection
Preoperative Curve Flexibility
Neurologic Status
Rib Deformities
Future Growth Potential
Transfusion Requirements
Bone Grafting
Spinal Cord Monitoring
Postoperative Pain Management
Antibiotic Prophylaxis for Dental Procedures
Posterior Spinal Instrumentation
Development of Instrumentation for Scoliosis Surgery
Multiple-Hook Segmental Instrumentation
Pedicle Screws
Freehand Technique
Image-Guided Techniques
Other Methods of Assessing Screw Placement
Clinical Outcome
Posterior Mobilization Techniques
Anterior Mobilization Techniques
Correction Techniques
Complications of Posterior Instrumentation and Fusion for Adolescent Idiopathic Scoliosis
Anterior Spinal Instrumentation
Anterior Approach to Thoracolumbar and Lumbar Curves
Solid-Rod Anterior Instrumentation
Anterior Instrumentation for Thoracic Deformity
Juvenile Idiopathic Scoliosis
Predicting Curve Progression
Neural Axis Abnormalities
Congenital Spinal Deformities
Etiology
Associated Abnormalities
Congenital Scoliosis
Classification
Defects of Formation
Defects of Segmentation
Natural History
Radiographic Findings
Nonoperative Treatment
Operative Treatment
Anterior and Posterior Fusion
Posterior Spinal Fusion
Hemivertebra Excision
Osteotomy of the Spine
Congenital Kyphosis
Classification
Defects of Formation (Type I)
Defects of Segmentation (Type II)
Natural History
Clinical Features
Radiographic Findings
Treatment
Type I Kyphosis
Type II Kyphosis
Type III Kyphosis
Segmental Spinal Dysgenesis, Congenital Vertebral Displacement, and Congenital Dislocation of the Spine
Early-Onset Scoliosis
Effect on Respiratory Function
Intrinsic Alveolar Hypoplasia
Extrinsic Disturbance of Chest Wall Function
Treatment
Nonoperative Delaying Tactics
Bracing
Casting
Traction
Operative Treatment
Instrumentation Without Fusion (Traditional Growing Rods, TGR)
Instrumentation Without Fusion: Current Technique, “Final” Fusion
Outcome—Traditional Growing Rods
Magnetic Controlled Growing Rod
Results—Magnetic Controlled Growing Rods
Hybrid Technique
Expansion Thoracoplasty With VEPTR
Growth Guidance Constructs
Summary
Other Causes of Scoliosis
Neurofibromatosis
Nondystrophic Scoliosis
Dystrophic Scoliosis
Marfan Syndrome
Congenital Heart Disease
Thoracotomy
Laminectomy
Irradiation
Hysterical Scoliosis
References
Chapter 10: Kyphosis
Posture
Causes of Hyperkyphosis
Postural Kyphosis
Scheuermann Kyphosis
Clinical Features
Radiographic Findings
Radiographic Findings for Lumbar Scheuermann Disease
Nonoperative Treatment
Indications
Brace Therapy
Operative Treatment
Determining Fusion Levels
Posterior Instrumentation and Fusion
Summary
Progressive Noninfectious Anterior Fusion
Postlaminectomy or PostirradiationKyphosis
Postlaminectomy Kyphosis
Postirradiation Kyphosis
Treatment
Prevention
Prophylactic Treatment
Prophylactic Surgical Treatment
Prophylactic Nonsurgical Treatment
Surgical Treatment
Miscellaneous Causes of Kyphosis
Achondroplasia
Pseudoachondroplasia
Spondyloepiphyseal Dysplasia/Mucopolysaccharidosis
Marfan Syndrome
References
Chapter 11: Other Anatomic Disorders of the Spine
Spondylolisthesis
Classification
Pathoanatomy
Dysplastic Spondylolisthesis (Wiltse Type I)
Isthmic Spondylolisthesis (Wiltse Type II)
Other Types of Spondylolisthesis
Clinical Features
Radiographic Findings
Prognosis and Natural History
Treatment
Spondylolysis
Asymptomatic Spondylolysis
Symptomatic Spondylolysis
Direct Repair
Low-Grade Spondylolisthesis
Isthmic (Acquired) Spondylolisthesis
Dysplastic Spondylolisthesis
Technique of In Situ Fusion
High-Grade Spondylolisthesis
Surgical Methods: High-Grade Spondylolisthesis
In Situ Fusion Versus Reduction
Alternative Instrumented Reduction Techniques
Lumbar Disk Herniation
Incidence
Causes
Clinical Features
Radiographic Findings
Treatment
Slipped Vertebral Apophysis
Clinical Features
Radiographic Findings
Treatment
Transitional Vertebra (Bertolotti) Syndrome
References
Chapter 12: Disorders of the Upper Extremity
Introduction
Embryology
History and Examination
Pertinent History
Physical Examination
Timing of Surgical Procedures
The Parent
Denial
Anger
Distress
The Child’s Maturity
The Surgeon
The Hand
The Anesthesiologist
Suggested Surgical Milestones
Principles of Dressings and Splinting
Dressings
Wound Closure
Primary Dressing
Gentle Compression Components
Padding and Skin Protection
Rigid Outer Shell
Hand Therapy
Activities of Daily Living
Splinting
Materials
Securing Splints
Children Not Suitable for Splinting
Static Splinting
Dynamic Splinting
Serial Casting or Serial Static Splinting
Static-Progressive Splinting
Custom Splints
Prefabricated Splints
Combination Custom/Prefabricated Splints
Specific Splints for Specific Joints
Fingers
Thumbs
Wrist
Forearm
Elbow
Writing a Prescription for Hand Therapists
Scar Management
Principles of Acute Care
General Principles
Tendon Injury
Nerve Injury
Skin Injury
Bone Injury
Vascular Injury
Principles of Reconstruction
Architecture and Hand Physiology
Nerve Function: Sensibility and Power
Architecture of the Hand
Planning Reconstruction
Evaluation of the Child for Reconstruction
Congenital Anomalies
Classification
Diagnosing Associated Anomalies
Radial Longitudinal Deficiency
Prevalence and Epidemiology
Etiology
Clinical Features
Prevalence
Laterality
Upper Limb
Associated Anomalies
Holt-Oram Syndrome
Fanconi Anemia
Thrombocytopenia–Absent Radius Syndrome
VACTERL Association
Clinical Evaluation
Classification
Anatomic and Surgical Pathology
Imaging
Treatment
General Principles
Pollicization
Adolescence
Other Procedures
Centralization
Radialization
Ilizarov Correction
Vascularized Epiphyseal Transfer
Contraindications to Surgery
Congenital High Scapula (Sprengel Deformity)(Video 12.1)
Pseudarthrosis of the Clavicle (Video 12.2)
Ulnar Longitudinal Deficiency
History
Etiology
Clinical Features
Classification
Pathology
Imaging
Treatment
General Principles of Management
Nonoperative Treatment
Operative Treatment
Wrist
Hand
Forearm
Elbow
Phocomelia (Proximal Longitudinal Dysplasias)
Classification
Synostosis of the Radius and Ulna
Etiology
Clinical Features
Imaging
Treatment
Results
Preferred Treatment at the Texas Scottish Rite Hospital for Children
Arthrogryposis in the Upper Limb
Principles and Goals
Treatment
Shoulder
Elbow
Posterior Release With Tricepsplasty
Procedures to Achieve Active Elbow Flexion
Bipolar Pectoralis Major Transfer
Bipolar Latissimus Transfer
Transfer of the Long Head of the Triceps
Steindler Flexorplasty
Free Gracilis Transfers
Wrist
Dorsal Closing Wedge Osteotomy of the Midcarpus and Tendon Transfers
Proximal Row Carpectomy
Wrist Fusion
Hand
Thenar Release
Madelung Deformity
Etiology
Pathology
Clinical Features
Imaging
Treatment
Epiphysiolysis
Ligamentous Release and Dome Osteotomy
Results
Complications
Polydactyly
Etiology
Pathology
Incidence
Clinical Features and Classification Systems
Radial Polydactyly (Video 12.3)
Associated Conditions
Classifications
Surgical Challenges
Central Polydactyly
Associated Conditions
Classification
Ulnar Polydactyly
Mirror Hand
Imaging
Treatment
Radial Polydactyly
Wassel Type I and II Thumbs
Wassel Type III Thumbs
Wassel Type IV Thumbs
Wassel Type V and VI Duplications
Triphalangeal Thumbs
Central Polydactyly
Ulnar Polydactyly
Mirror Hand
Complications
Radial Polydactyly
Central Polydactyly
Ulnar Polydactyly
Syndactyly
Etiology
Pathology
Clinical Features
Incidence
Associated Syndromes
Imaging
Treatment
Timing
Cutaneous (Simple) Syndactyly
Preparation
Design of the Incisions
Separation of the Digits
Flap Closure
Skin Graft Patterns
Graft Harvest and Donor Site Closure
Attaching Grafts to the Digital Skin Defects
Tip Reconstruction
The Composite Graft
Buck-Gramcko “Stiletto Flap” Reconstruction
Dressing Application
Aftercare
Syndactyly of the First (Thumb–Index) Web
Complications and Outcomes
Thumb Abnormalities
Tight Thumbs (Thumb-In-Palm Deformity)
Trigger Thumb
Clinical Features
Etiology
Pathology
Imaging
Treatment
Complications
Spastic Thumb
Clinical Features
Etiology
Imaging
Treatment
Results
Clasped Thumb
Etiology
Clinical Features
Imaging
Treatment
Results
Angled Thumbs
Etiology
Pathology
Imaging
Treatment
Complications
Miscellaneous Thumb Anomalies
Diastrophic Dwarfism
Macrodactyly
History
Etiology
Clinical Features
Imaging
Treatment
Complications
Congenital Band Syndrome
History and Etiology
Pathology
Clinical Features
Classification
Imaging
Treatment
Acute Treatment
Reconstruction
Results
Complications
Apert Syndrome
Clinical Features
Treatment
Juvenile Arthritis and Other Noninfectious Inflammatory Conditions
General Principles
Education of the Patient and Parents
Appropriate Therapy and Splinting
Intraarticular Corticosteroid Injection
Wrist Involvement
Wrist Joint Synovitis
Tendon Synovitis (Tenosynovitis)
Treatment of Synovitis and Tenosynovitis
Splints
Heat
Intraarticular Corticosteroids
Exercises
Operative Treatment
General Principles
Synovectomy
Wrist Fusion
Indications
Technique
Darrach Resection
Indications
Technique
Hand Involvement
Digital Involvement
Synovitis of the Digits
Finger Synovitis and Deformity
Thumb Synovitis and Deformity
Tenosynovitis in the Digits
Treatment of Digital Involvement
Splinting
Injections
Synovectomy
Joint Reconstruction
Proximal Interphalangeal Joints
Metacarpophalangeal Joints
Thumb Deformities
Other Noninfectious Inflammatory Conditions
Infections
Paronychia
Felon
Herpetic Whitlow
Pyogenic Tenosynovitis
Deep-Space Infections
Bite Wounds
Human Bite Wounds
Animal Bite Wounds
Septic Arthritis
Osteomyelitis
Other Infections
Human Papillomavirus (Common Warts)
Atypical Mycobacterial Infections
Conditions Mimicking Infection4
Neonatal Brachial Plexus Palsy
Etiology
Classification
Clinical Features
Prognosis and Natural History
Differential Diagnosis
Treatment
Initial Management
Assessment
Later Treatment
Residual Deformities
Shoulder
Contractures
Flaccid Paralysis
Elbow
Wrist
Hand
Management of Residual Deformities
Shoulder
Internal Rotation and Adduction Contracture of the Shoulder
Rationale
Management
Recommended Correction of Internal Rotation Shoulder Deformities
Abduction and External Rotation Contracture
Abduction Contracture
Elbow and Forearm
Hand
Tumors of the Upper Limb
Nonneoplastic Masses
Synovial Cysts (Ganglions, Retinacular Cysts)
