| Pediatric orthopedic injuries are a common presentation to the ED, representing 12% of pediatric visits.1 In this special feature, our authors focus on the challenge of evaluating and managing the pediatric orthopedic patient and spotlight conditions where the emergency physician (EP) might not have significant clinical experience. |
While many pediatric orthopedic injuries are the simple “bruises and bumps” of active childhood and need little more than pain control and parental education, there are some age-specific injuries that require truly emergent care in order to salvage an extremity or prevent loss of function. Differentiation between the urgent and emergent patient may not be obvious in the preverbal child or in a child whose radiographs show open growth plates and ossification centers obscuring interpretation.
This educational series begins by covering the physiological differences in pediatric musculoskeletal injuries and reviews both the general approach to examination and some pediatric splinting basics. With an enhanced awareness of the structural differences between growing and mature bones (along with their tendons and ligaments), subtle age-related injuries are less likely to be missed.
With the basics firmly in hand, we turn your attention to several common orthopedic injuries unique to children and review acute-care management. The third article deals with the frustrating diagnostic dilemma of “my child won’t walk” and explores some nontraumatic pediatric orthopedic presentations. Our series concludes with a review of some “high risk/can’t miss” pediatric injury patterns and presenting symptoms and also reminds us of injuries that might be suggestive of nonaccidental trauma as the underlying etiology.
While pediatric bones are indeed not simply little adult bones, EPs need not be intimidated in caring for these patients. A basic understanding of pediatric musculoskeletal physiology and an enhanced clinical awareness as to common injury patterns will equip most EPs with the knowledge necessary to ensure the best possible outcome for these children.