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Episode 180: Pediatric Hip PainFuture Dr. Pena-Brockett explains the differential diagnosis in a 14-year-old patient who has a new onset of left hip pain. Dr. Arreaza adds comments and explains toxic synovitis. Written by Natalie Pena-Brockett, MSIV, California Health Sciences University. Comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Having a limping kid can be terrifying. Many questions may cross your mind: Is this a permanent damage? What is going on here? Where is the pain located? Do I need to send this child to the hospital? Today, hopefully, we can help you ease some of your fears. Case: This is a 14-year-old boy with no past medical history, no trauma, presents to the family medicine clinic with a complaint of left-sided hip pain. Mom notes that her son has been limping for the last week and complaining of pain in his left hip and knee when he walks. He has never experienced this pain before this week. He does not take any medications. Physical exam: He is afebrile and all of his vitals are within normal limits. On exam, you note that his BMI is at the 90th percentile (overweight), and has an antalgic gait where he is favoring the right side and has tenderness on his left groin. His left foot is turned outward while standing up straight. His left knee has negative findings on specialized tests, but he has restricted movement of the left hip. Discussion: This is a common topic that you will see on board exams or limping into your office. Although pediatric hip pain may seem like a benign musculoskeletal concern, taking the time to take a complete history and perform a thorough physical exam is critical to assess the severity of the patient's concern.Physical Exam for Pediatric Hip Pain.Observation: Every physical exam begins the moment you first see the patient. This allows you to gauge the patient's comfort level, the natural stature, length, and positioning of the patient's extremities, skin changes, gait, and ability to bear weight. Palpation: In medicine, our hands are one of our greatest tools for evaluating patients, especially those with musculoskeletal concerns. This is the time to palpate the area for any tenderness or gross deformities of the pelvis, hip, knee, or leg. Special Tests: In the world of MSK, we have all sorts of tests to evaluate the range of movement of our joints and tendons. When specifically evaluating the hip, the most common are the FABER(flexion, abduction, external rotation),test to assess the sacroiliac joint, Ober's Test to assess the iliotibial band, and Straight Leg Raise to assess for lumbar radiculopathy.Legg-Calve Perthes Disease-Legg-Calve Perthes disease is an idiopathic avascular necrosis of the femoral head. -It is most commonly observed in patients between the ages of 2-12 years and in a higher ratio of males to females 1. -It often manifests as an atraumatic limp with limited movement in abduction and internal rotation. -X-ray imaging may demonstrate a widening of the joint space and sclerosis of the femur, and MRI will confirm osteonecrosis of the femoral head. -Early diagnosis is key to minimizing the risk of developing osteoarthritis of the hip. -The goal of treatment is to maintain the shape of the femoral head and the range of motion of the hip. -The first-line treatment includes managing pain with NSAIDs, limiting weight-bearing activity, and physical therapy for range of motion.-If the disease progresses, bracing and casting can be used to retain the femoral head within the acetabulum to keep the shape and integrity of the femoral head. In more serious cases, a surgical osteotomy may be done to cut and realign the bones. Developmental Dysplasia of the Hip (DDH)-Developmental Dysplasia of the Hip (DDH) is a pediatric condition that results in unilateral or bilateral instability of the hip due to the abnormal development of the acetabulum or femur. -This is most commonly seen in newborns, especially those which develop in a breech position. -These patients often present with a shortened leg or asymmetric gluteal creases and a Trendelenburg gait when walking. -The Trendelenburg gait is an abnormal gait caused by weak hip abductor muscles. The person's trunk shifts over the affected hip during the stance phase of walking and away from it during the swing phase, making it look like the person is missing steps or limping. -On physical exam, hip joint laxity can be evaluated with the Ortolani and Barlow maneuvers to apply pressure to the proximal femur to assess dislocatability of the hip joints. These maneuvers would both be considered positive if a “clunk” is felt over the hip as this means that the hip is dislocated with pressure. Due to the patient's age usually being under 6 months old, ultrasound is the most common imaging modality to confirm the diagnosis, otherwise, an X-ray can be used. -The treatment in patients under 18 months old, a Pavlik Harness is often used to treat patients to maintain the placement of the hip within the acetabulum. -Patients between the ages of 18 months and 9 years old, are most often treated with open or closed reduction of the hip. -There is generally less success in reduction treatment of children older than 9 years old as they have likely developed femoral head deformities and are at greater risk of osteonecrosis. -Children with DDH should continue to be monitored with regular imaging to evaluate for complications. These patients should also be made aware that they are also at increased risk of requiring a hip replacement, especially if their treatment included a reduction. 