That being said, let’s go through some commonly tested and easily confused orthopedic entities…

Salter-Harris Classification

http://orthoinfo.aaos.org/topic.cfm?topic=A00040
  • Type 1 – Slipped (Physis)
  • Type 2 – Above (metaphysis)
  • Type 3 – Lower (Epiphysis)
  • Type 4 – Transverse all 3
  • Type 5 – Rammed (crush)

Hand/Wrist injuries

Scapholunate vs. Perilunate vs. Lunate Dislocation

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  • Mechanism for all 3: forceful extension of the wrist
  • Scapholunate dislocation
    • Space between the lunate and scaphoid widened >3mm
    • Tx: Thumb Spica, refer to hand surgeon
  • Perilunate dislocation
    • Capitate is dislocated dorsally in relation to the lunate
      • Lunate (teacup) is aligned with the distal radius
    • Risk: Median nerve injury, avascular necrosis, compartment syndrome
    • Tx: Hand surgeon consult and prompt reduction
  • Lunate dislocation
    • Lunate displaced and rotated volarly (“Spilled teacup”)
    • Risk: Median nerve injury, avascular necrosis, compartment syndrome
    • Tx: Hand surgeon consult and prompt reduction

Scaphoid fracture: See Nusbaum’s tribute to Egan’s wrist (http://sinaiem.org/the-matt-egans-wrist-memorial-radiology-pearl/)

galGaleazzi

  • Middle distal 3rd of radius fracture
  • Associated with dislocation/subluxation of distal radioulnar joint
  • Mechanism: fall on outstretched hand (FOOSH) or direct wrist trauma
  • Risk: AIN (branch of median) injury
  • Tx: ORIF

Monteggia

  • Proximal 1/3 ulna fracture
  • Associated with radial head dislocation
  • More common in pediatrics (peak 4- 10 years)
  • Risk: PIN (branch of radial) injury
  • Tx: Closed reduction vs. ORIF

 

Pediatric leg pain

SCFE. Case courtesy of Dr Hani Al Salam, Radiopaedia.org, rID: 9298
SCFE. Case courtesy of Dr Hani Al Salam, Radiopaedia.org, rID: 9298

SCFE (Slipped Capital Femoral Epiphysis)

  • M>F
  • Adolescent males
  • Risk factors: Obesity
  • Symptoms: Groin, thigh or knee pain; may be for weeks to months
  • Findings: Abnormal gait, decreased hip motion, abnormal leg alignment
  • X-ray: Obtain Frog leg view
  • Tx: Percutaneous fixation (at times bilateral)

 

 

Right AVN. Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 8464
Right AVN. Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 8464

Legg-Calve-Perthes Disease

  • Idiopathic avascular necrosis of the proximal femur
  • M>F
  • 4 – 8 years
  • Symptoms: Insidious onset; may cause painless limp; intermittent knee, hip, groin, or thigh pain
  • Findings: Decreased ROM particularly internal rotation and abduction, gait disturbance, limb length discrepancy
  • Tx: Orthopedic consult for nonoperative vs. operative

 

 

 

Osgood Schlatter. Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 7848
Osgood Schlatter. Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 7848

Osgood Schlatter’s Disease (Tibial Tubercle Apophysitis)

  • M>F
  • Boys 12-15 years, Girls 8-12 years
  • Risk factors: jumpers or sprinters
  • Symptoms: anterior knee pain, bilateral 20-30%
  • Findings: Tenderness at anterior knee, enlarged tibial tubercle
  • Tx: RICE, Self-limited
  • Similar to Sinding-Larsen-Johansson Syndrome which is inferior pole of the patella apophysitis found more often in jumpers

 

 

References (Accessed 1/2/17)

  1. Gaillard, Frank. Salter-Harris Classification. Radiopaedia.org. https://radiopaedia.org/articles/salter-harris-classification
  2. Watts, Evan. Scapholunate Ligament Injury & DISI. http://www.orthobullets.com/hand/6041/scapholunate-ligament-injury-and-disi
  3. Karadsheh, Mark. Lunate Dislocaton (Perilunate Dissociation). http://www.orthobullets.com/hand/6045/lunate-dislocation-perilunate-dissociation
  4. Jones, Tracy. Monteggia Fractures. http://www.orthobullets.com/trauma/1024/monteggia-fractures
  5. Allen, Deborah. Galeazzi Fractures. http://www.orthobullets.com/trauma/1029/galeazzi-fractures
  6. Souder, Chris. Slipped Capital Femoral Epiphysis. http://www.orthobullets.com/pediatrics/4040/slipped-capital-femoral-epiphysis
  7. Souder, Chris. Legg-Calve-Perthes Disease. http://www.orthobullets.com/pediatrics/4119/legg-calve-perthes-disease-coxa-plana
  8. Woon, Colin. Osgood Schlatter’s Disease (Tibial Tubercle Apophysitis). http://www.orthobullets.com/sports/3029/osgood-schlatters-disease-tibial-tubercle-apophysitis
  9. McKean, Jason. Sinding-Larsen-Johansson Syndrome. http://www.orthobullets.com/sports/3030/sinding-larsen-johansson-syndrome?expandLeftMenu=true