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Pediatric Orthopaedics and Sports Injuries: A Quick Reference Guide PDF

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Pediatric Orthopaedics A P Q e Pediatric u d ic i k a and Sports Injuries R t e r f i e c re O Orthopaedics n A Quick Reference Guide 3rd Edition c e r G t John F. Sarwark, MD, FAAP, FAAOS • Cynthia R. LaBella, MD, FAAP, FAMSSM u h id o Fully updated and revised, the third edition of this quick reference delivers targeted e guidance on the diagnosis, treatment, and management of musculoskeletal problems p and Sports Injuries a and sports-related injuries. e You’ll turn here often for concise summaries of disorders and injuries; proven 3 d evaluation, treatment, and rehabilitation approaches; practice-tested tips; and invaluable r d i clinical pearls. c E s EFFICIENTLY RESPOND TO DIVERSE CLINICAL CHALLENGES. dit a A Quick Reference Guide Get all the essentials for addressing io n • Common sports injuries n • Fractures NEW IN THE 3RD EDITION d • Trauma • Femoroacetabular impingement S 3rd Edition • Limb disorders • Pediatric athletes with disabilities p • Spine disorders • Bone health evaluation o • Hip and pelvis disorders Plus, you’ll fi nd step-by-step help r • Infections with musculoskeletal examina- t • Tumors tion and evaluation, casting and s • Skeletal dysplasias splinting, imaging techniques, and I • And more… rehabilitation strategies. n j u FAST-ACCESS FEATURES r STREAMLINE ORTHOPAEDIC HELP YOU GET RIGHT TO i e PROBLEM-SOLVING. THE POINT. s Each condition-focused chapter steps you Bulleted, outline-format text through every stage of patient care. lets you rapidly focus in on what • Etiology/epidemiology you need. • Signs and symptoms Full-color clinical photographs • Differential diagnosis and illustrations, as well as radio- • Diagnostic considerations graphic images, demonstrate exami- SA • Treatment nation techniques and pathologic R • Expected outcomes/prognosis physical fi ndings. Multiple tables W • When to refer and fi gures help simplify diagnosis. AR K • For other pediatric resources, visit the American Academy of Pediatrics at L A shop.aap.org. B E L L A John F. Sarwark, MD, FAAP, FAAOS • Cynthia R. LaBella, MD, FAAP, FAMSSM AAP Pediatric Orthopaedics and Sports Injuries A Quick Reference Guide 3rd Edition John F. Sarwark, MD, FAAP, FAAOS Cynthia R. LaBella, MD, FAAP, FAMSSM American Academy of Pediatrics Publishing Staff Mary Lou White, Chief Product and Services Officer/SVP, Membership, Marketing, and Publishing Mark Grimes, Vice President, Publishing Chris Wiberg, Senior Editor, Professional/Clinical Publishing Theresa Wiener, Production Manager, Clinical and Professional Publications Mary Louise Carr, MBA, Marketing Manager, Clinical Publications Published by the American Academy of Pediatrics 345 Park Blvd Itasca, IL 60143 Telephone: 630/626-6000 Facsimile: 847/434-8000 www.aap.org The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults. The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. Any websites, brand names, products, or manufacturers are mentioned for informational and identification purposes only and do not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication. The publishers have made every effort to trace the copyright holders for borrowed material. If they have inadvertently overlooked any, they will be pleased to make the necessary arrangements at the first opportunity. This publication has been developed by the American Academy of Pediatrics. The authors, editors, and contributors are expert authorities in the field of pediatrics. No commercial involvement of any kind has been solicited or accepted in the development of the content of this publication. Disclosures: Dr Andras disclosed a consultant/speaker relationship with Zimmer Biomet, Medtronic, and Nuvasive; and a stockholder relationship with Eli Lily. Dr Davids disclosed a consultant relationship with Orthopediatrics, Inc. Dr Fingarson disclosed an expert witness relationship with Illinois state courts. Dr Andrew Gregory disclosed a board of directors relationship with PRISM and an editor relationship with UpToDate. Dr James disclosed a deputy editor relationship with Journal of Bone and Joint Surgery. Dr Kocher disclosed a consultant relationship with Orthopediatrics, Ossur, Best Doctors, Smith & Nephew, Saunders/Mosby-Elsevier, and Wolters Kluwer Health/Lippincott Williams & Wilkins; a royalties relationship with Saunders/Mosby-Elsevier and Lippincott Williams & Wilkins; and an advisory board member relationship with PRISM. Dr Koutures disclosed an independent contractor relationship with SLACK Publishing and a consultant relationship with TeleAT Services. Dr Listernick disclosed a consultant relationship with AstraZeneca. Dr