2Slipped Capital Femoral Epiphysis (SCFE)-Slipped Capital Femoral Epiphysis (SCFE) is one of the most common pediatric hip pathologies in which the capital femoral epiphysis is anterolaterally displaced from the femoral neck. -Although slightly more common in males than females between the ages of 10 to 16, the greatest risk factor for an SCFE is childhood obesity 3. -Common symptoms include an insidious onset of unilateral hip pain and a change in gait due to the displacement of the hip from the acetabulum. In some instances of chronic SCFE, some patients will experience ipsilateral knee pain due to compensation. -A SCFE can be evaluated with an AP radiograph which will demonstrate a widened physis in the early stages or the classic “slipped ice cream cone sign” which is the posterior displacement of the femoral epiphysis. -Management of a SCFE includes limiting weight-bearing activities as well as screw fixation by an orthopedic surgeon to stabilize the hip.Patients should consider pinning the contralateral hip due to increased risk of developing a future SCFE. Early diagnosis is critical as untreated SCFE can lead to osteonecrosis.Osgood-Schlatter-Osgood-Schlatter is a repetitive-use pediatric condition as a result of traction to the growth plate of the tibial tubercle. -This pathology is most common in male children between the ages of 9 to 14 years old 4. -Active athletes or children with rapid growth spurts are at greater risk of developing Osgood-Schlatter than non-active children.-These children often present with an achy knee pain that can lead to a unilateral limping gait. On physical exam, these patients often have a bony prominence over the tubercle that is tender to palpation with greater tenderness over the patellar tendon. -The knee will have full range of motion and stability, but will likely have a warmth and erythema over the knee. Imaging of the knees can have nonspecific findings and diagnosis is made clinically. -For management, it is recommended that children continue their regular activities and rest with NSAIDs for pain management as needed 5. Physical therapy can be prescribed to prevent deconditioning as this can result in recurrence or additional injuries.Arreaza: It seems like the pain is more localized to the knee, but it can be referred to the hip. If you have tenderness on the tibial tubercle, you got the diagnosis. Juvenile Idiopathic Arthritis (JIA)-Juvenile Idiopathic Arthritis (JIA) is a systemic rheumatologic condition in children that often presents as a polyarticular pain. The onset of disease is often bimodal with peaks between 2 to 5 years old and 10 to 14 years old. 6-Patients will often complain of minor symmetric joint pain and stiffness until an infection causes an inflammatory reaction that exacerbates the joint pain or can increase joint involvement. Small joints are the most likely to be involved, but hips and knees can also be affected. -Lab evaluation will demonstrate inflammation with an elevated ESR, low hemoglobin, and a positive ANA. -Disease management starts with NSAIDS for pain control and can escalate to immunosuppressive measures for moderate disease7.Toxic Synovitis-Toxic synovitis, also known as transient synovitis, is the leading cause of acute hip pain and limping in children aged 2–12, more commonly affecting boys. -This self-limited inflammatory condition, often confused by its name as "toxic," has no relation to a toxic state. It typically arises after an upper respiratory or other viral infection (e.g., rubella or coxsackie virus).-Children with toxic synovitis may show mild to moderate hip pain, limp, and keep their hip in abduction and external rotation. Movement is usually possible within a limited range, and weight-bearing is often maintained.-Evaluation: A thorough history and physical exam are key, as laboratory tests like CBC, ESR, and CRP are often normal, mainly used to rule out other conditions like septic arthritis. X-rays typically show no abnormalities, although small changes may appear. Ultrasound can help detect joint effusion and rule out septic arthritis if no effusion is present.Arreaza: DDX: DDH, SCFE, Osgood Schlatter, and toxic synovitis.Osteopathic Manipulative Treatment in Pediatric Hip PathologiesSacroiliac Articulatory Technique- this is a technique in which you move the joint into an out of its barrier to reduce restriction and improve movementCounterstrain of Tender points (psoas, piriformis, hip adductors)- in this technique we shorten the muscle to decrease tension. This allows the muscle to increase blood lymphatic flow to reduce nociceptive and proprioceptive activity of the muscleBalanced Ligamentous Tension of the Innominate- with this technique, we manipulate the joint in a way that moves the ligaments into neutral position so that there is balance in all planes of motion. The goal is to again release tension within the muscles and the jointClinical Decision Making Now that we have covered the most common differential diagnoses for pediatric hip pain, let's revisit our patient presentation and identify the key characteristics to determine which diagnosis