Tachdjian's Pediatric Orthopaedics: From the Texas Scottish Rite Hospital for Children

2397 Pages·2021·174.064 MB·English

by  John A. Herring

Volume One
Tachdjian’s
Pediatric
Orthopaedics
From the Texas Scottish Rite Hospital for Children
John A. Herring, MD
Chief of Staff Emeritus
Department of Orthopaedic Surgery
Texas Scottish Rite Hospital for Children
Professor
Department of Orthopaedic Surgery
University of Texas Southwestern Medical Center
Dallas, Texas
Sixth Edition
Volume Two
Tachdjian’s
Pediatric
Orthopaedics
From the Texas Scottish Rite Hospital for Children
John A. Herring, MD
Chief of Staff Emeritus
Department of Orthopaedic Surgery
Texas Scottish Rite Hospital for Children
Professor
Department of Orthopaedic Surgery
University of Texas Southwestern Medical Center
Dallas, Texas
Sixth Edition
Elsevier
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TACHDJIAN’S PEDIATRIC ORTHOPAEDICS: FROM THE ISBN: 978- 0- 323- 56769- 5
TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN: SIXTH EDITION VOL I: 978- 0- 323- 79169- 4
VOL II: 978- 0- 323- 79170- 0
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CONTRI BU T OR S
Megan E. Anderson, MD Christine A. Ho, MD
Orthopedic Surgeon Staff Orthopaedist
Orthopedic Center Department of Orthopaedic Surgery
Boston Children’s Hospital Texas Scottish Rite Hospital for Children
Assistant Professor of Orthopedic Surgery Division Director
Harvard Medical School Department of Pediatric Orthopaedics
Boston, Massachusetts Children’s Health Dallas
Professor
Jane S. Chung, MD Department of Orthopaedic Surgery
Staff Sports Medicine Physician University of Texas Southwestern Medical School
Department of Orthopaedics Dallas, Texas
Texas Scottish Rite Hospital for Children
Assistant Professor Charles E. Johnston, MD
Department of Orthopaedic Surgery Chief of Staff Emeritus
University of Texas Southwestern Medical Center Department of Orthopaedic Surgery
Dallas, Texas Texas Scottish Rite Hospital for Children
Professor
Lawson A.B. Copley, MD, MBA Department of Orthopaedic Surgery
Professor University of Texas Southwestern Medical Center
Departments of Orthopaedic Surgery and Pediatrics Dallas, Texas
University of Texas Southwestern Medical Center
Pediatric Orthopaedic Surgeon Lori A. Karol, MD
Department of Orthopaedic Surgery Chief
Children’s Medical Center of Dallas Division of Pediatric Orthopaedic Surgery
Dallas, Texas Rose Brown Chair of Pediatric Orthopaedics
Professor
Donald Cummings, CP, LP Department of Orthopedics
Director of Prosthetics University of Colorado School of Medicine
Texas Scottish Rite Hospital for Children Aurora, Colorado
Dallas, Texas
Harry K.W. Kim, MD
Henry Bone Ellis, Jr., MD Director
Staff Sports Medicine Surgeon Center for Excellence in Hip Disorders
Department of Orthopaedic Surgery Texas Scottish Rite Hospital for Children
Texas Scottish Rite Hospital for Children Professor
Associate Professor Department of Orthopaedic Surgery
Department of Orthopaedic Surgery University of Texas Southwestern Medical Center
University of Texas Southwestern Medical Center Dallas, Texas
Staff Orthopaedic Surgeon
Department of Orthopaedics Amy Lake, OTR, CHT
Children’s Medical Center Occupational Therapist
Dallas, Texas Texas Scottish Rite Hospital for Children
Dallas, Texas
John A. Herring, MD
Chief of Staff Emeritus Amy L. McIntosh, MD
Department of Orthopaedic Surgery Associate Professor
Texas Scottish Rite Hospital for Children Department of Orthopaedic Surgery
Professor Texas Scottish Rite Hospital for Children
Department of Orthopaedic Surgery Dallas, Texas
University of Texas Southwestern Medical Center
Dallas, Texas
v
vi Contributors
Scott Oishi, MD Mouin G. Seikaly, MD
Director of Hand Service Medical Director
Texas Scottish Rite Hospital for Children Metabolic Bone Disease Clinic
Professor Texas Scottish Rite Hospital for Children
Department of Orthopaedic and Plastic Surgery Professor
University of Texas Southwestern Medical School Department of Pediatric Nephrology
Dallas, Texas University of Texas Southwestern Medical Center
Dallas, Texas
David Podeszwa, MD
Pediatric Orthopedic Surgeon Chris Stutz, MD