Peterson disclosed a royalties relationship with McGraw-Hill, a board of directors relationship with the American Medical Society for Sports Medicine, and a spouse/partner’s consultant relationship with Rhythm Pharmaceuticals. Dr Vitale disclosed a consultant relationship with Stryker Spine and Zimmer Biomet Spine. Dr Walter disclosed a consultant relationship with the National Football League and an advisory board relationship with Wisconsin Interscholastic Athletic Association. Dr Weiss Kelly disclosed an employee relationship with the National Football League. Every effort has been made to ensure that the drug selection and dosages set forth in this text are in accordance with the current recommendations and practice at the time of publication. It is the responsibility of the health care professional to check the package insert of each drug for any change in indications or dosage and for added warnings and precautions. Every effort is made to keep Pediatric Orthopaedics and Sports Injuries: A Quick Reference Guide consistent with the most recent advice and information available from the American Academy of Pediatrics. Please visit www.aap.org/errata for an up-to-date list of any applicable errata for this publication. Special discounts are available for bulk purchases of this publication. Email Special Sales at nationalaccounts@ aap.org for more information. © 2021 American Academy of Pediatrics All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means—electronic, mechanical, photocopying, recording, or otherwise—without prior written permission from the publisher (locate title at https://ebooks.aappublications.org and click on © Get permissions; you may also fax the permissions editor at 847/434-8780 or email [email protected]). First edition published 2010; second, 2014. Printed in the United States of America 9-460/0621 1 2 3 4 5 6 7 8 9 10 MA1018 ISBN: 978-1-61002-504-1 eBook: 978-1-61002-505-8 Cover and publication design by Peg Mulcahy Library of Congress Control Number: 2020944032 To the pediatricians, primary care professionals, medical/surgical specialists, residents and fellows in training, health care professionals in training, and research professionals who devote their careers to the well-being of our children Contents EDITORS/CONTRIBUTORS �������������������������������������������������������������������������������������ix PREFACE ����������������������������������������������������������������������������������������������������������������xv PART 1 GROWTH AND MOTOR DEVELOPMENT���������������������������������������������1 Chapter 1 Typical Growth and Motor Development .................................................3 Chapter 2 Atypical Musculoskeletal Growth and Motor Development .....................17 PART 2 MUSCULOSKELETAL EVALUATION ����������������������������������������������������23 Chapter 3 History .................................................................................................25 Chapter 4 Physical Examination ............................................................................33 Chapter 5 Musculoskeletal Imaging Studies ...........................................................63 Chapter 6 Laboratory Studies ................................................................................75 PART 3 MUSCULOSKELETAL INFECTIONS �����������������������������������������������������79 Chapter 7 Osteomyelitis ........................................................................................81 Chapter 8 Septic Arthritis ......................................................................................95 Chapter 9 Miscellaneous Infections ......................................................................101 PART 4 EVALUATING THE LIMPING CHILD ��������������������������������������������������107 Chapter 10 The Limping Child: General Approach and Differential Diagnosis ........109 PART 5 SPINAL DEFORMITIES ���������������������������������������������������������������������119 Chapter 11 Idiopathic Scoliosis and Congenital Scoliosis ........................................121 Chapter 12 Kyphosis .............................................................................................133 Chapter 13 Spondylolysis and Spondylolisthesis .....................................................141 PART 6 BACK PAIN ���������������������������������������������������������������������������������������151 Chapter 14 Back Pain: General Approach and Differential Diagnosis. ......................153 PART 7 PEDIATRIC CERVICAL SPINE ������������������������������������������������������������163 Chapter 15 Pediatric Cervical Spine: Basic Radiographic Interpretation ..................165 Chapter 16 Torticollis ...........................................................................................171 Chapter 17 Atlantoaxial Rotatory Subluxation or Fixation ......................................179 PART 8 HIP DISORDERS �������������������������������������������������������������������������������187 Chapter 18 Developmental Dysplasia of the Hip ....................................................189 Chapter 19 Perthes Disease ...................................................................................195 Chapter 20 Slipped Capital Femoral Epiphysis .......................................................199 Chapter 21 Snapping Hip ......................................................................................205 Chapter 22 Femoroacetabular Impingement ..........................................................211 vi Contents PART 9 ROTATIONAL AND ANGULAR DEFORMITIES ����������������������������������219 Chapter 23 Rotational and Angular Deformities: General Treatment Guidelines ......221 Chapter 24 In-toeing .............................................................................................223 Chapter 25 Out-toeing ..........................................................................................229 Chapter 26 Angular Variations: Genu Varum (Bowleg) and Genu Valgum (Knock-Knee) .....................................................................................231 PART 10 UPPER EXTREMITY PROBLEMS �������������������������������������������������������235 Chapter 27 Brachial Plexus Injuries .......................................................................237 Chapter 28 Nursemaid Elbow (Radial Head Subluxation) ......................................249 Chapter 29 Congenital Upper Limb Differences .....................................................253 PART 11 PEDIATRIC SPORTS MEDICINE AND INJURIES ��������������������������������271 Chapter 30 Preparticipation Physical Evaluation.....................................................273 Chapter 31 Strains, Sprains, and Dislocations ........................................................283 Chapter 32 Traumatic Muscle Injuries ...................................................................301 Chapter 33 Overuse Injuries ..................................................................................311 Chapter 34 Patellofemoral Disorders .....................................................................343 Chapter 35 Internal Derangement of the Knee (Knee Injury) .................................355 Chapter 36 Sports-Related Concussion ..................................................................375 Chapter 37 Pediatric Athletes With Disabilities .......................................................389 PART 12 COMMON FRACTURES AND PHYSEAL INJURIES ���������������������������405 Chapter 38 Pediatric Trauma Overview ..................................................................407 Chapter 39 Imaging Fractures ...............................................................................409 Chapter 40 Fracture Types Overview .....................................................................411 Chapter 41 Stages of Fracture Healing ...................................................................415 Chapter 42 Physeal Fractures ................................................................................419 Chapter 43 Bone Health Evaluation in the Child Vulnerable to Fracture ..................425 Chapter 44 Common Fractures of the Upper Extremities .......................................433 Chapter 45 Common Fractures of the Lower Extremities .......................................451 Chapter 46 Casting and Splinting ..........................................................................465 Chapter 47 Occult Fractures (Injury Not Detected by Radiography) .......................479 Chapter 48 Compartment Syndrome .....................................................................483 Chapter 49 Nonaccidental Trauma ........................................................................489 PART 13 FOOT AND ANKLE ��������������������������������������������������������������������������499 Chapter 50 Foot and Ankle: General Considerations ..............................................501 Chapter 51 Clubfoot .............................................................................................505 Chapter 52 Flatfoot ...............................................................................................511 Chapter 53 Metatarsus Adductus and Metatarsus Varus ..........................................515 Chapter 54 Pes Cavus and Cavovarus ....................................................................519 Chapter 55 Calcaneal Valgus ..................................................................................523 Chapter 56 