he most likely has.The patient is 14 years old. This makes DDH and Legg-Calve Perthe less likely, and SCFE more likely.He has been complaining of symptoms for 1 week, which indicates that is not likely a chronic condition. This makes DDH and Osgood-Schlatter less likely.The patient has never experienced joint pain like this before. This makes JIA, DDH, and Osgood-Schlatter less likely.The patient is overweight. This makes SCFE more likely.The unilateral hip tenderness and no knee pain. This makes Osgood-Schlatter and JIA less likely.The patient has antalgic gait and limited internal rotation of the foot. This makes Legg-Calve Perthes and SCFE more likely. Now when we take the epidemiological factors, the history of the present illness, and the physical exam findings into account, this patient's presentation best aligns with a SCFE. We would order a bilateral AP and Frog-leg views of the hips. If either imaging shows a widened physis or the classic “ice cream cone sign”, this is when we would start the referral process for an orthopedic surgery consultation for internal fixation. As family medicine physicians, we would give instructions for strict non-weight bearing activities and analgesics or anti-inflammatories for pain management.Keep in mind some of the DDX: Calve Legg-Perthes disease, Developmental Dysplasia of the Hip (DDH), Juvenile Idiopathic Arthritis (JIA), Osgood Schlatter, toxic synovitis, and Slipped Capital Femoral Epiphysis (SCFE). Hopefully, the next time you have a pediatric patient present with a complaint of hip pain, you'll feel more comfortable evaluating and working up the case._________________________This week we thank Hector Arreaza and Natalie Pena-Brockett. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Osteonecrosis of the femoral head / Legg-Calvé-Perthes disease | Time of Care. Accessed October 27, 2024. https://www.timeofcare.com/osteonecrosis-of-the-femoral-head-legg-calve-perthes-disease/Scott EJ, Dolan LA, Weinstein SL. Closed Vs. Open Reduction/Salter Innominate Osteotomy for Developmental Hip Dislocation After Age 18 Months: Comparative Survival at 45-Year Follow-up. J Bone Joint Surg Am. 2020;102(15):1351-1357. doi:10.2106/JBJS.19.01278. https://europepmc.org/article/med/32769602Perry DC, Metcalfe D, Costa ML, Van Staa T. A nationwide cohort study of slipped capital femoral epiphysis. Arch Dis Child. 2017;102(12):1132-1136. doi:10.1136/archdischild-2016-312328. https://pubmed.ncbi.nlm.nih.gov/28663349/Haines M, Pirlo L, Bowles K-A, Williams CM. Describing Frequencies of Lower-Limb Apophyseal Injuries in Children and Adolescents: A Systematic Review. Clin J Sport Med. 2022;32(4):433-439. doi:10.1097/JSM.0000000000000925. https://pubmed.ncbi.nlm.nih.gov/34009802/Wall EJ. Osgood-Schlatter disease: practical treatment for a self-limiting condition. Phys Sportsmed. 1998;26(3):29-34. doi:10.3810/psm.1998.03.802. https://pubmed.ncbi.nlm.nih.gov/20086789/Oberle EJ, Harris JG, Verbsky JW. Polyarticular juvenile idiopathic arthritis - epidemiology and management approaches. Clin Epidemiol. 2014;6:379-393. doi:10.2147/CLEP.S53168. https://pubmed.ncbi.nlm.nih.gov/25368531/Beukelman T, Patkar NM, Saag KG, et al. 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features. Arthritis Care Res (Hoboken). 2011;63(4):465-482. doi:10.1002/acr.20460. https://pubmed.ncbi.nlm.nih.gov/21452260/Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.
In this episode, we review the high-yield topic of Slipped Capital Femoral Epiphysis (SCFE) from the Pediatric section. Follow Orthobullets on Social Media: Facebook Instagram Twitter LinkedIn YouTube --- Send in a voice message: https://podcasters.spotify.com/pod/show/orthobullets/message
Pediatrician Dr. Paul Bunch consults Dr. Patrick Whitlock on SCFE (Slipped Capital Femoral Epiphysis). Episode recorded on October 11, 2023. CME & MOC Part 2 We are proud to offer CME and MOC Part 2 from Cincinnati Children's. Credit is free and registration is required. Please click here to claim CME credit via the post-test under "Launch Activity." Resources discussed in this episode: Community Practice Support Tools
In this episode, we cover the following:What is Slipped Capital Femoral Epiphysis (SCFE)?What are some risk factors for developing this?What do we look for in a patient's clinical presentation?How is this identified in imaging?Support the showThe purpose of this podcast is to provide useful, condensed information for exhausted, time-crunched Physical Therapists and Student Physical Therapists who looking to build confidence in their foundational knowledge base and still have time to focus on other important aspects of life. Hit follow to make sure you never miss an episode. Have questions? Want to connect? Contact me at ptsnackspodcast@gmail.com or check out more at ptsnackspodcast.com. On Instagram? Check out the unique content on @dr.kasey.hankins! Need CEUs but low on time and resources? Go to https://www.medbridgeeducation.com/pt-snacks-podcast for over 40% off a year subscription. Use the promo code PTSNACKSPODCAST. This is an affiliate link, but I wouldn't recommend MedBridge if I didn't think they offered value. Willing to support monetarily? Follow the link below to help me continue to create free content. You can also support the show by sharing the word about this show with someone you think would benefit from it.