Co- director, Center for Excellence in Limb Lengthening Staff Hand Surgeon
Texas Scottish Rite Hospital for Children Hand Service
Professor Texas Scottish Rite Hospital for Children
Department of Orthopaedic Surgery Assistant Professor
University of Texas Southwestern Medical Center Department of Orthopaedic Surgery
Dallas, Texas University of Texas Southwestern Medical Center
Dallas, Texas
Marilyn Purano, MD
Professor of Pediatrics Daniel J. Sucato, MD
University of Texas Southwestern Medical School Chief of Staff
Dallas, Texas Department of Orthopaedic Surgery
Texas Scottish Rite Hospital for Children
Brandon A. Ramo, MD Professor
Staff Orthopaedist Department of Orthopaedic Surgery
Department of Orthopaedic Surgery University of Texas Southwestern Medical Center
Texas Scottish Rite Hospital for Children Dallas, Texas
Dallas, Texas
Philip Wilson, MD
Karl E. Rathjen, MD Assistant Chief of Staff
Assistant Chief of Staff Department of Orthopaedic Surgery
Department of Orthopaedic Surgery Texas Scottish Rite Hospital for Children
Texas Scottish Rite Hospital for Children Professor
Professor Department of Orthopaedic Surgery
Department of Orthopaedic Surgery University of Texas Southwestern Medical Center
University of Texas Southwestern Medical Center Dallas, Texas, Assistant Chief of Staff
Dallas, Texas Director, Pediatric Sports Medicine
Department of Sports Medicine and Orthopaedics
Anthony I. Riccio, MD Texas Scottish Rite Hospital for Children North
Staff Orthopaedic Surgeon Frisco, Texas
Department of Orthopaedic Surgery
Texas Scottish Rite Hospital for Children Robert Lane Wimberly, MD
Professor Medical Director of Movement Science
Department of Orthopaedic Surgery Texas Scottish Rite Hospital for Children
University of Texas Southwestern Medical Center Associate Professor
Dallas, Texas Department of Orthopaedic Surgery
University of Texas Southwestern Medical Center
B. Stephens Richards, MD Dallas, Texas
Chief Medical Officer
Texas Scottish Rite Hospital for Children
Professor
Department of Orthopaedic Surgery
University of Texas Southwestern Medical Center
Dallas, Texas
PRE FACE
This edition of Tachdjian’s Pediatric Orthopaedics is the The authors of this book are experienced clinicians
fourth that has been written and edited by the staff of the with expertise and training in pediatric orthopaedics,
Texas Scottish Rite Hospital for Children. As we research and most have subspeciality interests and expertise. They
and reevaluate each chapter, we are usually surprised to are leaders in their fields and base their discussions and
see how many things have changed between editions. recommendations on a very rich clinical experience in
For example, in recent years we have seen considerable an academic practice. An important feature of our aca-
growth in the knowledge and practice in the field of demic environment is the vigorous preoperative group
pediatric sports subspecialization. In recognition of this discussion of surgical procedures. As academic leaders,
growth, we have added a new chapter dedicated to pedi- they regularly present their research at national and inter-
atric and adolescent sports conditions, which includes national meetings. Their work is widely published and
the most recent developments in the management of broadly respected.
concussion. In the scoliosis chapter, exciting new infor- Users of the text include students from all levels from
mation about the rapidly evolving management of early medical school, residency, fellowship, new and estab-
onset scoliosis has been added, including important non- lished physicians, and non-p hysician practitioners, as well
operative measures such as serial casting and bracing, as as established professors as they augment their publica-
well as the use of tethering. The field of genetics is con- tions. The text of this edition is fully produced in two print
tinually expanding, and genetics-related content, which volumes. To lighten the load of the textbook, a compre-
appears in many of our chapters, has been updated to hensive bibliography is available in the online version. This
reflect current understanding. placement facilitates Internet access to other resources.