Foot and Ankle: Miscellaneous Conditions ...........................................525 Contents vii PART 14 BENIGN AND MALIGNANT MUSCULOSKELETAL TUMORS ������������547 Chapter 57 Evaluation of Benign and Malignant Musculoskeletal Tumors ...............549 Chapter 58 Common Benign Tumors ....................................................................555 Chapter 59 Malignant Tumors ...............................................................................577 PART 15 LIMB-LENGTH DISCREPANCY ����������������������������������������������������������589 Chapter 60 Limb-Length Discrepancy ...................................................................591 PART 16 NEUROMUSCULAR DISORDERS, PART 1 �����������������������������������������601 Chapter 61 Cerebral Palsy .....................................................................................603 Chapter 62 Myelomeningocele (Spina Bifida) ........................................................611 PART 17 NEUROMUSCULAR DISORDERS, PART 2 �����������������������������������������621 Chapter 63 Neurodegenerative Disorders ...............................................................623 Chapter 64 Hereditary Neuropathies: Charcot-Marie-Tooth Disease .......................631 Chapter 65 Spinal Muscular Atrophy .....................................................................637 Chapter 66 Friedreich Ataxia .................................................................................645 Chapter 67 Arthrogryposis ....................................................................................653 PART 18 GENETIC DISEASES AND SYNDROMES WITH MUSCULOSKELETAL MANIFESTATIONS ������������������������������������������661 Chapter 68 Skeletal Dysplasias ..............................................................................663 Chapter 69 Metabolic Bone Diseases .....................................................................675 Chapter 70 Neurofibromatosis 1 ............................................................................683 Chapter 71 Hemophilia .........................................................................................689 Chapter 72 Achondroplasia ...................................................................................695 Chapter 73 Down Syndrome .................................................................................701 PART 19 RHEUMATOLOGIC AND CONNECTIVE TISSUE DISEASES ��������������707 Chapter 74 Juvenile Idiopathic Arthritis .................................................................709 Chapter 75 Autoimmune Connective Tissue Diseases .............................................723 Chapter 76 Inherited Connective Tissue Diseases ...................................................737 INDEX ���������������������������������������������������������������������������������������������������������������� 747 Editors John F. Sarwark, MD, FAAP, FAAOS Cynthia R. LaBella, MD, FAAP, Professor of Orthopaedic Surgery FAMSSM Northwestern University Feinberg School of Professor of Pediatrics Medicine Northwestern University Feinberg School of Martha Washington Professor of Medicine Orthopaedic Surgery Medical Director, Institute for Sports Head, Orthopaedic Surgery Medicine Ann & Robert H. Lurie Children’s Hospital Ann & Robert H. Lurie Children’s Hospital of Chicago of Chicago Chicago, IL Chicago, IL Contributing Authors Lindsay M. Andras, MD, FAAP Jennette L. Boakes, MD Associate Professor of Orthopaedic Surgery Pediatric Orthopaedic Surgeon Children’s Orthopaedic Center Shriners Hospitals for Children – Northern Children’s Hospital Los Angeles California Los Angeles, CA Clinical Professor of Orthopaedic Surgery University of California, Davis School of Arvind Balaji, MD, FAAP Medicine Fellow, Primary Care Sports Medicine California Northstate University College of Children’s Hospital of Philadelphia Medicine Philadelphia, PA Sacramento, CA Holly J. Benjamin, MD, FAAP, Susannah M. Briskin, MD, FAAP FACSM Associate Professor of Pediatrics Professor of Orthopaedic Surgery and Division of Pediatric Sports Medicine Rehabilitation Medicine Rainbow Babies & Children’s Hospital Professor of Pediatrics University Hospitals Cleveland Director of Primary Care Sports Medicine Medical Center University of Chicago Cleveland, OH Chicago, IL Rebecca Carl, MD, MS, FAAP David T. Bernhardt, MD, FAAP Institute for Sports Medicine Professor Ann & Robert H. Lurie Children’s Hospital Department of Pediatrics of Chicago Department of Orthopedics and Assistant Professor of Pediatrics Rehabilitation Northwestern University Feinberg School of Division of Sports Medicine Medicine University of Wisconsin School of Medicine Chicago, IL and Public Health Madison, WI

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