Epidermoid Inclusion Cysts
Foreign Bodies or Reactions
Aneurysm and Pseudoaneurysm
Malformations
Vascular Malformations
Hamartoma of the Nerve
Neoplasms
Benign Soft Tissue Lesions
Hemangiomas
Giant Cell Tumor of the Tendon Sheath
Glomus Tumors
Pyogenic Granuloma
Lipomas
Fibrous Tumors
Aponeurotic Fibroma
Infantile Digital Fibroma
Simple Fibromas
Neurofibromas
Malignant Soft Tissue Tumors
Malignant Schwannomas and Nerve Sheath Tumors
Subungual Melanoma
Other Malignant Tumors
Benign Bone Tumors
Solitary Enchondroma
Enchondromatosis (Ollier Disease)
Osteochondromatosis
Microsurgery
Replantation (Attachment of Severed Parts)
Preoperative Care
Indications and Contraindications
Revascularization
Free Tissue Transfer
Disadvantages of a Pedicle Flap
Inherent Advantages of Free Tissue Transfer
Free Motorized Muscle Transfer
Free Toe Transfer
Free Vascularized Bone Transfers
Free Joint Transfer for Radial Clubhand
References
Chapter 13: Developmental Dysplasia of the Hip
Definition
Incidence
Etiology
Ligamentous Laxity
Prenatal Positioning
Postnatal Positioning
Racial Predilection
Associated Conditions
Pathophysiology
Normal Hip Development
Hip Development With Developmental Dysplasia of the Hip
Natural History
Neonatal Hip Instability
Dysplasia, Subluxation, and Dislocation After the Neonatal Period
Clinical Features
Neonate
Infant (Video 13.1)
Walking Child
Radiographic Findings
Ultrasonography
Graf Technique
The Harcke Method
The Terjesen Method
Treatment Implications
Radiography
Arthrography
Magnetic Resonance Imaging
Screening Criteria
Treatment
Treatment of the Neonate
Pavlik Harness
Treatment of the Young Child (2 to 6 Months Old)
Pavlik Harness
Treatment Plan
Problems and Complications Associated With the Pavlik Harness
Other Splints and Braces
Frejka Pillow and Triple Diapers
Treatment of the Child (6 Months to 2 Years Old)
General Guidelines
Traction
Closed Reduction (Video 13.5)
Open Reduction
Medial Approach
Anterior Open Reduction
Open Reduction With Femoral Shortening (Videos 13.7 and 13.8)
Open Reduction With Innominate Osteotomy
Treatment of the Older Child (2 Years Old and Older)
Complications and Pitfalls
Avascular Necrosis
Etiology
Diagnosis
Classification
Other Manifestations of Avascular Necrosis
Interventions to Alter the Effects of Avascular Necrosis
Trochanteric Epiphysiodesis
Trochanteric Advancement
Intertrochanteric Double Osteotomy
Lateral Closing Wedge Valgus Osteotomy With Trochanteric Advancement
Inadequate Reduction and Redislocation
Residual Acetabular Dysplasia
Acetabular Dysplasia Presenting Late
Reconstructive Procedures for Dysplasia
Simple Pelvic Osteotomies That Reposition the Acetabulum
Pemberton Osteotomy (Video 13.9)
Salter Innominate Osteotomy (Video 13.10)
Dega Osteotomy
Complex Osteotomies That Reposition the Acetabulum
Steel Osteotomy
Tönnis Osteotomy
Ganz Osteotomy
Spherical Acetabular Osteotomy
Osteotomies That Augment the Acetabulum
Chiari Osteotomy
Shelf Procedures
Teratologic Dislocation of the Hip
References
Chapter 14: Legg­Calvé­Perthes Disease
Definition
Incidence
History
Etiology
Pathology and Pathophysiology
Hip Synovitis
Histopathology of the Epiphysis
Findings Suggestive of Double Infarction of the Epiphysis
Pathogenesis of Femoral Head Deformity
Histopathology of the Epiphyseal and the Physeal Cartilage
Metaphyseal Changes
Clinical Features
Symptoms
Signs
Clinical Course
Natural History of the Disease
Radiographic Findings
Radiographic Staging of Disease Evolution
Initial Stage
Fragmentation Stage
Reossification (Healing) Stage
Healed (Residual) Stage
Other Radiographic Findings
Changes in the Metaphysis
Changes in the Physis
Changes in the Acetabulum
Limited Radiographic Changes of Meyer Dysplasia
Bilateral Changes
Magnetic Resonance Imaging
Scintigraphy
Arthrography
Ultrasonography
Computed Tomography
Radiographic Classification Systems for Prognostication
Catterall Classification
Salter-Thompson Classification
Lateral Pillar Classification
Classification of End Results
Mose Classification
Stulberg Classification
Deformity Index
Quantitative Measures of Femoral Head Sphericity and Congruency
Prognostic Risk Factors
Differential Diagnosis
Treatment
Concept of Containment Treatment
Evaluation of the Concept of Containment Treatment
Symptomatic Therapy
Nonsurgical Containment Using Orthotic Devices
Surgical Containment
Femoral Varus Osteotomy
Salter Innominate Osteotomy
Triple Innominate Osteotomy
Combined Femoral and Innominate Osteotomy
Shelf Arthroplasty
Other Surgical Treatments
Femoral Valgus Osteotomy
Hip Joint Distraction
Chiari Osteotomy
Our Current Treatment Approach During the Early Stages of the Disease
Age at Onset Before 6 Years
Age at Onset 8 to 11 Years
Age at Onset After 11 Years
Treatment of Healed Femoral Heads With Incongruity and Impingement
Age at Onset 6 to 8 Years
Treatment of Osteochondrotic Lesions in the Femoral Head
Long-Term Prognosis
References
Chapter 15: Slipped Capital Femoral Epiphysis
Incidence and Epidemiology
Classification
Functional Classification
Classification Based on Onset of Symptoms
Morphologic Classification
Etiology
Mechanical Factors
Thinning of the Perichondral Ring Complex
Relative or Absolute Femoral Retroversion
Change in Inclination of the Adolescent Proximal Femoral Physis Relative to the Femoral Neck and Shaft
Associated Conditions With a Mechanical Etiology
Endocrine Factors
Pathology
Clinical Features
Stable, Chronic Slipped Capital Femoral Epiphysis
Unstable Acute or Acute-on-Chronic Slipped Capital Femoral Epiphysis
Chondrolysis Complicating Slipped Capital Femoral Epiphysis
Radiographic Findings
Plain Radiography
Computed Tomography
Technetium-99 Bone Scan
Ultrasonography
Magnetic Resonance Imaging
Treatment
Initial Management
Definitive Treatment
Stable Slipped Capital Femoral Epiphysis
In Situ Pinning
Percutaneous In Situ Fixation With a Fracture Table
Operative Technique
Postoperative Management
Percutaneous In Situ Fixation Using a Radiolucent Tabletop
Cannulated Screw, Design and Positioning
Screw-RelatedComplications
Routine Removal of Screws
Summary of In Situ Pinning
Bone Graft Epiphysiodesis
Spica Cast
Unstable Slipped Capital Femoral Epiphysis
Closed Versus Open Reduction
Timing of Reduction
Primary Open Reduction of the Slipped Epiphysis
Operative Technique
Results
Other Open Reduction Techniques
Screw Fixation With Minimal Reduction
Aftercare
Complications
Summary
Residual Deformity After Primary Treatment
Proximal Femoral Osteotomy
Base-of-Neck Osteotomy (Kramer and Barmada Procedures)
Intertrochanteric Osteotomy (Imhauser/Southwick Procedure)
Operative Technique
Anterior and Valgus Slips
Prophylactic Treatment of the Contralateral Hip
Complications
Avascular Necrosis
Epidemiology
Radiographic Findings and Clinical Features
Natural History
Treatment
Chondrolysis
Epidemiology
Etiology
Pathology
Natural History
Treatment
Prognosis
Remodeling After Epiphyseal Stabilization
Summary of Natural History and Prognosis
References
Chapter 16: Congenital Coxa Vara
Incidence
Etiology
Clinical Features
Radiographic Findings
Pathophysiology
Biomechanics
Treatment
References
Chapter 17: Disorders of the Femur
Femoral Anteversion
Definition
Clinical Features
Differential Diagnosis
Prognosis and Natural History
Association With Other Conditions
Measurement
Treatment
Snapping Iliotibial Band Syndrome
References
Chapter 18: Disorders of the Leg
Disorders of the Knee Presenting in Infancy
Congenital Hyperextension and Dislocation of the Knee
Classification
Etiology
Clinical Features
Treatment
Manipulative
Surgical
Preoperative Planning
Operative Technique
Congenital Dislocation of the Patella
Etiology
Clinical Features
Treatment
Disorders of the Legs Presenting After Infancy
Genu Varum (Bowlegs)
Physiologic Genu Varum
Tibia Vara
Infantile Tibia Vara (Blount Disease)
Etiology
Physiology
Clinical Features
Radiographic Findings
Differential Diagnosis
Classification
Treatment
Orthoses
Treatment of Langenskiöld Stage II Lesions
Guided Growth
Treatment of Langenskiöld Stage III Lesions
Treatment of Langenskiöld Stages IV/V Lesions
Technique
Treatment of Langenskiöld Stage VI Lesions
Complications of Surgery
Summary
Adolescent Tibia Vara
Etiology
Clinical Features
Radiographic Findings
Treatment
Osteotomy
Realignment by External Fixation
Hemiepiphysiodesis
Lateral Epiphysiodesis
Hemiepiphyseal Stapling
Hemiepiphyseal Plating
Tibia Vara Secondary to Focal Fibrocartilaginous Dysplasia
Radiographic Findings
Treatment
Genu Valgum (Knock-Knees)
Idiopathic Genu Valgum (Video 18.1)
Genu Valgum Secondary to Previous Proximal Tibial Fracture
Genu Valgum Secondary to Miscellaneous Causes
Rickets
Spondyloepiphyseal and Metaphyseal Dysplasias
Tumor-Like Conditions
Multiple Hereditary Exostoses
Tibial Torsion
Clinical Features
Treatment
Bowing of the Tibia
Anterolateral Bowing of the Tibia
Anterolateral Bowing With Congenital Dysplasia
Etiology and Pathology
Classification
Clinical Features
Treatment
Prophylaxis
Intramedullary Fixation
Bone Morphogenetic Protein
Bisphosphonates
Vascularized Fibular Graft
External Fixation and Distraction Osteogenesis
Periosteal Grafting
Electrical Stimulation
Late Fracture in Previously Undiagnosed Congenital Dysplasia
Amputation
Benign Form of Anterolateral Bowing of the Tibia
Congenital Posteromedial Bowing of the Tibia
Etiology and Clinical Features
Treatment
Congenital Pseudarthrosis of the Fibula
Treatment
References
Chapter 19: Disorders of the Foot
Introduction
Normal Variations
Os Trigonum
Accessory Navicular
Etiology
Pathology
Clinical Features
Radiographic Findings
Treatment
Results and Complications
Osteochondroses
Köhler Disease
Etiology
Clinical Features
Radiographic Findings
Treatment
Outcomes
Freiberg Infraction
Etiology
Clinical Features
Radiographic Findings
Treatment
Congenital Deformities
Postural Deformities
Metatarsus Adductus
Etiology
Incidence
Pathology
Clinical Features
Radiographic Findings
Treatment
Talipes Calcaneovalgus
Etiology and Clinical Features
Treatment
Flexible Flatfoot (Pes Planovalgus)
Definition
Clinical Features
Natural History
Treatment
Conservative Treatment
Surgical Treatment
Indications
Arthroereisi
Heel Cord Lengthening
Subtalar Fusion
Lateral Column Lengthening
Imbrication of Talonaviculocuneiform Complex