Twenty years ago, we took on the challenge to build As in prior editions, our popular surgical videos are
on the groundwork laid by Dr. Mirhan Tachdjian in his available online. These videos present the important steps
two editions. Our goal has been to produce a textbook of actual surgical cases and are narrated by the operating
that fully encompasses the broad field of pediatric ortho- surgeons. We receive frequent positive comments from
paedics. We have based our descriptions on the best avail- surgeons throughout the world who find these very use-
able published knowledge. We have sought to present the ful for planning their surgical procedures. Other videos in
most current evidence from the literature from level 1 to the collection cover non- operative subjects such as cast
5 in a succinct and readable format. We have augmented application for scoliosis, club foot casting, and Pavlik har-
the discussions with recommendations based on personal ness application.
experiences of a top-l evel clinical faculty. When presenting I am sincerely grateful to each of our authors and truly
controversial topics, we prefer to give the reader the evi- appreciate the effort involved in making the sixth edition a
dence from the different arguments so that the reader can reality. We welcome two new authors, Dr. Jane Chung and
make a reasoned decision after reviewing the conflicting Dr. Shane Miller, who are pediatric- trained practitioners
evidence. We carefully avoid the “cookbook” approach in with expertise in sports medicine. We continue to be grate-
which one puts forth their preferred treatment as gospel. ful for the contribution of our Boston colleagues, Professor
We continue to insist that our text be comprehensive, Mark Gebhardt and Dr. Megan Anderson, who are respon-
even though a shorter text would be more convenient to sible for the chapter on malignant tumors. I especially want
handle. We fully present each topic, include the descrip- to thank my administrative assistant, Louise Hamilton, who
tion of a disorder, and discuss appropriate history and had the huge task of putting the whole project together.
physical exam, relevant studies, differential diagnosis, and She was able to devote the time needed for this edition
details of treatment. We believe that it is important to because of coverage by the other administrative assistants,
present the important details of decision making, and we including Stacy Duckworth, Lisa Sherman, Rebecca Fuller,
emphasize the complexity of overall patient care. Our sur- Amy Park, and our administrative director, Laura Griffiths.
gical discussions stress proper preoperative planning and Again, our heartfelt appreciation goes to our families, who
preparation, as well as description of operative details. We are vitally important in every facet of our lives; thanks for
also provide the important postoperative protocols that giving us your support and understanding.
are necessary to ensure the best results.
John A. Herring, MD
vii
PRE FACE
This edition of Tachdjian’s Pediatric Orthopaedics is the The authors of this book are experienced clinicians
fourth that has been written and edited by the staff of the with expertise and training in pediatric orthopaedics,
Texas Scottish Rite Hospital for Children. As we research and most have subspeciality interests and expertise. They
and reevaluate each chapter, we are usually surprised to are leaders in their fields and base their discussions and
see how many things have changed between editions. recommendations on a very rich clinical experience in
For example, in recent years we have seen considerable an academic practice. An important feature of our aca-
growth in the knowledge and practice in the field of demic environment is the vigorous preoperative group
pediatric sports subspecialization. In recognition of this discussion of surgical procedures. As academic leaders,
growth, we have added a new chapter dedicated to pedi- they regularly present their research at national and inter-
atric and adolescent sports conditions, which includes national meetings. Their work is widely published and
the most recent developments in the management of broadly respected.
concussion. In the scoliosis chapter, exciting new infor- Users of the text include students from all levels from
mation about the rapidly evolving management of early medical school, residency, fellowship, new and estab-
onset scoliosis has been added, including important non- lished physicians, and non-p hysician practitioners, as well
operative measures such as serial casting and bracing, as as established professors as they augment their publica-
well as the use of tethering. The field of genetics is con- tions. The text of this edition is fully produced in two print
tinually expanding, and genetics-related content, which volumes. To lighten the load of the textbook, a compre-
appears in many of our chapters, has been updated to hensive bibliography is available in the online version. This
reflect current understanding. placement facilitates Internet access to other resources.
Twenty years ago, we took on the challenge to build As in prior editions, our popular surgical videos are
on the groundwork laid by Dr. Mirhan Tachdjian in his available online. These videos present the important steps
two editions. Our goal has been to produce a textbook of actual surgical cases and are narrated by the operating
that fully encompasses the broad field of pediatric ortho- surgeons. We receive frequent positive comments from sur-
paedics. We have based our descriptions on the best avail- geons throughout the world who find these very useful for
able published knowledge. We have sought to present the planning their surgical procedures. Other videos in the col-
most current evidence from the literature from level 1 to lection cover non-o perative subjects such as cast application
5 in a succinct and readable format. We have augmented for scoliosis, club foot casting, and Pavlik harness application.
