Radial Head Subluxation (Nursemaid’s elbow)

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Normally head of radius is fixed in radial notch of the ulna by mature annular ligament.

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Epidemiology

• Children < 5 years.

Cause

• Sudden pull on the arm→ immature annular ligament slipping over the head of the radius.

Presentation

• Injured arm held in a slightly flexed and pronated position.

• Other pictures

Osgood-Schlatter Disease (Traction apophysitis)

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Anatomy correlates

• The quadriceps tendon inserts at the superior pole of the patella and wraps distally around the patella to become the patellar tendon, which inserts at the tibial tuberosity.
• Anatomy of the lateral knee </aside>

Epidemiology

• Occurs in adolescents after a growth spurt
• Common in athletes who run and jump.

Cause

• Overuse (especially sports involving sprinting and jumping) during the ossification period (adolescence) → excessive strain and repeated avulsion of the patellar ligament on the tibial tuberosity → inflammation → traction apophysitis.

Presentation

• Progressive anterior knee pain.

• Other pictures

Patellofemoral Syndrome

Etiology

• Overuse injury

Epidemiology

• Common in young, female athletes.

Presentation

• Retropatellar or peripatellar pain worsened by
  • Flexion of the knee while weight-bearing, e.g., jumping, squatting, running, ascending or descending stairs
  • Periods of prolonged sitting
• Crepitus during knee flexion

Developmental Dysplasia of the Hip

Cause

• Abnormal acetabulum development in newborns→ hip instability or dislocation.

Risk factors

• Breech presentation

Diagnosis

• Maneuvers
  • Ortolani and Barlow maneuvers → manipulation of newborn hip reveals a “clunk”.
• Imaging
  • Confirmed via ultrasound
  • X-ray not used until ~4–6 months because cartilage is not ossified.

• Overlay

Legg-Calvé-Perthes Disease

Epidemiology

• 5–7 years.
• More common in males (4:1 ratio).

Cause

• Avascular necrosis of the femoral head due to a mismatch between the rapid growth of the femoral epiphyses and the slower development of adequate blood supply to the area

Presentation

• Insidious onset of hip pain that may cause the child to limp.
• Imaging
  • Initial x-ray often normal.

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• Other Pictures

Slipped Capital Femoral Epiphysis

Demographics

• Classically presents in an obese young adolescent.

Pathophysiology

• ↑ axial force on the femoral head→ the epiphysis displaces relative to the femoral neck (like a scoop of ice cream slipping off a cone)

Presentation

• Hip/knee pain
• Altered gait
• Imaging
  • Diagnosed via x-ray.

• Overlay

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Common Pediatric Fractures

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Incomplete fractures are more common in children due to stronger periosteum.

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Achondroplasia