Summary
Skewfoot
Incidence and Natural History
Radiographic Findings
Treatment
Congenital Talipes Equinovarus (Clubfoot)
Etiology
Pathologic Anatomy
Diagnostic Features and Differential Diagnosis
Nonoperative Treatment
Ponseti Method
Technique
Results
French Physiotherapy (Functional) Method
Origin of the Procedure
Current Procedure
Results
Surgical Treatment
Timing of the Procedure
Various Techniques
Suggested Operative Technique
Postoperative Complications
Loss of Correction
Dorsal Subluxation of the Navicular
Valgus Overcorrection
Dorsal Bunion
Revision and Secondary Procedures
Soft Tissue Surgery
Anterior Tibial Tendon Transfer (Video 19.7)
Transfer for Insufficient Triceps Surae (Calcaneus Gait)
Bony Surgery
Lateral Column Shortening (Video 19.8)
Calcaneal Osteotomy
Supramalleolar Osteotomy
Triple Arthrodesis
Correction Using the Ilizarov Technique
Vertical Talus
Definition
Etiology
Clinical Features and Associated Conditions
Pathologic Anatomy
Radiographic Findings
Differential Diagnosis
Treatment
Results and Complications
Tarsal Coalition
Etiology
Clinical Features and Differential Diagnosis
Radiographic Findings
Treatment
Conservative Treatment
Surgical Treatment
Calcaneonavicular Coalition
Medial Talocalcaneal Coalition
Results and Complications
Cleft Foot
Etiology
Clinical Features
Treatment
Neurogenic Abnormalities
Cavus Foot
Etiology
Clinical Features
Radiographic Findings
Further Diagnostic Evaluation
Treatment
Conservative Treatment
Surgical Treatment
Soft Tissue Surgery
Plantar Release
Peroneus Longus–to–Peroneus Brevis Transfer
Anterior Transfer of the Posterior Tibialis Tendon
Transfer of the Toe Extensors to the Metatarsal Heads
Osteotomies
Metatarsal Osteotomies
Calcaneal Osteotomy
Midfoot Osteotomies
Triple Arthrodesis
Toe Deformities
Hallux Valgus
Anatomy
Clinical Features
Radiographic Examination
Classification
Treatment
Distal Soft Tissue Realignment (McBride Procedure)
Distal Metatarsal Osteotomy
Mitchell Osteotomy
Chevron Osteotomy
Proximal First Metatarsal Osteotomy
Double Metatarsal Osteotomy
Diaphyseal Osteotomies
Metatarsal-Cuneiform Fusion
Other Procedures
Recommended Treatment
Hallux Valgus Interphalangeus
Hallux Varus
Hallux Rigidus
Polydactyly
Syndactyly
Macrodactyly
Varus Fifth Toe
Curly Toe
Hammer Toe
Mallet Toe
Longitudinal Epiphyseal Bracket
Hair Tourniquet Syndrome
Subungual Exostosis
Glomus Tumor
References
Chapter 20: Limb Length Discrepancy
Leg Length Inequality
Etiology and Associated Conditions
Congenital and Developmental Conditions
Acquired Conditions
Impact of Inequality
Assessment of Inequality
Clinical
Radiographic
Plain Radiography
Teleoroentgenography
Orthoroentgenography
Scanography
Computed Radiography
Computed Tomography
Ultrasonography
Prediction of Leg Length Inequality in the Skeletally Immature Child
Normal Skeletal Growth
Longitudinal Growth of Long Bones
Alterations of Growth
Functional Physeal Anatomy
Prediction of Growth Remaining in the Femur and Tibia
Anderson-Green-Messner Growth-Remaining Charts
Menelaus Method
Moseley Straight-Line Graph
Paley Multiplier Method
Summary of Prediction Methods
Treatment
Psychological and Social Factors
Indications
Orthotic Management
Shortening of the Long Leg
Epiphysiodesis
History
Results
Percutaneous Methods
Epiphyseal Stapling
History
Results
Eight Plate and Tension Band Plating
Transphyseal Screws
Acute Shortening
Femoral Shortening
Indications
Results
Complications
Tibial Shortening
Lengthening of the Short Leg
Stimulation of Growth in the Short Leg
Surgical Lengthening of the Short Leg
History
Indications
Acute Lengthening Techniques
Transiliac
Femoral and Tibial
Gradual Lengthening Techniques
Chondrodiatasis
Callotasis
Effects of Gradual Lengthening
Bone
Muscle
Peripheral Nerves
Joints and Articular Cartilage
Complications of Gradual Lengthening
Nerve or Vessel Injury During Device Application
Incomplete Osteotomy
Premature Consolidation
Poor Regenerate Bone Formation
Joint Subluxation
Neurapraxia
Pin Site Infection
Sequestrum
Regenerate Bone Fracture
Subsequent Growth Disturbance of the Lengthened Limb
Psychological Stress
Other Complications
Devices for Gradual Lengthening
Wagner Device
Dynamic Axial Fixator
Ilizarov Apparatus
Combined Internal and External Fixation (Lengthening Over Intramedullary Rods)
Totally Implantable Lengthening Devices
Summary of Lower Extremity Lengthening
Angular Deformity
Etiology
Normal Lower Extremity Alignment
Assessment of Deformity
Principles of Deformity Correction
Surgical Options for Deformity Correction
Hemiepiphyseal Stapling
Hemiepiphysiodesis
Osteotomy
Acute Correction
Internal Fixation
External Fixation
Gradual Correction
References
Section III: Common Orthopaedic Disorders
Chapter 21: Limb Deficiencies
Proximal-Distal Axis
Anterior-Posterior Axis
Dorso-Ventral Axis
Genetic Regulation of Limb Development
Progress Zone Model
Early Specification Model
Differentiation Front Model
Two-Signal Gradient Model
Four-Dimensional Concept
Classifying Limb Deficiencies
Frantz and O’Rahilly Classification System
International Society for Orthotics/International Society for Prosthetics and Orthotics International Classification System
General Treatment Concepts
Timing of Treatment
Social Factors
Long-Term Planning
Congenital Absence of Limbs
Timing of Limb Malformation and Deformation
Etiology of Limb Absence
Heritable Limb Deficiencies and Associated Anomalies
Hypothesis of Subclavian Artery Supply Disruption Sequence
Psychosocial Issues
Congenital Lower Limb Deficiencies
Proximal Focal Femoral Deficiency
Classification
Aitken Classification
Hamanishi Classification
Gillespie Classification
Clinical Features
Treatment
Techniques
Amputation and Knee Arthrodesis
Rotationplasty
Femoral Pseudarthrosis Stabilization
Hip Stabilization
Limb Lengthening
Fibular Deficiency
Clinical Features
Classification
Frantz and O’Rahilly Classification
Coventry and Johnson Classification
Achterman and Kalamchi Classification
Birch Classification
Treatment
Mild to Moderate Fibular Hemimelia
Amputation or Limb Lengthening With Deformity Correction
Severe Fibular Hemimelia
Amputation
Limb Lengthening
Bilateral Fibular Hemimelia
Amputation
Limb Lengthening
Tibial Deficiency
Classification
Weber Classification
Clinical Features
Treatment
Partial Tibial Hemimelia
Complete Tibial Hemimelia
Foot Deficiency
Congenital Upper Limb Deficiencies
Transverse Deficiencies
Symbrachydactyly
Classification
Treatment
Amnion Disruption Sequence
Treatment
Radial Deficiency
Classification
Treatment
Complications
Ulnar Deficiency
Classification
Clinical Features
Treatment
Acquired Limb Absences
Primary Causes and Treatment Principles
Trauma
Malignant Tumors
Purpura Fulminans
Surgical Amputations
Upper Limb Amputation
Above-Knee Amputation
Knee Disarticulation
Below-Knee Amputation
Complications
Overgrowth After Amputations Through Long Bones
Complications Following Burns or Purpura Fulminans
Immediate Fitting of Prostheses in Young Children
Phantom Pain
Psychosocial Aspects
Multilimb Deficiencies
Bilateral Upper Limb Absence
Bilateral Lower Limb Absence
Bilateral Upper and Lower Limb Absence (Quadrimelic Limb Deficiency)
One Upper-Limb and One Lower-Limb Absence
Bilateral Upper-Limb and One Lower-Limb Absence
Prosthetic Management
Concepts of Prosthetic Management
General Guidelines
Timing
Evaluation and fabrication
Nonstandard Prostheses
Modifications
Upper-Limb Prostheses
Lower-Limb Prostheses
Guidelines for Replacing Prostheses
Prosthetic Management of Specific Deficiencies
Proximal Focal Femoral Deficiency
Fibular Deficiency
Tibial Deficiency
Foot Deficiency
Foot Amputation
Amputation for Malignant Tumor
Above-Knee Amputation
Knee Disarticulation
Below-Knee Amputation
References
Chapter 22: Arthritis
Joints
General Considerations
Joint Fluid Analysis
Gross Appearance
Viscosity and Mucin Clot
Microscopic Examination
Other Examinations
Juvenile Idiopathic Arthritis (Formerly Juvenile Rheumatoid Arthritis)
Definition and Classification
Incidence and Prevalence
Demographics
Etiology
Pathology
Clinical Features
Oligoarticular Juvenile Idiopathic Arthritis
Polyarticular Juvenile Idiopathic Arthritis
Systemic Juvenile Idiopathic Arthritis
Laboratory Evaluation
Radiographic Evaluation
Treatment
Medical Treatment
Physical and Occupational Therapy
Orthopaedic Treatment
Total Joint Arthroplasty
Enthesitis-Related Arthritis and Spondyloarthropathies
Juvenile Ankylosing Spondylitis
Reactive Arthritis
Psoriatic Arthritis
Acute Transient Synovitis of the Hip
Etiology
Clinical Features
Diagnostic Studies
Differential Diagnosis
Clinical Course
Treatment
Natural History
Neuropathic Arthropathies
Clinicopathologic Features
Radiographic Findings
Treatment
Tuberculous Arthritis
Tuberculosis of the Spine
Gonococcal Arthritis
References
Chapter 23: Infections of the Musculoskeletal System
Overview
Radiology
Plain Radiography
Ultrasonography
Fluoroscopy
Nuclear Imaging
Computed Tomography
Magnetic Resonance Imaging
Laboratory Studies
Complete Blood Count
Erythrocyte Sedimentation Rate
C-Reactive Protein
Interleukin-6
Local Tissue and Blood Cultures (Microbiology)
Staphylococcus aureus
Streptococcus pyogenes
Kingella kingae
Streptococcus pneumoniae
Neisseria meningitidis
Neisseria gonorrhoeae
Borrelia burgdorferi
Mycobacterium tuberculosis
Nontuberculous Mycobacteria
Treponema pallidum
Brucella melitensis
Bartonella henselae
Mycotic Organisms
Coccidioides immitis
Blastomyces dermatitidis
Actinomyces israelii
Sporothrix schenckii
Disease Manifestations
Osteomyelitis
Acute Hematogenous Osteomyelitis
Epidemiology
Pathophysiology
Classification
Neonatal
Infantile and Early Childhood
Childhood
Adolescent
Treatment
Antibiotic Therapy
Surgery
Outcomes of Osteomyelitis
Subacute Osteomyelitis
Epidemiology
Pathophysiology
Classification
Evaluation and Treatment
Outcomes
Chronic Osteomyelitis
Epidemiology
Pathophysiology
Classification
Evaluation
Treatment
Antibiotic Therapy
Surgery
Complications
Chronic Recurrent Multifocal Osteomyelitis
Epidemiology
Pathophysiology
Evaluation
Treatment
Complications
Septic Arthritis
Epidemiology
Pathophysiology
Evaluation
Treatment
Antibiotic Therapy
Surgery
Clinical Practice Guideline
Outcomes
Tuberculous Arthritis
Clinical Features