the discussions with recommendations based on personal I am sincerely grateful to each of our authors and truly
experiences of a top- level clinical faculty. When presenting appreciate the effort involved in making the sixth edition a
controversial topics, we prefer to give the reader the evi- reality. We welcome two new authors, Dr. Jane Chung and
dence from the different arguments so that the reader can Dr. Shane Miller, who are pediatric- trained practitioners
make a reasoned decision after reviewing the conflicting with expertise in sports medicine. We continue to be grate-
evidence. We carefully avoid the “cookbook” approach in ful for the contribution of our Boston colleagues, Professor
which one puts forth their preferred treatment as gospel. Mark Gebhardt and Dr. Megan Anderson, who are respon-
We continue to insist that our text be comprehensive, sible for the chapter on malignant tumors. I especially want
even though a shorter text would be more convenient to to thank my administrative assistant, Louise Hamilton, who
handle. We fully present each topic, include the descrip- had the huge task of putting the whole project together.
tion of a disorder, and discuss appropriate history and She was able to devote the time needed for this edition
physical exam, relevant studies, differential diagnosis, and because of coverage by the other administrative assistants,
details of treatment. We believe that it is important to including Stacy Duckworth, Lisa Sherman, Rebecca Fuller,
present the important details of decision making, and we Amy Park, and our administrative director, Laura Griffiths.
emphasize the complexity of overall patient care. Our sur- Again, our heartfelt appreciation goes to our families, who
gical discussions stress proper preoperative planning and are vitally important in every facet of our lives; thanks for
preparation, as well as description of operative details. We giving us your support and understanding.
also provide the important postoperative protocols that
are necessary to ensure the best results. John A. Herring, MD
vii
C H A P T E R 1
Growth and Development
John A. Herring
Normal Growth and Development
Chapter Contents
Neonates are primarily reflexive, but they do exhibit some
Normal Growth and Development 3
cognitive traits.8 These traits include showing more curiosity
Disorders of Normal Growth and
about facelike FIG.s than about other FIG.s of comparable
Development 3
brightness, as well as a preference for black- and- white tones
Evolution of Proportionate Body Size 5
rather than gray. Neonates should turn their eyes toward sound
Physical Growth 5
and be able to distinguish their mothers from other people.
Developmental Milestones 6
The normal neonate is born with a predominant flexor
tone, and physiologic flexion contractures are typical (Fig.
1.2). At birth the newborn’s limbs are maintained in flexion
This chapter on growth and development is presented first posture, and passive movement of the extremities and neck
for several important reasons. One of the unique aspects of elicits strong flexor tone. A normal neonate’s limbs move in
pediatric care is the dynamic evolution of each individual an alternating fashion when they are stimulated.
from neonate to adolescent. During this period, a remark- Normal development progresses cephalocaudad; infants
able process of growth and development takes place in gross acquire the ability to control their head and hands before
and fine motor skills; intellectual, social, and verbal skills; they are able to control their legs.8 During the first few
body size; gait; and sexual characteristics. months, gaining head control predominates. Hand control,
Growth refers to an increase in an individual’s total body size such as the ability to grasp objects, follows. As development
or to an increase in the physical size of a particular organ or organ continues, the infant gains more and more control of the
system.9,17 References to normal human growth parameters legs.
from the third trimester to adulthood are provided in Proceed- To determine whether an infant’s growth and develop-
ings of the Greenwood Genetic Center: Growth References.10 ment are progressing normally, the examiner needs to find
This publication also provides parameters for growth patterns out from the parents what developmental milestones the
seen in specific diseases, such as achondroplasia, diastrophic child has attained and when and then compare them with
dysplasia, Down syndrome, Marfan syndrome, and skeletal the norms. If the child appears to have developmental
dysplasias (comparative curves). Growth standards are also delays, referral to a physician who specializes in growth and
available in Hensinger’s Standards in Pediatric Orthopedics.7 development problems is recommended.
