Children and Orthopaedic Surgical Emergencies

Severe musculoskeletal conditions in children include bone and joint infections, a hip problem known as slipped epiphysis, and elbow fractures. These can lead to long-term health problems and other complications if children are not treated properly and in a timely manner, according to information released today at the 2009 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

“We see a lot more children with infections of the joints, bones and particularly the soft tissue around the bone, that are caused by bacteria which is resistant to many antibiotics,” explains Dr. Martin Herman, MD, pediatric orthopaedic surgeon at St. Christopher’s Hospital for Children in Philadelphia and associate professor of orthopaedic surgery at Drexel University College of Medicine.

The infections usually result from bacteria in the bloodstream, which settle into the child’s bone or joint and within days can lead to:
• A high fever
• Severe swelling
• Redness and a great deal of pain

If the infection is not diagnosed and treated early, it can cause permanent damage. “Parents should not ignore an area of infection that looks like it is spreading quickly,” noted Dr. Herman, “or one that is associated with a fever or swelling.”

Another serious pediatric orthopaedic condition that needs to be on a parent’s radar is slipped capital femoral epiphysis. This hip condition is usually seen in a pre-teen or teenage patient. The ball of the hip (the epiphysis) gradually slips out of position through the soft growth plate cartilage. This condition produces pain in the hip, the knee, or the groin, and results in a limp. If the growth plate fractures, due to a slip or fall, the hip becomes extremely painful and the patient is unable to walk.

“This is the most frequently seen hip problem in children and adolescents that requires surgery,” cites Dr. Herman. “If a child complains of hip, knee or groin pain and has a limp there is a chance they could have the earliest version of the disorder.” If caught early, before the hip fractures, it is much easier to treat and there are fewer complications.”

Fractures of the elbow are also common in children. “We see these injuries after a child falls off monkey bars or a bike,” said Dr. Herman. “One of the tips for parents is that immediate swelling or deformity is almost always associated with a fracture. When you believe your child may have any type of serious injury or fracture of the arm or leg, it is important to get them to a hospital quickly,” noted Dr. Herman.

Note: This topic will be the focus of a Media Briefing entitled: “The Top 10 Pediatric Surgical Emergencies” on Wednesday, February 25 in the Sands Expo Center, Venetian Hotel, Level One, Room 904 at 11:30am. Panelists include: Moderator: Martin Herman, MD, James McCarthy, MD, and Peter Pizzutillo, MD.