Follow along with our Nailed it Board/OITE Podcast Companion book. Get your copy by clicking here >> https://a.co/d/cr4i8nD Enjoy another episode from our board review series featuring Dr. Cole and Dr. Woolwine. ____________________________ This episode is sponsored by Locumstory: Everyone has a story. Different needs, wants, and goals, and how to attain them. Your story determines your solution. Whatever your situation and story, locum tenens should be part of the conversation. How do you find out if locums is a good option for you? Go to an unbiased, informative source like locumstory.com. You'll learn all the ins and outs of locums, details on travel and housing, assignment coordination, tax information, and more. You'll also hear firsthand stories from locums physicians from all walks of life, so you get a bigger picture of the diverse options.
Dr. Coleen Sabatini from UCSF joins the show to discuss implicit bias and bullying in our field, changing and international trends in supracondylars, and two international orthopedic public health issues she is immersed in solving: gluteal fibrosis and post-injection paralysis. The lightning round highlights new ultrasound techniques, SCFE implants, and more. Your hosts are Carter Clement from Children's Hospital of New Orleans, Craig Louer from Vanderbilt, and Josh Holt from University of Iowa. Music by A. A. Alto. References: New Injury Patterns in Pediatric Supracondylar Fractures During COVID-19: Beds Are the New Monkey Bars. Soriano et al. JPO Apr 2023. https://pubmed.ncbi.nlm.nih.gov/36662751/ Supracondylar humerus fractures in low- and lower middle-income countries: a scoping review of the current epidemiology, treatment modalities, and outcomes. Challa et al. International Orthopedics 2020. https://pubmed.ncbi.nlm.nih.gov/32691122/ Implicit Racial Bias in Pediatric Orthopaedic Surgery. Guzek et al. JPO 2022. https://pubmed.ncbi.nlm.nih.gov/35522848/ The Prevalence of Bullying Among Pediatric Orthopaedic Patients. Carrillo et al. JPO 2021. https://pubmed.ncbi.nlm.nih.gov/34294669/ Epidemiology and treatment outcomes in pediatric patients with post-injection paralysis. Song et al. BMC Musculoskeletal Disorders 2022. https://pubmed.ncbi.nlm.nih.gov/35932071/ Surgical Release of Gluteal Fibrosis in Children Results in Sustained Benefit at 5-Year Follow-up. Reilly et al. JPO 2021. https://pubmed.ncbi.nlm.nih.gov/33481480/ Gluteal Fibrosis and Its Surgical Treatment. Alves et al. JBJS 2019. https://pubmed.ncbi.nlm.nih.gov/30801376/ Gluteal fibrosis, post-injection paralysis, and related injection practices in Uganda: a qualitative analysis. Alves et al. BMC Health Services Research 2018. https://pubmed.ncbi.nlm.nih.gov/30477506/ Burden of gluteal fibrosis and post-injection paralysis in the children of Kumi District in Uganda. BMC Musculoskeletal Disorders 2018. https://pubmed.ncbi.nlm.nih.gov/30249239/ Lightning Round: The Usefulness of Dynamic Ultrasonography in Nursemaid's Elbow: A Prospective Case Series of 13 Patients Reconsideration of the Pathophysiology of Nursemaid's Elbow. Tsai et al. JPO July 2023. https://pubmed.ncbi.nlm.nih.gov/36962080/ Seven-year Outcomes of Adolescent Forearm Fractures Treated With Plate Fixation. Folkman et al. JPO June 2023. https://pubmed.ncbi.nlm.nih.gov/37072917/ The Addition of Daytime Physiotherapeutic Scoliosis-specific Exercises to Adolescent Idiopathic Scoliosis Nighttime Bracing Reduces Curve Progression. Zapata et al. JPO July 2023. https://pubmed.ncbi.nlm.nih.gov/36922003/ Who Benefits From Allowing the Physis to Grow in Slipped Capital Femoral Epiphysis? Winger et al. JPO July 2023. https://pubmed.ncbi.nlm.nih.gov/36977364/
This podcast presents an overview of slipped capital femoral epiphysis (SCFE). It will cover the basic anatomy of growth plates in addition to the clinical presentation, differential diagnoses, investigations, treatments and complications of SCFE. It was developed by Reva Qiu, a second-year medical student at McMaster University, and Dr. Waleed Kishta, a pediatric orthopedic surgeon at the McMaster University Medical Centre.