Radiographic Findings
Laboratory Studies
Treatment
General Medical Treatment
Antituberculous Drugs
Orthopaedic Treatment of the Tuberculous Joint
Tuberculosis of the Spine
Pathology
Clinical Features
Radiographic Findings
Treatment
Paraplegia in Tuberculous Spondylitis
Gonococcal Arthritis
Pyomyositis
Epidemiology
Pathophysiology
Evaluation
Treatment
Antibiotic Therapy
Surgery
Complications
Other Soft Tissue Infections of Orthopaedic Significance
Purpura Fulminans
Epidemiology
Pathophysiology
Evaluation and Treatment
Necrotizing Fasciitis
Soft Tissue Abscess and Septic Bursitis
Infection in Challenging Locations
Spine
Pyogenic Infectious Spondylitis
Epidemiology
Pathophysiology
Evaluation
Treatment
Complications
Pelvis
Foot
Hematogenous Calcaneal Osteomyelitis
Plantar Puncture Wounds
Systemic Diseases Associated With Infection
Sickle Cell Disease
Chronic Granulomatous Disease
Human Immunodeficiency Virus
References
Section IV: Musculoskeletal Tumors
Chapter 24: General Principles of Tumor Management
Tumors of the Musculoskeletal System
Classification
Clinical Features
Radiographic Findings
Evaluation of the Initial Radiograph
Anatomic Site of the Lesion
Character of the Lesion
Reaction of Surrounding Bone
Staging Studies
Computed Tomography
Magnetic Resonance Imaging
Angiography
Positron Emission Tomography
Biopsy
Treatment
References
Chapter 25: Benign Musculoskeletal Tumors
Simple Bone Cysts (Solitary Bone Cyst, Unicameral Bone Cyst)
Incidence
Etiology
Pathology
Clinical Features
Radiographic Findings
Differential Diagnosis
Treatment
Corticosteroid Injections
Autologous Bone Marrow Injections and Other Bone Substitutes
Decompression of Cysts by Multiple Drilling
Curettage of Cysts Followed by Bone Grafting
Aneurysmal Bone Cyst
Incidence
Etiology
Pathology
Clinical Features
Radiographic Findings
Treatment
Curettage and Adjunctive Therapy
Treatment of Spinal Aneurysmal Cysts
Radiation Therapy
Fibrous Dysplasia
Incidence
Classification
Etiology
Pathology
Clinical Features
Radiographic Findings
Differential Diagnosis
Treatment
Nonsurgical Treatment
Surgical Treatment
Osteofibrous Dysplasia of the Tibia and Fibula (Campanacci Disease)
Incidence
Etiology
Pathology
Clinical Features
Radiographic Findings
Differential Diagnosis
Treatment
Solitary Osteochondroma
Incidence
Etiology
Pathology
Clinical Features
Radiographic Findings
Differential Diagnosis
Sarcomatous Change
Treatment
Hereditary Multiple Exostoses
Incidence
Etiology
Pathology
Clinical Features
Radiographic Findings
Differential Diagnosis
Sarcomatous Change
Treatment
Solitary Enchondroma
Incidence
Pathology
Clinical Features
Radiographic Findings
Differential Diagnosis
Treatment
Multiple Enchondromatosis (Ollier Disease) and Maffucci Syndrome
Pathology
Clinical Features
Radiographic Findings
Sarcomatous Change
Treatment
Chondroblastoma
Incidence
Etiology
Pathology
Clinical Features
Radiographic Findings
Differential Diagnosis
Treatment
Chondromyxoid Fibroma
Incidence
Etiology
Pathology
Clinical Features
Radiographic Findings
Differential Diagnosis
Treatment
Osteoid Osteoma
Incidence
Etiology
Pathology
Clinical Features
Radiographic Findings
Differential Diagnosis
Treatment
Nonsurgical Treatment
Radiofrequency Ablation
Surgical Treatment
Open Surgical Techniques
Osteoblastoma
Incidence
Pathology
Clinical Features
Radiographic Findings
Differential Diagnosis
Treatment
Langerhans Cell Histiocytosis (Histiocytosis X)
Eosinophilic Granuloma: Solitary and Multiple Without Extraskeletal Involvement
Pathology
Clinical Features
Radiographic Findings
Differential Diagnosis
Treatment
Hand-Schüller-Christian Disease: Multifocal Eosinophilic Granuloma With Extraskeletal Involvement (Chronic Disseminated Type)
Letterer-Siwe Disease: Multifocal Eosinophilic Granuloma (Acute Disseminated or Infantile Form)
Nonossifying Fibroma and Fibrous Cortical Defect
Incidence
Etiology
Pathology
Clinical Features
Radiographic Findings
Differential Diagnosis
Natural History
Treatment
Primary Synovial Chondromatosis
Incidence
Etiology
Pathology
Clinical Features
Radiographic Findings
Treatment
Pigmented Villonodular Synovitis and Giant Cell Tumor of the Tendon Sheath
Incidence
Etiology
Pathology
Clinical Features
Radiographic Findings
Differential Diagnosis
Treatment
Dysplasia Epiphysealis Hemimelica (Trevor Disease)
Incidence
Etiology
Pathology
Clinical Features
Radiographic Findings
Natural History
Treatment
References
Chapter 26: Malignant Bone Tumors
Osteosarcoma
Classic Osteosarcoma
Pathology
Clinical Features
Radiographic Findings
Magnetic Resonance Imaging and Computed Tomography
Bone Scanning
Angiography
Position Emission Tomography-­Computed ­Tomography
Laboratory Findings
Differential Diagnosis
Staging
Biopsy
Treatment
Chemotherapy
Surgical Treatment
Amputation
Rotationplasty
Limb salvage
Metastatic Osteosarcoma
Ewing Sarcoma and Peripheral Primitive Neuroectodermal Tumor
Pathology
Clinical Features
Radiographic Findings
Staging
Biopsy
Prognosis
Treatment
Nonmetastatic Ewing Sarcoma
Chemotherapy
Radiation Therapy
Surgical Treatment
Metastatic Ewing Sarcoma and Peripheral Primitive Neuroectodermal Tumor
Chondrosarcoma
Pathology
Radiographic Findings
Treatment
Soft Tissue Sarcomas
Rhabdomyosarcoma
Pathology
Clinical Features
Radiographic Findings
Biopsy
Treatment and Prognosis
Nonrhabdomyosarcoma Soft Tissue Sarcoma
Congenital and Infantile Fibrosarcoma
Pathology
Clinical Features
Treatment
Nonrhabdomyosarcoma Soft Tissue Sarcoma in Older Children
Clinical Features
Staging and Radiographic Findings
Treatment and Prognosis
References
Section V: Injuries
Chapter 27: General Principles of Managing Orthopaedic Injuries
Properties of the Immature Skeleton
Plastic Deformation
Fractures
Buckle (Torus) Fractures
Greenstick Fractures
Remodeling and Overgrowth
Physeal Injuries
Physeal Anatomy
Harris Growth Arrest Lines
Classification of Physeal Injuries
Treatment of Physeal Injuries
Complications of Physeal Injuries
Assessment of Growth Disturbance
Treatment of Physeal Arrest
Observation
Growth Modulation
Completion
Resection
Care of the Multiply Injured Child
Anatomic and Physiologic Characteristics Specific to Children
Management of Airway, Breathing, and Circulation
Primary and Secondary Assessments
Open Fractures
Overview of Treatment
Gunshot Wounds
Lawnmower Injuries
Compartment Syndrome
Incidence
Pathophysiology
Diagnosis
Prevention and Treatment
Vascular Injuries
Casts
Principles of Application
Materials
Child Abuse
Incidence
Diagnosis
Reporting
Summary
References
Chapter 28: Spinal Injuries
Traumatic Injuries of the Cervical Spine
Anatomy
Epidemiology
Diagnosis
Radiographic Findings
Cervical Spine Radiographs
Other Studies
Treatment
Atlantooccipital Dislocation
Atlas Fractures
Traumatic Atlantoaxial Instability
Odontoid Fractures
Traumatic Spondylolisthesis of C2 (Hangman’s Fracture)
Fractures and Dislocations of the Subaxial Spine
Traumatic Injuries of the Thoracic and Lumbar Spine
Anatomy
Mechanism of Injury
Classification
Diagnosis
Radiographic Findings
Treatment
Nonsurgical Treatment
Surgical Treatment
Pharmacologic Treatment of Spinal Cord Injury
Spinal Cord Injury Without Radiographic Abnormality
Complications After Spinal Cord Injury
References
Chapter 29: Upper Extremity Injuries
Injuries to the Clavicle
Anatomy
Mechanism of Injury
Diagnosis
Birth Fractures
Midshaft Clavicle Fractures
Medial Physeal Separation (Pseudodislocation) of the Sternoclavicular Joint
Lateral Physeal Separation and Acromioclavicular Joint Dislocation
Radiographic Findings
Treatment
Birth Fractures
Midshaft Clavicle Fractures
Medial Physeal Separation (Pseudodislocation) of the Sternoclavicular Joint
Reduction of Anterior Displacement
Reduction of Posterior Displacement
Lateral Physeal Separation and Acromioclavicular Joint Dislocation
Complications
Fractures of the Scapula
Anatomy
Mechanism of Injury
Diagnosis
Treatment
Complications
Associated Conditions
Scapulothoracic Dissociation
Os Acromiale
Fractures Involving the Proximal Humeral Physis
Anatomy
Mechanism of Injury
Classification
Diagnosis
Treatment
Grades I and II Injuries
Grades III and IV Injuries
Complications
Traumatic Dislocation of the Glenohumeral Joint
Anatomy
Mechanism of Injury
Diagnosis
Treatment
Complications
Fractures of the Proximal Metaphysis and Shaft of the Humerus
Anatomy
Mechanism of Injury
Diagnosis
Treatment
Complications
Fractures About the Elbow
Supracondylar Fractures of the Humerus
Anatomy
Mechanism of Injury
Classification
Diagnosis
Radiographic Findings
Treatment
Emergency Treatment
Treatment of Nondisplaced Fractures
Treatment of Displaced Fractures
Closed Reduction
Reduction of Extension-Type Fracture
Closed Reduction of Flexion-Type Fractures
Open Reduction of Supracondylar Humerus Fractures
Percutaneous Pinning
Cast Immobilization
Traction
Controversies in Treatment
Management of Minimally Displaced Fractures
Timing of Reduction for Type III Fractures
Pinning Technique and Iatrogenic Ulnar Nerve Injury
Management of a Viable, Pulseless Hand
Management of Late-Presenting or Malreduced Fractures
Complications
Vascular Injury
Peripheral Nerve Injury
Volkmann’s Ischemic Contracture (Compartment Syndrome)
Malunion: Cubitus Varus and Cubitus Valgus
Elbow Stiffness and Myositis Ossificans
Transphyseal Fractures
Anatomy
Mechanism of Injury
Classification
Diagnosis
Radiographic Findings
Treatment
Complications
Lateral Condyle Fractures
Anatomy
Mechanism of Injury
Classification
Diagnosis
Radiographic Findings
Treatment
Displaced Fractures
Nondisplaced Fractures
Minimally Displaced Fractures
Complications
Cubitus Varus and Lateral Spur Formation
Delayed Union and Nonunion
Fractures With Delayed Union
Late-Presenting Fractures
Nonunited Fractures
Growth Arrest
Fishtail Deformity and Avascular Necrosis
Medial Epicondyle Fractures
Anatomy
Mechanism of Injury
Classification
Diagnosis
Radiographic Findings
Treatment
Nondisplaced and Minimally Displaced Fractures
Displaced Fractures
Complications
Elbow Dislocations
Anatomy
Mechanism of Injury
Diagnosis
Treatment
Complications
Radial Head and Neck Fractures
Anatomy
Mechanism of Injury
Classification
Diagnosis
Radiographic Findings
Treatment
Immobilization
Reduction
Closed Reduction
Percutaneous and Intramedullary Reduction
