An Evidence-Based Approach To Pediatric Orthopedic Emergencies

Davenport, Moira MD
Nesbit, Chad MD, PhD
McElderry, Craig A. MD
Whiteman, Paula J. MD, FACEP, FAAP

¹Authors
²Assistant Professor of Emergency Medicine and Orthopedic Surgery, Drexel University School of Medicine, Allegheny General Hospital, Pittsburg, PA
³Clinical Instructor of Emergency Medicine, Drexel University School of Medicine, Allegheny General Hospital, Pittsburg, PA
⁴Peer Reviewers
⁵Assistant Professor of Clinical Pediatrics, USC Keck School of Medicine, The University of Southern California, Los Angeles, CA
⁶Attending Physician, Ruth and Harry Roman Emergency Department, Cedars-Sinai Medical Center, Los Angeles, CA; Director of Pediatric Emergency Services, Tarzana Regional Medical Center, Tarzana, CA

Date of original release: May 1, 2009

Date of most recent review: April 10, 2009

Termination date: May 1, 2012

Medium: Print and Online

Method of participation: Print or online answer form and evaluation

Prior to beginning this activity, see “Physician CME Information” on the back page.

Pediatric Emergency Medicine Practice 6(5):p 1-16, May 2009.

You are working the Friday night shift when the triage nurse tells you that a 4-year-old-boy has been brought in by his parents because he is refusing to walk. The nurse tells you that the boy looks “pale and sweaty” in his dad's arms. On your examination you find an ill-appearing child who is very irri-table, febrile, and complaining that his right hip hurts. You order acetaminophen, fluids, a CBC and a hip x-ray. Half an hour later, the child is resting more comfortably but still complaining of hip pain and refusing to move his leg. Although he looks better, you ask yourself, “Do I need to do anything more here?”

Your next patient is a 5-year-old girl who is holding her right forearm and refusing to use her hand. Her mother tells you that the patient and her 8-year-old brother were playing on the swings and jumped off, landing on outstretched hands. The 8-year-old notes pain to his left elbow. He is also hesitant to use the extremity. Neither has any other obvious trauma. Are x-rays needed? What common injury should be suspected for each sibling? What is the best treatment modality?

Your third patient is a 14-year-old football player who has significant left knee pain after falling on his flexed knee during a tackle. He is not able to walk due to the pain. What condition should you consider in addition to patellar fracture or dislocation? How is this diagnosed?

The fourth patient to present is a 15-year-old male noting increasing left knee pain over the last 1 to 2 months. His pain is increasing to the point that he has difficulty ambulating. What conditions should be considered in this case? What imaging should be performed? What is the prognosis for this condition?