Assessment and management of pediatric orthopedic injuries
Aim: The trainee should have an understanding of orthopedic injuries in the pediatric patient and
the management of such injuries.
Objectives:
Knowledge objectives:
The trainee should have acquired the following knowledge:
 An understanding of the anatomy of the musculoskeletal system, and the changes that occur
with age
 Appreciate that ligaments are stronger than immature bone, and this changes with time,
therefore making sprains unlikely in younger children
 Knowledge of fractures that are suspicious for child abuse
 Describe the Salter-Harris classification scheme
 Appreciate the ossification centres, and how injury patterns can change with them (e.g.
elbow)
 Know that normal x-rays do not rule out fractures, especially in younger children
 Identification of gross abnormalities and the need to immobilize / splint
 Ensuring adequate analgesia is provided for musculoskeletal injuries
 Know the importance of assessing neurovascular status of an affected limb and
o know the indications for immediate reduction if neurovascular compromise is noted
o know the need for serial examination in high risk patients to be able to follow
evolving pathology (progressive neurological deficit, compartment syndrome)
 When to obtain specific x-rays and the specific views required
 Be able to describe fractures using the following parameters
o Area of injury
o Open versus closed fracture
o Angulation and displacement of deformity
o Type of fracture (linear, spiral, hairline, comminuted, torus, buckle, greenstick)
o Joint surface involvement
o Neurovascular status
 Appreciate the urgency of open fractures, while realizing the importance of stabilization
versus limb threatening injuries, including
o The choice and timing of antibiotics
o Operative debridement and management of these fractures
 Know the common dislocations for the following joints, and how to relocate them:
o Shoulder (anterior, posterior, and inferior)
o Elbow
o Hip
o Patella
o Ankle
 Identify crush injuries and monitor / treat appropriately for rhabdomyolysis
 Know the role for antibiotics and tetanus prophylaxis for open fractures
 Understand fat embolization including risks, diagnosis, and management
 Classify and manage the following upper limb injuries
o Sternoclavicular joint disruption
o Acromioclavicular joint separation (Grade I-III)
o Clavicular fractures
o Humeral fractures
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o Supracondylar fractures
o Elbow fractures
o Forearm fractures, including Galeazzi and Monteggia
o Wrist
o Fractures of the hand
Classify and manage the following lower limb injuries
o Femoral fractures (head, neck, shaft, distal)
o Patellar fractures
o Tibial plateau fractures
o Ligamentous injuries to the knee
o Ankle fractures
o Foot fractures
Appreciate that child abuse often manifests in musculoskeletal injuries (fractures are second
most common injury seen after skin lesions)
Understand the Gustillo classification of open fractures
Skills objectives:
The trainee should have an understanding of the following skill set:
 Understand the role for operative management versus conservative treatment for
musculoskeletal injuries, and the need for orthopedic consultation
 Reduction techniques for the following joints:
o Elbow
o Finger
o Shoulder
o Knee
o Patella
o Hip
o Ankle
 Be able to splint most fractures, and assess for neurovascular integrity before and after
immobilization
 Assess a patient for compartment syndrome
 Be able to interpret musculoskeletal x-rays
 Understand how compartment pressures are measured and what pressure cut-offs mandate
immediate fasciotomy
 Complete and thorough hand exam ,assessing for neurovascular status and tendon function
 Use and application of splints for older children to immobilize femoral fractures
 Know how to properly examine the major joints in the body
 The Ottawa ankle and knee rules and the applicability at different ages