Open Reduction
Treatment of Late-Presenting Displaced Fractures
Radial Head Excision
Complications
Olecranon Fractures
Anatomy
Mechanism of Injury
Classification
Diagnosis
Treatment
Complications
Uncommon Elbow Fractures
T-Condylar Fractures
Anatomy and Mechanism of Injury
Classification
Treatment
Closed Reduction and Percutaneous Pinning
Open Reduction and Internal Fixation
Complications
Medial Condyle Fractures
Anatomy and Mechanism of Injury
Classification
Treatment and Complications
Capitellar Fractures
Anatomy and Mechanism of Injury
Treatment
Coronoid Fractures
Trochlear Fractures
Lateral Epicondyle Fractures
Associated Conditions
Nursemaid’s Elbow (Pulled Elbow, Traumatic Subluxation of the Radial Head)
Fractures of the Forearm
Monteggia Fractures
Anatomy
Classification
Mechanism of Injury
Diagnosis
Radiographic Findings
Treatment
Closed Reduction and Cast Immobilization
Open Reduction and Fixation
Complications
Chronic, Missed, or Neglected Monteggia Fracture
Recurrence of Radial Head Dislocation
Malunion of the Ulna
Stiffness
Nerve Palsy
Compartment Syndrome and Volkmann’s Ischemic Contracture
Fractures of the Shaft of the Radius and Ulna
Anatomy
Mechanism of Injury
Classification
Diagnosis
Radiographic Findings
Treatment
Closed Reduction
Position of Immobilization
Follow-Up
Parameters of an Acceptable Closed Reduction
Operative Treatment
Open Reduction and Internal Fixation
Flexible Intramedullary Fixation
Single-Bone Fixation
External Fixation
Complications
Re-fracture
Malunion
Delayed Union or Nonunion
Synostosis
Compartment Syndrome
Peripheral Nerve Injury
Other Complications
Fractures of the Distal Forearm
Anatomy
Mechanism of Injury
Classification
Diagnosis
Radiographic Findings
Treatment
Buckle Fractures
Greenstick Fractures
Metaphyseal Fractures
Nondisplaced Metaphyseal Fractures
Displaced Distal Metaphyseal Fractures
Treatment by Closed Reduction and Casting
Operative Treatment
Parameters of an Acceptable Reduction
Distal Radial Physeal Fractures
Distal Ulnar Physeal Injuries
Galeazzi Fractures
Complications
Malunion
Re-fracture
Growth Arrest
Peripheral Nerve Injury
Compartment Syndrome and Acute Carpal Tunnel Syndrome
Nonunion, Cross-Union, Infection, and Tendon Rupture
Reflex Sympathetic Dystrophy
Associated Conditions
Chronic Radial Physeal Injuries
Fractures and Dislocations of the Wrist and Hand
Fractures of the Scaphoid
Anatomy
Radiographic Findings
Routine Scaphoid Radiographic Series
Computed Tomography Scans
Magnetic Resonance Imaging
Treatment
Stable or Nondisplaced Scaphoid Fractures
Unstable or Displaced Scaphoid Fractures
Chronic Scaphoid Fractures
Dislocation and Fracture-Dislocationof theImmature Wrist
Fractures and Dislocations of the Hand
Metacarpal Fractures
Fracture of the Phalanges
Proximal and Middle Phalanx
Distal Phalanx (P3)
Intraarticular Fractures
References
Chapter 30: Lower Extremity Injuries
Pelvis and Acetabulum
Pelvis
Anatomy
Mechanism of Injury
Classification
Associated Injuries
Clinical Features
Radiographic Findings
Treatment
Types of Injuries (Torode and Zieg Classification)
Type I: Avulsion Fractures
Type II: Iliac Wing Fractures
Type III: Simple Pelvic Ring Fractures
Type IV: Pelvic Ring Disruption Fractures
Straddle Fracture
Double-Ring Fracture
Lateral Compression
Anterior Compression
Vertical Shear
Treatment Techniques
External Fixation
Open Reduction and Internal Fixation of the Symphysis Pubis
Internal Fixation of the Sacroiliac Joint
Complications
Acetabulum
Anatomy
Mechanism of Injury
Classification
Associated Injuries
Clinical Features
Radiographic Findings
Treatment
Types of Injuries
Type I Fractures
Type II Fractures
Type III Fractures
Type IV Fractures
Triradiate Cartilage Injuries
Treatment Techniques
Complications
Hip
Hip Dislocations
Anatomy
Mechanism of Injury
Classification
Clinical Features
Radiographic Findings
Treatment
Closed Reduction
Posterior Dislocation
Anterior Dislocation
Central Dislocation
Open Reduction
Posterior Approach
Anterior Approach
Surgical Hip Dislocation
Hip Arthroscopy
Postreduction Treatment
Complications
Avascular Necrosis
Sciatic Nerve Palsy
Recurrent Hip Dislocation
Degenerative Arthritis
Vascular Injury
Hip Fractures
Anatomy
Mechanism of Injury
Classification
Clinical Features
Radiographic Findings
Treatment
Type I: Transepiphyseal Fractures
Type II: Transcervical Fractures
Type III: Cervicotrochanteric Fractures
Type IV: Pertrochanteric or Intertrochanteric Fractures
Stress Fractures
Complications
Avascular Necrosis
Predisposing Factors
Clinical Features and Radiographic Findings
Patterns
Treatment and Prognosis
Coxa Vara
Nonunion
Premature Physeal Arrest
Infection
Femur
Femoral Shaft Fractures
Anatomy and Development
Mechanism of Injury
Classification
Clinical Features
Radiographic Findings
Treatment
Age Guidelines
0 to 6 Months
7 Months to 5 Years
6 to 10 Years
11 Years to Skeletal Maturity
Treatment Techniques
Traction
Skin Traction
Skeletal Traction
Results and Cautions
Spica Casting
External Fixation
Open Reduction and Internal Fixation
Submuscular Bridge Plating
Intramedullary Fixation: Overview
Flexible Intramedullary Fixation
Indications
Procedure
Complications
Results
Rigid Intramedullary Nailing
Indications
Complications
Complications
Limb Length Inequality
Unacceptable Angulation
Rotational Deformities
Nonunion and Delayed Union
Compartment Syndrome
Traction Injuries
Vascular Injury
Knee
Distal Femoral Injuries and Fractures
Anatomy
Mechanism of Injury
Classification
Clinical Features
Radiographic Findings
Treatment
Distal Femoral Metaphyseal Fractures
External Fixation
Closed Reduction and Internal Fixation
Open Reduction and Internal Fixation
Distal Femoral Physeal Fractures
Treatment Principles
Nondisplaced Physeal Fractures
Salter-Harris Type I Fractures
Salter-Harris Type II Fractures
Salter-Harris Type III Fractures
Salter-Harris Type IV Fractures
Complications
Acute Complications
Arterial Injury
Peroneal Nerve Injury
Ligamentous Injuries
Loss of Reduction
Late Complications
Physeal Arrest
Angular Deformity
Loss of Knee Motion
Patellar Fractures
Anatomy
Mechanism of Injury
Classification
Clinical Features
Radiographic Findings
Treatment
Sleeve Fracture
Displaced Transverse Patellar Fracture
Comminuted Fracture
Ipsilateral Femoral or Tibial Fracture
Marginal Fracture
Complications
Tibial Tuberosity Fractures
Anatomy
Mechanism of Injury
Classification
Clinical Features
Radiographic Findings
Treatment
Complications
Proximal Tibial Physeal Fractures
Anatomy
Mechanism of Injury
Classification
Clinical Features
Radiographic Findings
Treatment
Closed Reduction
Open Reduction
Complications
Proximal Tibiofibular Joint Dislocations
Anatomy
Mechanism of Injury
Classification
Clinical Features
Radiographic Findings
Treatment
Tibia and Fibula
Anatomy
Tibial and Fibular Fractures
Mechanism of Injury
Classification
Clinical Features
Radiographic Findings
Proximal Tibial Metaphyseal Fractures
Mechanism of Injury
Clinical Features and Radiographic Findings
Treatment
Complications
Tibial and Fibular Diaphyseal Fractures
Mechanism of Injury
Classification
Clinical Features
Treatment
Nonoperative Treatment
Nondisplaced Oblique or Spiral Tibial Fracture With an Intact Fibula (Toddler’s Fracture)
Displaced Tibial Fracture With an Intact Fibula in an Older Child
Displaced Tibial Fracture With a Fibular Fracture in an Older Child
Operative Treatment
Open Tibial Diaphyseal Fractures
Mechanism of Injury
Classification
Treatment
Early Treatment: Antibiotics, Débridement, and Splinting
Wound Management
Soft Tissue Management
Management of Bony Defects
Fracture Stabilization
Treatment of Neurovascular Injury
Complications
Compartment Syndrome
Other Complications
Distal Tibial Metaphyseal Fractures
Stress Fractures of the Tibia
Ipsilateral Femoral and Tibial Fracture (“Floating Knee”)
Ankle
Anatomy
Ankle Fractures
Classification
Supination-Inversion Injury
Supination–Plantar Flexion Injury
Supination–External Rotation Fracture
Pronation–Eversion–External Rotation Fracture
Axial Compression Injuries and Other Physeal Injuries
Clinical Features
Radiographic Findings
Treatment
Salter-Harris Types I and II Distal Fibular Fractures
Salter-Harris Type I Tibial Fractures
Salter-Harris Type II Distal Tibial Fractures
Salter-Harris Type III Distal Tibial Fractures
Salter-Harris Type IV Distal Tibial Fractures
Salter-Harris Type V Distal Tibial Fractures
Complications
Premature Closure of the Physis
Delayed Union or Nonunion
Valgus Deformity Secondary to Malunion
Distal Tibiofibular Synostosis
Tillaux Fractures
Mechanism of Injury
Clinical Features
Treatment
Closed Reduction
Open Reduction and Internal Fixation
Results
Triplane Fractures
Mechanism of Injury
Radiographic Findings
Treatment
Closed Reduction
Open Reduction and Internal Fixation
Results
Syndesmosis Injuries
Foot
Talar Fractures
Anatomy
Mechanism of Injury
Classification
Clinical Features
Radiographic Findings
Treatment
Fractures of the Neck of the Talus
Fractures of the Body of the Talus
Fractures of the Lateral Process
Complications
Calcaneal Fractures
Anatomy
Mechanism of Injury
Classification
Clinical Features
Radiographic Findings
Treatment
Complications
Tarsometatarsal (Lisfranc) Fractures
Anatomy
Mechanism of Injury
Classification
Clinical Features
Radiographic Findings
Treatment
Nonoperative Treatment
Closed Reduction
Open Reduction and Internal Fixation
Complications
Metatarsal Fractures
Mechanism of Injury
Clinical Features
Radiographic Findings
Treatment
Nonoperative Treatment
Closed Reduction
Open Reduction and Internal Fixation
Fractures of the Base of the Fifth Metatarsal
Anatomy
Classification
Treatment
Zone I Fractures
Zone II Fractures
Zone III Fractures
Phalangeal Fractures
Lawnmower Injuries
Puncture Injuries of the Foot
References
Section VI: Neuromuscular Disorders
Chapter 31: Disorders of the Brain
Levels of Involvement
Spinomuscular Level
Spinal Level
Neural Level
Myoneural Level
Extrapyramidal Level
Pyramidal (Corticospinal) Level
Cerebellar Level
Cerebral Palsy
Definition
Epidemiology
Etiology
Prenatal
Perinatal
Postnatal
Classification
Physiologic
Geographic
Functional
Evaluation
History
Physical Examination
Muscle Tone
Reflexes
Balance, Sitting, and Gait
Other Assessments