In this episode, we review the high-yield topic of Slipped Capital Femoral Epiphysis (SCFE) from the Pediatrics section. Follow Orthobullets on Social Media: Facebook: www.facebook.com/orthobullets Instagram: www.instagram.com/orthobulletsofficial Twitter: www.twitter.com/orthobullets LinkedIn: www.linkedin.com/company/27125689 YouTube: www.youtube.com/channel/UCMZSlD9OhkFG2t25oM14FvQ --- Send in a voice message: https://anchor.fm/orthobullets/message
Brian Scannell from CMC discusses his research on pre-operative antibiotics for CRPP of supracondylar humerus fractures as well as the residency match process and resident education. We also highlight papers on toddler's fractures, slip progression after in-situ SCFE pinning, and stem cell treatment for physeal injuries. Your hosts are Julia Sanders from Children's Hospital Colorado, Craig Louer from Vanderbilt, and Josh Holt from University of Iowa. Music by A. A. Aalto. Citations for papers discussed: Chen AF, Secrist ES, Scannell BP, Patt JC. Matching in Orthopaedic Surgery. J Am Acad Orthop Surg. 2020 Feb 15;28(4):135-144. doi: 10.5435/JAAOS-D-19-00313. PMID: 31567523. Bloomer AK, Coe KM, Brandt AM, Roomian T, Brighton B, Scannell BP. Hold the Antibiotics: Are Preoperative Antibiotics Unnecessary in the Treatment of Pediatric Supracondylar Humerus Fractures? J Pediatr Orthop. 2022 Feb 24. doi: 10.1097/BPO.0000000000002118. Epub ahead of print. PMID: 35200212. Fox J, Enriquez B, Bompadre V, Carlin K, Dales M. Observation Versus Cast Treatment of Toddler's Fractures. J Pediatr Orthop. 2022 Feb 18. doi: 10.1097/BPO.0000000000002086. Epub ahead of print. PMID: 35180728. Makarewich CA, Wait ES, Fedorak GT, MacWilliams BA. Factors Affecting Slip Progression After In Situ Screw Fixation of Stable Slipped Capital Femoral Epiphysis. J Pediatr Orthop. 2022 Feb 24. doi: 10.1097/BPO.0000000000002098. Epub ahead of print. PMID: 35200211. Wong KL, Zhang S, Heng Tan SS, Cheow YA, Lai RC, Lim SK, Po Hui JH, Toh WS. Mesenchymal Stem Cell Exosomes Promote Growth Plate Repair and Reduce Limb-Length Discrepancy in Young Rats. J Bone Joint Surg Am. 2022 Feb 17. doi: 10.2106/JBJS.21.00789. Epub ahead of print. PMID: 35175995.
Listen to Andrew Duckworth and Daniel Perry discuss two papers published in the April 2022 issue of The Bone & Joint Journal.Papers discussed:The British Orthopaedic Surgery Surveillance study: Perthes' diseaseThe British Orthopaedic Surgery Surveillance study: slipped capital femoral epiphysisFind out as soon as the next episode is live by following us on Twitter, Instagram, LinkedIn or Facebook!
Episode 102 NPTEFF Content SCFE vs LCPD
Episode 103 NPTEFF Question SCFE vs LCPD
Professor Dan Perry (NIHR Research Professor) speaks with us about developmental dysplasia of the hip, slipped capital femoral epiphysis and paediatric trauma trials. In this engaging and high-yield episode, he describes all the important factors we should be aware of in these common paediatric orthopaedic conditions.
