non operative

LC-1:  pubic rami fracture with sacral fracture

Ossification

3 - 5 years old

Management

Undisplaced

- manage in plaster in extension

Displaced > 3 mm

- ORIF

Patella sleeve fracture

- usually small inferior fragment seen on xray

- patella high riding on xray / alta

- is actually large cartilaginous fragment avulsed with retinaculum

- can be osteochondral

Issues

1.  More common recently

- more high level sport

2.  High risk of reinjuring knee from instability

- can suffer permanent severe chondral and meniscal damage

3.  Risk of physeal arrest high if bone block across physis

- risk is growth arrest with ACL reconstruction

Epidemiology

Hemarthrosis

- 60% children have ACL tear

Definition

Rockerbottom foot / Persian Slipper Foot

Epidemiology

Uncommon

50% bilateral

Doesn't delay walking

- may present in toddler with callus under talus head

Associations

Congenital anomalies

- CNS disorders

- spina bifida & diastematomyelia ~10%

- arthrogryposis

- neurofibromatosis 

Non operative Management

Indications

< 20^o sagittal

< 30^o coronal

< 3 cm of shortening

Options

Ossification

Primary

- 8 / 52 gestation radius & ulna

Secondary

- distal radius age 1

- distal ulna age 5

Non Operative Management

Unacceptable Position

< 10:  > 15^o malalignment

> 10:  > 10^o malalignment

Postreduction Positionin / Rule of Thirds 

Definition

Condition of traction apophysis into which part of patellar tendon inserts

- pulling osteochondritis of tibial tubercle

Epidemiology

Early teens

- M:F

- corresponds with growth spurt

- M 12-14 

- F 11-13 

- 1/3 bilateral

- athletes 21% vs 5% normal