Histopathologic and Imaging Findings
Gait Analysis
Cadence
Kinematics
Electromyography
Kinetics
Oxygen Consumption
Controversies in Gait Analysis
Summary
Muscle Strength
Prognosis for Ambulation
Treatment
Nonsurgical Treatment
Physical Therapy
Casting
Orthoses
Medical Treatment of Spasticity
Oral Medication
Intrathecal Baclofen
Botulinum Toxin
Surgical Treatment
General Considerations
Timing of Surgery
Anesthetic Concerns
Postoperative Management
Management of Foot Involvement in Cerebral Palsy
Equinus
Differential Diagnosis of Equinus
Clinical Features
Treatment
Gastrocnemius Recession
Achilles Tendon Lengthening
Postoperative Care
Complications
Preferred Procedure
Equinovarus
Etiology and Clinical Features
Treatment
Posterior Tibialis Tendon Lengthening
Transfer of the Posterior Tibialis Tendon to the Dorsum
Split Posterior Tibialis Tendon Transfer
Split Anterior Tibialis Tendon Transfer
Bone Surgery
Pes Valgus
Incidence and Etiology
Clinical Features and Radiographic Findings
Treatment
Grice Extraarticular Arthrodesis (see Plate 31.3)
Lateral Column (Calcaneal) Lengthening
Calcaneal Osteotomy
Subtalar Arthrodesis
Talonavicular Fusion
Triple Arthrodesis
Ankle Valgus
Hallux Valgus
Dorsal Bunion
Management of Knee Involvement in Cerebral Palsy
Hamstring Lengthening
Clinical Features
Treatment
Orthotic Management
Surgical Technique
Postoperative Care
Results
Complications
Rectus Femoris Transfer
Indications
Surgical Technique
Postoperative Care
Results
Indications for Distal Hamstring Lengthening With Simultaneous Rectus Femoris Transfer
Management of Rotational Abnormalities of the Femur and Tibia
Clinical Features
Surgical Technique
Derotational Osteotomy
Management of Hip Involvement in Cerebral Palsy
Hip Flexion Contracture
Clinical Features
Diagnosis
Surgical Technique
Adduction Contracture
Clinical Features
Diagnosis
Surgical Treatment
Adductor Release
Posterior Adductor Transfer
Hip Subluxation or Dislocation
Etiology and Epidemiology
Diagnosis
Treatment
Categories of Surgical Treatment
Soft Tissue Release for Subluxation or a Hip at Risk
Reduction and Reconstruction of the Subluxated or Dislocated Hip
Femoral Osteotomy
Combined Femoral Varus and Pelvic Osteotomies
Chiari Osteotomy
Shelf Acetabular Augmentation (Plate 31.9)
Dega Osteotomy
Bernese Osteotomy
Complications
Salvage Surgery for Long-Standing Painful Dislocations
Proximal Femoral Resection–Interposition Arthroplasty
Valgus Osteotomy of the Proximal Femur
Hip Arthrodesis
Total Hip Arthroplasty
Anterior Dislocation of the Hip
Management of Upper Limb Involvement inCerebral Palsy
Sensory Impairment
Effects on Growth
Treatment
Nonsurgical Treatment
Casting, Splinting, and Physical Therapy
Botulinum Toxin
Surgical Treatment
Surgical Planning
Preoperative Evaluation
Motor Examination
Sensory Examination
Surgical Techniques for the Elbow
Flexion Contracture
Pronation Contracture
Surgical Techniques for the Wrist and Fingers
Surgical Techniques for the Thumb
Management of Spinal Deformity in Cerebral Palsy
Scoliosis
Nonoperative Treatment
Surgical Treatment
Factors in Decision Making
Indications
Preoperative Evaluation
Choice and Timing of Procedures
Precautions
Segmental Instrumentation of Scoliosis
Galveston Technique
Dunn-McCarthy Technique
Iliac and Sacroiliac Screw Fixation Technique
Growing Rod Instrumentation
Complications
Results
Spondylolysis and Spondylolisthesis
Cervical Spine Spondylosis in Athetoid Cerebral Palsy
Rhizotomy
Indications
Surgical Technique
Postoperative Care
Results
Complications
Management of Fractures in Cerebral Palsy
Outcome Assessment
Rett Syndrome
Diagnosis
Pathogenesis
Clinical Features
Treatment
Hereditary Spastic Paraparesis
Pathogenesis
Clinical Features
Treatment
Ataxia Syndromes
Friedreich Ataxia (Hereditary Spinocerebellar Ataxia)
Pathogenesis
Clinical Features
Diagnosis
Treatment
Orthopaedic Treatment
Medical Treatment
Prognosis
References
Chapter 32: Disorders of the Spinal Cord
Myelomeningocele
Incidence
Embryology
Causative Factors
Folate
Heredity
Pathology
Skin
Meninges
Spinal Cord
Peripheral Nerve Roots
Vertebrae
Brain
Natural History
Prognosis
Associated Health Problems
General or Universal Problems
Upper Extremity Function
Early Puberty
Cognitive Problems
Psychosocial Implications
Specific Problems by Spinal Level
Thoracic Level
Upper Lumbar Level
Lower Lumbar Level
Sacral Level
Complications
Latex Allergy
Infection
Pressure Sores
Fractures
Treatment
Multidisciplinary Care
Neurosurgical Treatment
Closure of the Myelomeningocele Sac
Hydrocephalus
Other Spinal Cord Abnormalities
Urologic Treatment
Orthopaedic Treatment
Goals of Orthopaedic Management
Physical and Radiographic Examination of the Newborn
Periodic Assessment
Surgical Management of Specific Orthopaedic Problems
Foot and Ankle Deformities
Equinus
Equinovarus
Calcaneal Deformity
Vertical Talus
Valgus Deformity of the Foot and Ankle
Distal Tibia
Distal Tibial Osteotomy
Distal Tibial Medial Hemiepiphysiodesis
Achilles Tendon–Fibular Tenodesis
Subtalar Joint
Rotational Deformities (Internal or External)
Knee Deformities
Congenital Knee-Flexion Contracture
Congenital Knee Hyperextension or Dislocation
Developmental Knee-Flexion Contracture
Knee Extension Contracture
Knee Instability or Internal Derangement
Hip Deformities
Abduction or External Rotation Contracture
Flexion Deformity
Paralytic Hip Subluxation or Dislocation
Controversies in Treatment
Reduction
Correction of Bony Abnormality
Muscle Balancing Procedures
Surgical Complications
Summary: Management of Paralytic Hip Subluxation and Dislocation
Spinal Deformities
General Management of the Spine
Kyphosis
Management of Skin Breakdown
Definitive Management
Preoperative Preparation
Kyphectomy
Technique
Results
Scoliosis
Orthotic Treatment
Spinal Fusion
Technique
Postoperative Management
Results
Hyperlordosis
Hemimyelodysplasia
Orthotic Management
General Principles of Bracing and Rehabilitation
Specific Protocols by Spinal Level
Thoracic and Upper Lumbar Levels
Lower Lumbar and Sacral Levels
Braces
Ankle-Foot Orthoses
Knee-Ankle-Foot Orthoses
Hip-Knee-Ankle-Foot Orthoses
Reciprocating Gait Orthoses
Other Mobility Aids
Standing Frame
Parapodium
Wheelchair
Other Aspects of Care
Skin
Education and Counseling
Summary
Other Forms of Spinal Dysraphism
Lipomeningocele
Clinical Features
Treatment
Tethered Cord (Thickened Filum Terminale)
Diastematomyelia
Clinical Features
Radiographic Findings
Treatment
Spina Bifida Occulta
Caudal Regression Syndrome (Sacral and Lumbosacral Agenesis)
Pathology
Classification
Renshaw Classification
Guille Classification
Clinical Features
Renshaw Types
Type I
Type II
Type III
Type IV
Guille Types
Type A
Type B
Type C
Treatment
Spinal Muscular Atrophy
Etiology
Pathogenesis
Classification
Type I: Acute Infantile
Type II: Chronic Infantile
Type III: Kugelberg-Welander
Grading
Differential Diagnosis
Diagnostic Evaluation
Treatment
Medical Treatment
Orthopaedic Treatment
Contractures
Hip Subluxation and Dislocation
Scoliosis
Nonsurgical Treatment
Surgical Treatment
References
Chapter 33: Poliomyelitis
Worldwide Eradication Efforts
Postpolio Syndrome
Pathology
Course and Prognosis
Treatment Overview
Acute Phase
Management of Respiratory Involvement
Prevention of Deformity
Management of Muscle Spasm
Convalescent Phase
Management of Muscle Spasm and Prevention of Deformity
Muscle Examination
Preserving and Restoring Neuromuscular Function
Patterns of Motor Activity
Fatigue
Contractural Deformity and Progressive Loss of Function
Chronic Phase
Physical Therapy
Active Hypertrophy Exercises
Passive Stretching Exercises
Functional Training
Orthoses and Other Apparatus
General Principles
Specific Applications
Lower Extremity
Hip
Upper Extremity
Surgical Treatment
Principles of Tendon Transfer
Postoperative Care and Training
Management of the Hip
Soft Tissue Contracture
Lower Limb
Flexion, Abduction, and External Rotation Contracture of the Hip
Flexion and Valgus Deformity of the Knee and External Torsion of the Tibia
External Torsion of the Tibia and Subluxation of the Knee Joint
Positional Pes Varus
Pelvis and Trunk
Pelvic Deformity, Lumbar Scoliosis, and Subluxation of the Contralateral Hip
Exaggerated Lumbar Lordosis
Pelvic Obliquity
Treatment
Bivalved Casts
Passive Stretching Exercises
Ober and Yount Fasciotomies
Gluteus Medius Paralysis
Iliopsoas Muscle Transfer for Lateral Stability of the Hip
External Oblique Muscle Transfer for Hip Abduction
Gluteus Maximus Paralysis
Surgical Technique (Barr)
Technique for Correction of Remaining Contractures in Poliomyelitic Deformities
Paralytic Dislocation of the Hip
Surgical Treatment
Muscle Transfer
Varization Osteotomy
Arthrodesis of the Hip
Management of the Knee
Quadriceps Femoris Paralysis
Muscle Transfer
Indications and Contraindications
Surgical Technique
Postoperative Care and Functional Training
Complications
Flexion Deformity of the Knee
Genu Recurvatum
Genu Recurvatum Caused by Stretching of the Soft Tissues in the Back of the Knee
Genu Recurvatum Resulting From Ankle Equinus and Hamstring Weakness
Flail Knee
Management of Specific Deformities of the Foot and Ankle
Normal Physiology
Treatment of Muscle Imbalance
Paralysis of the Peroneal Muscles
Paralysis of the Peroneals, Extensor Digitorum Longus, and Extensor Hallucis Longus
Paralysis of the Anterior Tibial Muscle
Paralysis of the Anterior Tibial Muscle, Toe Extensors, and Peroneals
Paralysis of the Triceps Surae Muscle
Arthrodesis of the Foot and Ankle
Triple Arthrodesis
Indications and Preoperative Considerations
Surgical Technique
Varus Deformity Correction
Valgus Deformity Correction
Calcaneus Foot Deformity Correction
Pes Equinus Deformity Correction
Extraarticular Subtalar Arthrodesis
Ankle Fusion and Pantalar Arthrodesis
Anterior or Posterior Bone Blocks to Limit Motion at the Ankle
Management of the Trunk
Management of the Shoulder
Classification
Prime Movers
Treatment by Muscle Transfer
Steering Group
Depressor Group
Treatment by Muscle and Tendon Transfer
Arthrodesis of the Shoulder
Management of the Elbow
Paralysis of the Biceps Brachii and Brachialis Muscles
Steindler Flexorplasty
Techniques
Results
Complications and Disadvantages
Pectoralis Major Muscle Transfer
Techniques and Results
Disadvantages
