By Richard J. Mier M.D., Thomas D. Brower M.D. (auth.)
Many residency courses in fundamental care specialties don't give you the schooling in pediatric orthopedics essential to successfully take care of the field's demanding situations. the following, the authors current a framework for the powerful overview of adolescence musculoskeletal difficulties in a pragmatic and problem-based demeanour. the amount comprises case reports and over 2 hundred illustrations.
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Extra info for Pediatric Orthopedics: A Guide for the Primary Care Physician
Mild analgesics, like acetaminophen, used judiciously or ice packs may also be helpful. 15. Other Mechanical Knee Problems Other painful intraarticular problems involving the knee are handled in other parts of this book. 9. Patella alta laterally deviated IS 49 demonstrated m this AP knee film, with the patella (P) hlgh-ndmg and knee as dIscoid meniscus. See Chapter 8 for overuse or ligamentous injuries affecting the knees of young athletes. 16. Osteochondritis Dissecans (OD) OD is a local degenerative lesIOn of articular cartilage and bone which generally affects adolescents and older children.
If internal rotation or abduction is reduced or if a flexion contracture is present, anteroposterior and frog-leg lateral X-rays of the hip should be obtained. If initial films are negative but the diagnosis remains a possibility, repeat the X-rays in 1 month. Technetium bone scanning or MRI may be useful as well for early lesions. MRI is now considered by some to be the more sensitive imaging technique for these early lesions. Differential diagnosis includes a variety of structural lesions which are usually apparent on X-ray, like residual from old hip dysplasia, idiopathic chondrolysis of the hip, slipped capital femoral epiphysis, spondyloepiphyseal dysplasia, or a variety of inflammatory processes which should be demonstrable with a CBC and sedimentation rate, like osteomyelitis or septic arthritis.
1990). Girls are more often affected than boys. Though the etiology of RSD in children is unknown, psychosocial factors are thought to playa significant role in causation. Sherry and Weisman (1988) found an overly close, enmeshed relationship between affected children and their parents in the 21 families they studied. Overt or covert marital discord were also common as were school problems. They found the typical RSD patient to be a preadolescent girl, compliant and overachieving, trying her best to deal with excessive stress related to family dynamics or school problems or both.