Development refers to the physical changes of matura- Because of the wide variations in the times at which devel-
tion that occur as a child ages. The developmental process opmental milestones are achieved and the numerous reasons
encompasses other aspects of differentiation of form, but it for delays, the diagnosis of developmental delay can be diffi-
primarily involves changes in function that transform humans cult to make in the very young child. In addition, a child may
into increasingly more complex beings.9 Development is exhibit delay in acquiring certain skills and unusual rapidity
influenced by many interrelated factors, including genetics, in acquiring others. When a delay is evident, the physician
physical trauma, nutrition, and socioeconomic status.17 must determine the cause, which may be a neuromuscular
The age at which children reach specific milestones of condition. Factors suggesting a neurologic cause include fail-
development depends on the maturation rate of their cen- ure of normal developmental responses to appear, prolonged
tral nervous system (CNS), which varies from child to child. retention of primitive infant reflexes, or a delay in achieving
Ranges for variations in normal have been developed to assist gross motor milestones within normal limits. 
in the assessment of the pediatric patient, and the most com-
monly used assessment tool is the revised Denver Develop-
Disorders of Normal Growth and
mental Screening Test (DDST)(Fig. 1.1).5-7 It is important
to know when a child should normally achieve expected Development
milestones of growth and development so that potentially
abnormal situations are evident to the physician who is tak- Many pediatric orthopaedic problems result from disor-
ing a patient’s history and performing a physical examination. ders or conditions that adversely affect normal growth and
The significance of various findings must be related to development. The four major failures of normal growth and
the child’s particular stage of growth and development. development are malformations, deformations, disruptions,
Although no one should expect a 4-m onth- old infant to be and dysplasias.4,12
walking, it is distinctly abnormal for an 18- month- old child
not to be doing so. Similarly, a 12- month- old child is likely
Malformations
to have some degree of genu varum, whereas the presence
of genu varum in a 3-y ear- old child should be cause for con- Malformations are structural defects that result from inter-
cern and a focus of further investigation. ruption of normal organogenesis during the second month of
3
4 SECTION I Disciplines
DENVER ll Examiner: Name:
Date: Birthdate:
ID#:
Months 2 4 6 9 12 15 18 24 Years3 4 5 6
prepare cereal
Percent of children passing brush teeth, no help
play board/card games
25 50 75 90
dress, no help
test item put on t-shirt 86%
name friend
copy
wash and dry hands
brush teeth with help draw person, 6 parts
copy , demonstrate
put on clothes
pick longer line
feed doll copy +
remove garment
draw person, 3 parts
use spoon/fork
help in house copy 88%
wiggle thumb
drink from cup define 7 words
tower of 8 cubes
initate activites imit. vert. line name 2 opposites
play ball with examiner tower of 6 cubes count 5 blocks
wave bye-bye tower of 4 cubes know 3 adjectives
indicate wants tower of 2 cubes define 5 words
play pat-a-cake dump raisin, demonstrated name 4 colors
cial work ffoere tdo yself put block ins ccruibpbles speech all unudnedrsetarsntadnadb le4 prepostitions
So regard own hand bang 2 cubes know 4 actions
– smile held in hands use of 3 objects
al spontaneously thumb-finger count 1 block
son sremsipleo nsively take 2 cubgerassp use of 2 objects
er regard pass cube name 1 color
P face know 2
take raisin adjectives
look for yarn know 2 actions
balance each foot 6 sec
Adaptive htofaognlelodtwhsree 1gr8a0rd° raisinreaches speecnha hmanelaf 6um nbedo e4dr ypsn tipacaatmnurdtresea 4sb lpeicturebsalance eachb afolaobntac 3lea hsneeecaceecl h-et oafo-ctoohte f4 ow osate l5ck sec
or- grasp name 1 picture hops
ot rattle combine words balance each foot
M follow past point to pictures 2 sec
e midline 6 words balance each
Fin ftool lmowid ln. 3 words foborot a1d s jeucmp
2 words
throw ball overhand
1 word
jump up
Dada/Mama specific
kick ball forward
jabbers
walk up steps
combine syllables
runs
Dada/Mama
nonspecific walk backward
imitate speech sounds walk well
single syllables stoop and recover
turn to voice stand alone
turn to stand 2 sec
rattling sound get to
e squeals sitting
guag "Ooo/laaauhg"hs stand pstualln tdo
an vocalizes holding on
L respond sit–no
to bell support
pull to stand no head lag
roll over
chest up
arm support
wear wt. on legs
sit-head steady
or
ot head up 90°
M head up 45°
ss lift head
o
Gr emqouvael ments
Months 2 4 6 9 12 15 18 24 Years3 4 5 6
FIG. 1.1 The revised Denver Developmental Screening Test showing the range of age when a child should achieve milestones in the de-
velopment of gross motor skills, fine motor–adaptive skills, language, and personal-s ocial skills. (Modified from Frankenburg WK, Dodds JB.
The Denver Developmental Screening Test. J Pediatr. 1967;71:181; Hensinger RN. Standards in Pediatric Orthopedics. New York: Raven Press;
1986.)