Jeff Nepple from Wash U in St Louis joins us to discuss cartilage wear patterns in FAI and SCFE and implications for treatment from the most recent JPO. We also highlight new literature regarding resorbable implants in pediatrics, Pavlik harness success in hip dysplasia patients with irreducible dislocations, and much more. Your hosts are Carter Clement from Children's Hospital of New Orleans, Craig Louer from Vanderbilt, Josh Holt from Iowa and Julia Sanders from Children's Hospital Colorado. Music by A.A. Alto. Featured article: Lieberman EG, Pascual-Garrido C, Abu-Amer W, Nepple JJ, Shoenecker PL, Clohisy JC. Patients With Symptomatic Sequelae of Slipped Capital Femoral Epiphysis Have Advanced Cartilage Wear at the Time of Surgical Intervention. J Pediatr Orthop. 2021 Jul 1;41(6):e398-e403. Lightning Round: 1. Baldini M, Coppa V, Falcioni D, Senigagliesi E, Marinelli M, Gigante AP. Use of resorbable magnesium screws in children: systematic review of the literature and short-term follow-up from our series. J Child Orthop. 2021 Jun 1;15(3):194-203. 2. Patel HA, Chaudhry S, Lee MC, Solomito M. Streamlining Postoperative Care After Pediatric Supracondylar Humerus Fractures: Is Follow-up After Pin Removal Routinely Needed? J Pediatr Orthop. 2021 Jul 1;41(6):e464-e469. 3. Nicolaou N, Luo Q, Giles SN, Maruthainar K, Kitchen MP, Thomas S, Fernandes JA, Roposch A. Mechanical Analysis of Explanted Telescopic Rods in the Management of Osteogenesis Imperfecta: A Multicenter Study. J Pediatr Orthop. 2021 Jul 1;41(6):e448-e456. 4. Imerci A, Rogers KJ, Bhattacharjee A, Bowen JR, Thacker MM. Risk Factors for Failure of Pavlik Harness Treatment in Infants With Dislocated Hips That Are Evaluated by Dynamic Sonography. J Pediatr Orthop. 2021 Jul 1;41(6):e386-e391. 5. Fletcher AN, Liles JL, Pereira GF, Danilkowicz RM, Amendola A, Riboh JC. The Intrarater and Inter-rater Reliability of Radiographic Evaluation of the Posterior Tibial Slope in Pediatric Patients. J Pediatr Orthop. 2021 Jul 1;41(6):e404-e410.
In this episode, we review the high-yield topic of Slipped Capital Femoral Epiphysis (SCFE) from the Pediatrics section. Follow Orthobullets on Social Media: Facebook: www.facebook.com/orthobullets Instagram: www.instagram.com/orthobulletsofficial Twitter: www.twitter.com/orthobullets LinkedIn: www.linkedin.com/company/27125689 YouTube: www.youtube.com/channel/UCMZSlD9OhkFG2t25oM14FvQ --- Send in a voice message: https://anchor.fm/orthobullets/message
Ron El-Hawary and Karl Logan from IWK Health Centre and Dalhousie University in Halifax discuss their recent research on free-gliding SCFE screws. We also highlight papers from the newest editions of JBJS, JCO, JPO, and JPO-B. Your hosts are Carter Clement from Children’s Hospital of New Orleans, Craig Louer from Vanderbilt, Josh Holt from Iowa, and Julia Sanders from Children's Hospital Colorado. Music by A. A. Alto. "Femoral Neck Growth and Remodeling With Free-Gliding Screw Fixation of Slipped Capital Femoral Epiphysis." JPO. https://pubmed.ncbi.nlm.nih.gov/33560709/ "Open Reduction of Medial Epicondyle Fractures in the Pediatric Population: Supine Versus Prone Position." JPO. https://pubmed.ncbi.nlm.nih.gov/33734199/ "Pediatric Orthopaedic Surgeon Time Utilization in Clinic: A Pilot Study." JPO. https://pubmed.ncbi.nlm.nih.gov/33654028/ "Pediatric Simple Knee Value: a simple patient-reported outcome measure for the knee." JCO. https://pubmed.ncbi.nlm.nih.gov/33643462/ "Classifying Ischial Tuberosity Avulsion Fractures by Ossification Stage and Tendon Attachment." JBJS. https://pubmed.ncbi.nlm.nih.gov/33724973/ "Preliminary results: continuous double luminal catheter drainage for the management of septic hip arthritis in children." JPO-B. https://pubmed.ncbi.nlm.nih.gov/33741831/ "The Effect of Proximal Anchor Choice During Distraction-based Surgeries for Patients With Nonidiopathic Early-onset Scoliosis: A Retrospective Multicenter Study." JPO. https://pubmed.ncbi.nlm.nih.gov/33654027/