Pectoralis Minor Muscle Transfer
Sternocleidomastoid Muscle Transfer
Anterior Transfer of the Triceps Brachii Tendon
Techniques
Results and Disadvantages
Latissimus Dorsi Transfer
Paralysis of the Triceps Brachii Muscle
Management of the Forearm
References
Chapter 34: Disorders of the Peripheral Nervous System
Hereditary Motor and Sensory Neuropathies
Charcot-Marie-Tooth Disease
Genetics
Clinical Features
Diagnostic Evaluation
Medical Treatment
Orthopaedic Manifestations and SurgicalTreatment
Foot
Manifestations
Treatment
Hip
Spine
Hand
Manifestations
Treatment
Hypertrophic Interstitial Neuritis (Dejerine-SottasDisease)
Pathology
Clinical Features
Diagnosis
Prognosis and Treatment
Refsum Disease
Congenital and Acquired Analgia
Congenital Insensitivity to Pain
Familial Dysautonomia (Riley-Day Syndrome; Hereditary Sensory and Autonomic Neuropathy Type III)
Congenital Sensory Neuropathy
Hereditary Sensory Radicular Neuropathy (Hereditary Sensory and Autonomic Neuropathy Type I)
Congenital Insensitivity to Pain With Anhidrosis (Hereditary Sensory and Autonomic Neuropathy Type IV)
Lesch-Nyhan Syndrome
Syringomyelia
Guillain-Barré Syndrome (Acute Polyradiculoneuritis)
Cause and Pathophysiology
Diagnosis
Clinical Features
Differential Diagnosis
Treatment
Prognosis
Sciatic and Peroneal Nerve Palsy
Causes
Clinical Features
Radiographic Findings
Treatment
References
Chapter 35: Muscle Diseases
Muscular Dystrophies
Overview
Historical Background
Classification
Etiology
Pathology
Laboratory Findings
Electromyography and Nerve Conduction Velocity
Duchenne Muscular Dystrophy
Etiology and Diagnosis
Clinical Features
Physical Examination
Medical Concerns
Treatment
Gene Therapy
Corticosteroid Therapy
General Treatment
Physical Therapy
Lower Limb Surgery
Timing of Surgery
Techniques
Spinal Surgery
Timing of Surgery and Indications
Techniques
Results and Complications
Anesthetic Considerations
Upper Extremities
Fractures
Prognosis
Becker Muscular Dystrophy
Etiology and Diagnosis
Clinical Features
Medical Concerns
Treatment
Emery-Dreifuss Muscular Dystrophy
Etiology and Diagnosis
Clinical Features
Laboratory Findings
Medical Concerns
Treatment
Limb-Girdle Muscular Dystrophy
Etiology
Clinical Features
Laboratory Findings
Medical Concerns
Treatment
Facioscapulohumeral Muscular Dystrophy
Etiology
Clinical Features
Laboratory Findings
Medical Concerns
Treatment
Infantile Facioscapulohumeral Muscular Dystrophy
Scapuloperoneal Dystrophy
Congenital Muscular Dystrophy
Orthopaedic Disorders
Myotonic Dystrophy
Etiology
Clinical Features
Medical Concerns
Treatment and Prognosis
Metabolic Diseases of Muscle
Thomsen Myotonia
Pathology
Clinical Features
Laboratory Findings
Differential Diagnosis
Polymyositis and Dermatomyositis
Etiology
Diagnosis
Pathology
Clinical Features
Laboratory Findings
Treatment
Prognosis
Myositis Ossificans
Classification
Pathology
Clinical Features
Radiographic Findings
Differential Diagnosis
Treatment
Progressive Fibrosis of the Quadriceps
Etiology
Pathophysiology
Clinical Features
Treatment
Myasthenia Gravis
Incidence
Etiology
Clinical Features
Neonatal Transient Myasthenia Gravis
Congenital Myasthenic Syndromes
Juvenile Myasthenia Gravis
Diagnosis
Treatment
References
Section VII: Other Orthopaedic Disorders
Chapter 36: Skeletal Dysplasias
Overview
Nomenclature and Classification
Achondroplasia
Genetics
Pathophysiology
Clinical Features
Radiographic Findings
Diagnosis
Orthopaedic Considerations
Craniocervical Stenosis
Hypotonia
Sleep Apnea
Hydrocephalus
Thoracolumbar Kyphosis
Etiology
Treatment
Spinal Stenosis
Etiology
Clinical Features
Radiographic Findings
Treatment
Angular Deformities of the Lower Extremities
Elbow Deformity
Short Stature
Limb Lengthening
Growth Hormone
Outcomes Research
Hypochondroplasia
Genetics
Clinical Features
Radiographic Findings
Orthopaedic Considerations
Treatment
Thanatophoric Dwarfism
Genetics
Prenatal Diagnosis
Clinical Features
Radiographic Findings
Prognosis
Pseudoachondroplasia
Genetics
Pathology
Clinical Features
Radiographic Findings
Orthopaedic Considerations
Lower Extremity Malalignment
Hip
Thoracolumbar Kyphosis and Lumbar Lordosis
Cervical Atlantoaxial Instability
Scoliosis
Spondyloepiphyseal Dysplasia
Spondyloepiphyseal Dysplasia Congenita
Genetics
Clinical Features
Radiographic Findings
Orthopaedic Considerations
Spine
Lower Extremities
Pain and Joint Problems
Spondyloepiphyseal Dysplasia Tarda
Genetics
Clinical Features
Radiographic Findings
Orthopaedic Considerations
Multiple Epiphyseal Dysplasia
Genetics
Pathology
Clinical Features
Radiographic Findings
Orthopaedic Considerations
Diastrophic Dysplasia (Diastrophic Dwarfism)
Genetics
Pathology
Clinical Features
Radiographic Findings
Diagnosis
Orthopaedic Considerations
Foot
Hip
Spine
Kyphosis
Scoliosis
Prognosis
Kniest Dysplasia (Pseudometatrophic Dysplasia)
Genetics
Pathology
Clinical Features
Radiographic Findings
Treatment
Orthopaedic Considerations
Chondrodysplasia Punctata
Genetics
Pathology
Clinical Features
Radiographic Findings
Prenatal Diagnosis
Orthopaedic Considerations
Prognosis
Metaphyseal Chondrodysplasia
Jansen Type
Genetics
Clinical Features
Radiographic Findings
Laboratory Findings
Schmid Type
Genetics
Clinical Features
Radiographic Findings
Differential Diagnosis
Orthopaedic Considerations
Cartilage–Hair Hypoplasia (McKusick Type)
Genetics
Clinical Features
Radiographic Findings
Orthopaedic Considerations
Osteopetrosis
Types
Malignant Osteopetrosis
Benign or Tarda Osteopetrosis
Osteopetrosis Associated With Renal Tubular Acidosis
Genetics
Pathology
Clinical Features
Radiographic Findings
Laboratory Findings
Prenatal Diagnosis
Differential Diagnosis
Treatment
Orthopaedic Considerations
Progressive Diaphyseal Dysplasia (Camurati-­Engelmann Disease)
Genetics
Pathology
Clinical Features
Radiographic Findings
Laboratory Findings
Differential Diagnosis
Treatment
Osteopoikilosis
Genetics
Pathology
Clinical Features
Radiographic Findings
Differential Diagnosis
Clinical Course
Osteopathia Striata
Genetics
Clinical Features
Radiographic Findings
Differential Diagnosis
Clinical Course
Melorheostosis
Etiology
Pathology
Clinical Features
Radiographic Findings
Clinical Course
Differential Diagnosis
Treatment
Orthopaedic Considerations
Infantile Cortical Hyperostosis (Caffey Disease)
Genetics
Pathology
Clinical Features
Radiographic Findings
Prenatal Diagnosis
Diagnosis
Differential Diagnosis
Treatment
Orthopaedic Considerations
Clinical Course
Pyknodysostosis
Genetics
Pathology
Clinical Features
Radiographic Findings
Differential Diagnosis
Orthopaedic Considerations
Clinical Course
Cleidocranial Dysostosis
Genetics
Clinical Features
Radiographic Findings
Orthopaedic Considerations
Other Considerations
Idiopathic Osteolysis
Types
Gorham Massive Osteolysis
Hereditary Multicentric Osteolysis With Dominant Transmission
Hereditary Multicentric Osteolysis With Recessive Inheritance
Nonhereditary Multicentric Osteolysis With Nephropathy
Radiographic Findings
Differential Diagnosis
Treatment
Mucopolysaccharidoses
Diagnosis
Radiographic Findings
Types
Mucopolysaccharidosis I (Hurler Syndrome)
Genetics
Pathology
Clinical Features
Radiographic Findings
Treatment
Orthopaedic Considerations
Mucopolysaccharidosis II (Hunter Syndrome)
Genetics
Pathology
Clinical Features
Orthopaedic Considerations
Radiographic Findings
Treatment
Clinical Course
Mucopolysaccharidosis III (Sanfilippo Syndrome)
Genetics
Pathology
Clinical Features
Treatment
Mucopolysaccharidosis IV (Morquio Syndrome)
Genetics
Diagnosis
Histology
Clinical Features
Radiographic Findings
Prenatal Diagnosis
Orthopaedic Considerations
Mucopolysaccharidosis V (Scheie Syndrome)
Mucopolysaccharidosis VI (Maroteaux-Lamy Syndrome)
Mucopolysaccharidosis VII (Sly Syndrome)
Niemann-Pick Disease
References
Chapter 37: Orthopaedic-Related Syndromes
Marfan Syndrome
Heredity and Incidence
Genetics
Clinical Features
Stature and Proportion
Skull and Facies
Eyes
Cardiovascular System
Other Skeletal Manifestations
Other Associated Anomalies
Diagnosis
Differential Diagnosis
Homocystinuria
Congenital Contractural Arachnodactyly
Loeys-Dietz Syndrome
Hereditary Juvenile Ophthalmoarthropathy
Other Conditions
Treatment
Cardiovascular System
Skeletal System
Scoliosis
Protrusio Acetabuli
Developmental Dysplasia of the Hip
Generalized Joint Laxity
Infantile Marfan Syndrome
Prognosis
Hereditary Progressive Arthro-Ophthalmopathy (Stickler Syndrome)
Clinical Features
Orthopaedic Manifestations
Congenital Contractural Arachnodactyly (Beals Syndrome)
Clinical Features
Radiographic Findings
Differential Diagnosis
Treatment
Homocystinuria
Biochemical Defect and Pathophysiology
Clinical Features
Vascular Changes
Mental Retardation
Dislocation of the Lens
Skeletal Changes
Diagnosis
Treatment
Nail-Patella Syndrome (Hereditary Onycho-Osteodysplasia)
Inheritance and Genetics
Clinical Features
Radiographic Findings
Associated Anomalies
Treatment
Larsen Syndrome
Clinical Features
Neurologic Evaluation
Differential Diagnosis
Radiographic Findings
Treatment
Cervical Kyphosis
Congenital Dislocation of the Knee
Congenital Dislocation of the Hip
Foot Deformities
Congenital Dislocation of the Elbow or Radial Head
Scoliosis
Summary
Down Syndrome (Trisomy 21)
Clinical Features
Treatment
Hypermobility of the Upper Cervical Spine
Atlantoaxial Hypermobility
Occipitoatlantal Hypermobility
Upper Cervical Spine Hypermobility
Hip Disorders
Patellofemoral Disorders
Foot Disorders
Neurofibromatosis
Historical Perspective
Neurofibromatosis Type 1 (von Recklinghausen Disease)
Genetics
Diagnosis
Clinical Features
Café au Lait Spots
Axillary and Inguinal Freckling
Cutaneous Neurofibromas
Lisch Nodules
Plexiform Neurofibromas
Verrucous Hyperplasia
Optic Glioma
Skeletal Abnormalities
Spinal Deformities
Congenital Pseudarthrosis of the Tibia
Hemihypertrophy
Malignant Degeneration of Neurofibromas
Cognitive Deficits
Neurofibromatosis Type 2
Fibrodysplasia Ossificans Progressiva
Cause
Histology and Pathology
Clinical Features
Radiographic Findings
Treatment
Ehlers-Danlos Syndrome
Clinical Features
Classification
Type 1: Classic
Type 2: Hypermobility
Type 3: Vascular
Type 4: Kyphoscoliotic
Type 5: Arthrochalasis
Type 6: Dermatosparaxis
Treatment
Gaucher Disease
Genetics and Heredity
