pediatric

Kohler's Disease

DefinitionKohler's Disease

 

Osteonecrosis of the navicular

 

Epidemiology

 

Present at age 4-6 years

- same as Perthes disease

 

M:F 5:1

 

Bilateral in 20%

 

Aetiology

 

Repetitive trauma to maturing ossific nucleus

Monteggia

Paediatric Monteggia APPaediatric Monteggia Lateral

 

Definition

 

Fracture / plastic malformation of proximal ulna with dislocation of radial head

 

Xray

 

Radio-capitellar line disrupted

 

Tibial shaft fractures

Displaced Tibial Shaft Fractures

 

Acceptable reduction

- varus / valgus < 5o

- anterior / posterior < 5o

- rotation 5o

- shortening 10 mm

 

Poor remodelling potential

- valgus 

- apex posterior angulation  / recurvatum

- rotational alignment does not remodel

- shortening / in 2-10 year old average overgrowth is only 5mm

 

Pelvic and acetabular fractures

Anatomy

 

Bones more elastic and malleable

- absorb much more energy

 

Very thick periosteum

- can be periosteal sleeve fracture

 

Ossification

 

Triradiate cartilage fuses 13-16

 

Iliac / Ilium / ASIS apophysis

- appear as teenager

- fuse a couple of years later

- can confuse with fracture

 

Classification Key & Conwell 1951

 

Ankle Fracture

Ossification

 

Distal tibia

- appears by 2 years

- closed at maturity

- asymmetrical closure

- central initially, then posteromedial to anterolateral

- accounts for Tillaux and Triplanar fractures

 

Distal fibula

- appears by 2 years

- closes 2 years after distal tibia

 

Medial Malleolar Extension

- begins age 7

- closes age 10

 

Metastasis

DDx

 

Leukemia 

Neuroblastoma 

Wilm's    

 

Last two usually occur in < 5 year age group

 

Bone scan is method of choice for screening for metastasis

 

Leukemia

 

Epidemiology

 

Most common form of cancer in children 30%

- ALL 5 x AML

- 3 : 100 000

 

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