贊助我們做更好的內容☕ https://pay.firstory.me/user/ck4fgb04n698h0804wzdkaycj ▪SCFE暹羅貓再次提醒！絕育時間不糾結！(請聽EP77＆EP85) ▪早期絕育的目的是什麼？ ▪只知道犬髖關節發育不全CHD怎麼走在尖端勒！？ ▪什麼？一歲就被診斷關節炎？合理嗎？ ▪大型幼犬要惡補的剝離性骨軟骨炎(OCD) ▪生長板骨折的診斷為什麼這麼困難？ 歡迎大家一起關心並表達自己的想法給我們！ Powered by Firstory Hosting
▫每週四晚上9:00播出▫ 贊助我們做更好的內容☕ https://pay.firstory.me/user/ck4fgb04n698h0804wzdkaycj ▪髖關節脫臼怎麼辦？ ▪Ehmer sling跟Hobble band怎麼選擇？ ▪貓的股骨頭骨骺滑脫症(SCFE)是什麼？ ▪貓的股骨頭骨骺滑脫症(SCFE)有什麼危險因子？ ▪貓的股骨頭骨骺滑脫症(SCFE)該怎麼治療呢？ 歡迎大家一起關心並表達自己的想法給我們！ Powered by Firstory Hosting
Listen to our episode on pediatric hip pain as Dr. Gonzales gives us an excellent overview! Dr. Tony Gonzales specializes in Pediatric Orthopedics at Children’s Hospital. He received his medical degree from the University of Alabama School of Medicine in Birmingham, and completed his residency training at Jackson Memorial Hospital/University of Miami in Florida. He then completed a fellowship in Pediatric Orthopedics at Scottish Rite Hospital in Atlanta, Georgia. Dr. Gonzales has more than 11 years of experience, Dr. Gonzales is certified by the American Board of Orthopedic Surgeons and is serves as the Department Head of Pediatric Orthopedics at Children’s Hospital. Goal of episode: To develop a baseline knowledge on how to work up pediatric hip pain and the differences between SCFE and Legg-Calves Perthes disease. We cover: History and physical Pertinent imaging Classification systems Treatment Disclosures: NailedIt Ortho reports no relevant financial disclosures. Dr. Cole and Dr. Fitts report no relevant disclosures. This podcast is NOT medical advice, the podcast is for educational purposes only. Please consult your doctor prior to making any medical decisions. ----- You can follow NailedIt Ortho at: Website: https://naileditortho.com/ Instagram: www.instagram.com/naileditortho Dr. Fitts and Dr. Cole are orthopaedic surgery residents and the hosts of the NailedIt Ortho podcast.
Are you looking for an awesome cheatsheet that reviews the facts to know about SCFE vs LCPD for the NPTE? Look no further: www.kylericeprep.com/SCFE An 11-year-old child presents with intense groin and anterior thigh pain after falling from a tree. The therapist suspects that the child has slipped capital femoral epiphysis. Which of the following risk factors is MOST likely to cause the suspected pathology: Femoral retroversion and obesity Hyperthyroidism and proximal muscle weakness Coxa Valga Low body mass index (BMI) Check out the Podcast for the answer!! Did you get this question wrong?! If you were stuck between two answers and selected the wrong one, then you need to visit www.NPTEPASS.com, to learn about the #1 solution to STOP getting stuck.
In this episode, we review multiple-choice questions related to the high-yield topic of Slipped Capital Femoral Epiphysis (SCFE) from the Pediatrics section. --- Send in a voice message: https://anchor.fm/orthobullets/message
In this episode, we review the high-yield topic of Slipped Capital Femoral Epiphysis (SCFE) from the Pediatrics section. --- Send in a voice message: https://anchor.fm/orthobullets/message
Josh Howard of the Straight Cash Fantasy Sports Experts breaks down the MLB DFS slate tonight and gives you the player match-ups we like for DraftKings and FanDuel for July 12, 2019. We also give you our Straight Cash pick of the night, This is a player that we highlight for tonight as a building block for creating your line-up. Check us out for news and player updates.
Josh Howard of the Straight Cash Fantasy Sports Experts breaks down the MLB DFS slate tonight and gives you the player match-ups we like for DraftKings and FanDuel for July 1, 2019. We also give you our Straight Cash pick of the night, This is a player that we highlight for tonight as a building block for creating your line-up. Check us out for news and player updates.
Josh Howard of the Straight Cash Fantasy Sports Experts breaks down the MLB DFS slate tonight and gives you the player match-ups we like for DraftKings and FanDuel for June 28, 2019. We also give you our Straight Cash pick of the night, This is a player that we highlight for tonight as a building block for creating your line-up. Check us out for news and player updates.