Pathology and Diagnosis
Clinical Features
Type 1
Type 2
Type 3
Orthopaedic Manifestations
Bone Marrow Infiltration
Avascular Necrosis
Bone Crises
Pathologic Fractures
Lytic Lesions
Osteomyelitis
Treatment
Splenectomy
Enzyme Replacement Therapy
Bone Marrow and Stem Cell Transplantation
Gene Therapy
Orthopaedic Treatment
Prognosis
Arthrogryposis (Arthrogryposis Multiplex Congenita)
Cause
Genetics
Pathology
Clinical Features
Classic Arthrogryposis
Distal Arthrogryposis
Differential Diagnosis
Treatment
Hips
Hip Dislocation
Hip Contractures
Knees
Knee Hyperextension and Dislocation
Knee Flexion Contractures
Feet
Talipes Equinovarus
Vertical Talus
Cavovarus Deformity
Upper Extremities
Shoulder
Elbow
Posterior Release With Tricepsplasty
Procedures to Achieve Active Elbow Flexion
Bipolar Pectoralis Major Transfer
Bipolar Latissimus Transfer
Triceps Transfer
Transfer of the Long Head of the Triceps
Steindler Flexorplasty
Unipolar Pectoralis Major Transfer (Clark Procedure)
Free Gracilis Transfer
Wrist
Dorsal, Radial Closing Wedge Osteotomy of the Midcarpus With Tendon Transfer
Proximal Row Carpectomy
Wrist Fusion
Hand
Thenar Release
Scoliosis and Spinal Deformity
Craniocarpotarsal Dysplasia (Freeman-Sheldon or Whistling Face Syndrome)
Clinical Features
Treatment
Cornelia de Lange Syndrome
Rubinstein-Taybi Syndrome
Orthopaedic Manifestations
Associated Anomalies
Treatment
Otopalatodigital Syndrome
Proteus Syndrome
Clinical Features
Diagnosis
Differential Diagnosis
Orthopaedic Manifestations
Treatment
Klippel-Trénaunay Syndrome
Pathophysiology
Clinical Features
Nevus
Varicosities
Bone and Soft-Tissue Hypertrophy
Other Associated Conditions
Diagnosis and Evaluation
Treatment
Metatropic Dwarfism (Dysplasia)
Camptomelic Dysplasia
Chondroectodermal Dysplasia (Ellis-­van Creveld Syndrome)
Genetics
Clinical Features
Radiographic Findings
Treatment
Asphyxiating Thoracic Dysplasia (Jeune Disease)
Pathology
Clinical Features and Radiographic Findings
Treatment
References
Chapter 38: Metabolic and Endocrine Disorders of Bone
Biology of Healthy Bone
Bone Cell Biology
Bone Matrix and Mineralization
Metabolic Bone Disorders
Vitamin Disorders
Vitamin D Disorders
Vitamin D Deficiency Rickets
Pathology
Laboratory Findings
Clinical Features
Radiographic Findings
Treatment of Vitamin D Deficiency
Vitamin D–Resistant Rickets
Hypophosphatemic Rickets
Laboratory Findings
Clinical Features
Radiographic Findings
Treatment
Medical Treatment
Orthopaedic Treatment
Vitamin D Dependent Rickets
Clinical Features
Treatment
Medical Treatment
Orthopaedic Treatment
Hypervitaminosis D
Pathology
Laboratory Findings
Clinical Features
Radiographic Findings
Treatment
Disorders of Vitamin A
Clinical Features
Radiographic Findings
Diagnosis
Treatment
Vitamin C Deficiency
Pathology
Clinical Features
Radiographic Findings
Differential Diagnosis
Treatment
Osteogenesis Imperfecta
Normal Type 1 Collagen Metabolism
Pathology
Classifications
Clinical Manifestation
Genotypic-Phenotypic Correlation
Radiographic Findings
Severe Form
Milder Forms
Laboratory Findings
Survival
Ambulation
Diagnosis
Differential Diagnosis
Treatment
Medical Treatment
Orthopaedic Treatment
Orthotic Treatment
Management of Long Bone Fractures
Management of Long Bone Deformity
Closed Osteoclasis Without Internal Fixation
Closed Osteoclasis With Percutaneous Intramedullary Fixation
Open Osteotomy With Intramedullary Fixation (Sofield Procedure)
Use of Extensible Intramedullary Rods
Management of Spinal Deformity
Complications
Hyperplastic Callus Formation
Acetabular Protrusion
Tumors
Cranial Base Abnormalities (Basilar Invagination, Basilar Impression, and Platybasia)
Prognostication and Parental Counseling
Osteoporosis
Radiographic Findings
Diagnosis
Treatment
Hypophosphatasia
Inheritance
Pathogenesis
Pathology
Diagnosis
Radiographic Findings
Laboratory Findings
Antenatal Diagnosis
Clinical Features
Treatment
Orthopaedic Treatment
Osteopetrosis
Clinical Features
Radiographic Findings
Diagnosis
Treatment
Medical Treatment
Renal Osteodystrophy
Pathophysiology
Pathology
Laboratory Findings
Clinical Features
Diagnosis
Treatment
Medical Treatment
Orthopaedic Treatment
Angular Deformity
Slipped Capital Femoral Epiphysis
Osteonecrosis
References
Chapter 39: Hematologic Disorders
Hemophilia
Incidence
Classification and Inheritance
Hemophilia A
Hemophilia B
von Willebrand Disease
Clinical Features
Hemorrhage
Hemophilic Arthropathy
Site of Involvement
Pathophysiology
Clinical Findings
Differential Diagnosis
Radiographic Findings
Soft Tissue Bleeding
Intramuscular and Intermuscular Hemorrhage
Diagnostic Ultrasonography
Nerve Palsy
Hemophilic Pseudotumor
Fractures
Dislocations
Myositis Ossificans
Bone Mineral Density
Treatment
Gene Therapy
Medical Management
Treatment on Demand
Prophylactic Treatment
Early Treatment of Bleeding Into Muscles and Soft Tissues
Acute Treatment of Hemarthrosis
Analgesics
Aspiration
Subacute Hemophilic Arthropathy
Chronic Hemophilic Arthropathy
Nonsurgical Treatment of Joint Deformity
Surgical Treatment of Deformity
Hematologic Management
Hemophilic Arthropathy
Synovectomy
Arthroscopic Synovectomy
Open Synovectomy
Postoperative Care
Problems and Complications
Synoviorthesis
Total Joint Replacement and Arthrodesis
Total Joint Replacement
Arthrodesis
Neurapraxia
Fractures
Flexion Contractures
Pseudotumors
Athletic Participation
Sickle Cell Disease
Cause and Pathophysiology
Orthopaedic Manifestations and Treatment
Bone Infarction
Osteomyelitis
Hand-Foot Syndrome
Vertebral Involvement
Avascular Necrosis
Surgical Considerations
Miscellaneous Bone Changes
References
Chapter 40: Pediatric Sports Medicine: Issues in Contemporary Sports Participation
Current Patterns in Pediatric Sports Participation
Sport Specialization
Overuse
Burnout
Athletic Development
Youth Athlete Development
The Pediatric Athlete’s Shoulder
Anatomy
Little League Shoulder
Pathoanatomy
History and Physical Exam Features
Imaging
Nonoperative Treatment and Therapy
Return to Play
Complications
Glenohumeral Internal Rotation Deficit
Pathoanatomy/Mechanism
History and Physical Exam Features
Imaging
Nonoperative Treatment/Therapy
Operative Treatment
Shoulder Instability
Pathoanatomy/Mechanism
History and Physical Exam
Imaging
Nonoperative Treatment
Operative Treatment
The Pediatric Athlete’s Elbow
Medial Elbow (Epicondyle Apophysitis and Avulsion)
Anatomy
Pathoanatomy/Mechanism
Medial Epicondyle Apophysitis
History and Physical Exam Features
Imaging
Nonoperative Treatment
Medial Epicondyle Avulsion
History and Physical Exam Features
Imaging
Nonoperative Treatment
Nondisplaced and Minimally Displaced Fractures
Operative Treatment
Displaced Fractures
Physical Therapy and Return to Play
Complications
Ulnar Collateral Ligament Injury
Pathoanatomy/Mechanism
History and Physical Exam Features
Imaging
Nonoperative Treatment
Operative Treatment
Lateral Elbow
Pathoanatomy/Mechanism
Osteochondroses of the Elbow (Panner Syndrome)
History and Physical Exam Features
Imaging
Nonoperative Treatment
Osteochondritis Dissecans of the Capitellum
Pathoanatomy/Mechanism
History and Physical Exam Features
Imaging
Nonoperative Treatment
Operative Treatment
Physical Therapy and Return to Play
Outcomes
Complications
The Pediatric Athlete’s Hand and Wrist
The Pediatric Athlete’s Hip
Apophysitis of the Hip and Pelvis
Femoroacetabular Impingement
Apophyseal Avulsions
The Pediatric Athlete’s Knee
Overuse Conditions
Osgood-Schlatter Syndrome
Pathoanatomy/Mechanism
History and Physical Exam Features
Imaging
Nonoperative Treatment
Operative Treatment
Complications
Sinding-Larsen-Johansson Syndrome
Pathoanatomy/Mechanism
History and Physical Exam Features
Imaging
Nonoperative Treatment
Bi-Partite Patella
Pathoanatomy/Mechanism
History and Physical Exam Features
Imaging
Nonoperative Treatment
Operative Treatment
Discoid Meniscal Pathology
Pathoanatomy
History and Physical Exam Features
Imaging
Nonoperative Treatment
Operative Treatment
Physical Therapy and Return to Play
Outcomes
Osteochondritis Dissecans
Pathoanatomy
Hereditary
History and Physical Exam Features
Imaging
Nonoperative Treatment
Operative Treatment
Stable Lesion
Locked Door and Trapdoor Lesions
Crater Lesions
Complications
Collateral Ligament Injury
Anatomy
Mechanism of Injury
Medial Collateral Ligament Injury
Fibular (Lateral) Collateral Ligament Injury
Physical Exam Features
Medial Collateral Ligament Injury
Fibular Collateral Ligament Injury
Combination Injuries
Imaging
Treatment
Medial Collateral Ligament Injury
Lateral Collateral Ligament Injury
Anterior Cruciate Ligament and Medial Collateral Ligament Injuries
Pediatric Anterior Cruciate Ligament Injuries
Anatomy
Mechanism of Injury
Clinical Features
Anterior Cruciate Ligament Injury
Radiographic Findings
Treatment: Anterior Cruciate Ligament Injury
Surgical Treatment
Skeletal Mature Anterior Cruciate Ligament Reconstruction
Skeletal Immature Anterior Cruciate Ligament Reconstruction
Complications
Pediatric Posterior Cruciate Ligament Injuries
Anatomy
Mechanism of Injury
Clinical Features
Treatment of Posterior Cruciate Ligament Injury
Meniscal Injuries
Anatomy
Mechanism of Injury
Classification
Clinical Features
Radiographic Findings
Treatment
Complications
Tibial Eminence Fractures
Anatomy
Mechanism of Injury
Classification
Clinical Features
Radiographic Findings
Treatment
Type I Fractures
Type II Fractures
Type III Fractures
Posterior Cruciate Ligament Avulsion Fractures
Complications
Patellofemoral Instability
Recurrent Patellar Instability
Pathoanatomy
Patella Alta
Torsional and Angular Deformity
Trochlear Dysplasia
Ligamentous Laxity or Disruption
History and Physical Exam Features
Imaging
Nonoperative Treatment
Operative Treatment
Reconstruction of the Medial Patellofemoral Ligament
Realignment Procedures
Physical Therapy and Return to Play
Outcomes
Complications
The Pediatric Athlete’s Ankle
Ankle Instability
Anatomy
Mechanism of Injury
History and Physical Exam
Imaging
Nonoperative Treatment
Operative Treatment
Physical Therapy/Return to Play
Outcomes
Complications
Osteochondral Lesions of the Talus
Pathoanatomy
History and Physical Exam Features
Imaging
Classification
Nonoperative Treatment
Operative Treatment
Outcomes
The Pediatric Athlete’s Foot
References