Josh Howard of the Straight Cash Fantasy Sports Experts breaks down the MLB DFS slate tonight and gives you the player match-ups we like for DraftKings and FanDuel for June 26, 2019. We also give you our Straight Cash pick of the night, This is a player that we highlight for tonight as a building block for creating your line-up. Check us out for news and player updates.
Josh Howard of the Straight Cash Fantasy Sports Experts breaks down the MLB DFS slate tonight and gives you the player match-ups we like for DraftKings and FanDuel for June 25, 2019. We also give you our Straight Cash pick of the night, This is a player that we highlight for tonight as a building block for creating your line-up. Check us out for news and player updates.
Josh Howard of the Straight Cash Fantasy Sports Experts breaks down the MLB DFS slate tonight and gives you the player match-ups we like for DraftKings and FanDuel for June 21, 2019. We also give you our Straight Cash pick of the night, This is a player that we highlight for tonight as a building block for creating your line-up. Check us out for news and player updates.
Josh Howard of the Straight Cash Fantasy Sports Experts breaks down the MLB DFS slate tonight and gives you the player match-ups we like for DraftKings and FanDuel for June 19, 2019. We also give you our Straight Cash pick of the night, This is a player that we highlight for tonight as a building block for creating your line-up. Check us out for news and player updates.
Josh Howard of the Straight Cash Fantasy Sports Experts breaks down the MLB DFS slate tonight and gives you the player match-ups we like for DraftKings and FanDuel for June 13, 2019. We also give you our Straight Cash pick of the night, This is a player that we highlight for tonight as a building block for creating your line-up. Check us out for news and player updates.
Josh Howard of the Straight Cash Fantasy Sports Experts breaks down the MLB DFS slate tonight and gives you the player match-ups we like for DraftKings and FanDuel for June 10, 2019. We also give you our Straight Cash pick of the night, This is a player that we highlight for tonight as a building block for creating your line-up. Check us out for news and player updates.
Josh Howard of the Straight Cash Fantasy Sports Experts breaks down the MLB DFS slate tonight and gives you the player match-ups we like for DraftKings and FanDuel for June 8, 2019. We also give you our Straight Cash pick of the night, This is a player that we highlight for tonight as a building block for creating your line-up. Check us out for news and player updates.
Josh Howard of the Straight Cash Fantasy Sports Experts breaks down the MLB DFS slate tonight and gives you the player match-ups we like for DraftKings and FanDuel for June 7, 2019. We also give you our Straight Cash pick of the night, This is a player that we highlight for tonight as a building block for creating your line-up. Check us out for news and player updates.
Josh Howard of the Straight Cash Fantasy Sports Experts breaks down the MLB DFS slate tonight and gives you the player match-ups we like for DraftKings and FanDuel for June 5, 2019. We also give you our Straight Cash pick of the night, This is a player that we highlight for tonight as a building block for creating your line-up. Check us out for news and player updates.
Josh Howard of the Straight Cash Fantasy Sports Experts breaks down the MLB DFS slate tonight and gives you the player match-ups we like for DraftKings and FanDuel for June 4, 2019. We also give you our Straight Cash pick of the night, This is a player that we highlight for tonight as a building block for creating your line-up. Check us out for news and player updates.
Josh Howard of the Straight Cash Fantasy Sports Experts breaks down the MLB DFS slate tonight and gives you the player match-ups we like for DraftKings and FanDuel for May 29, 2019. We also give you our Straight Cash pick of the night, This is a player that we highlight for tonight as a building block for creating your line-up. Check us out for news and player updates.
Josh Howard of the Straight Cash Fantasy Sports Experts breaks down the MLB DFS slate tonight and gives you the player match-ups we like for DraftKings and FanDuel for May 28, 2019. We also give you our Straight Cash pick of the night, This is a player that we highlight for tonight as a building block for creating your line-up. Check us out for news and player updates.
Josh Howard of the Straight Cash Fantasy Sports Experts breaks down the MLB DFS slate tonight and gives you the player match-ups we like for DraftKings and FanDuel for May 24, 2019. We also give you our Straight Cash pick of the night, This is a player that we highlight for tonight as a building block for creating your line-up. Check us out for news and player updates.
Josh Howard of the Straight Cash Fantasy Sports Experts breaks down the MLB DFS slate tonight and gives you the player match-ups we like for DraftKings and FanDuel for May 22, 2019. We also give you our Straight Cash pick of the night, This is a player that we highlight for tonight as a building block for creating your line-up. Check us out for news and player updates.
Josh Howard of the Straight Cash Fantasy Sports Experts breaks down the MLB DFS slate tonight and gives you the player match-ups we like for DraftKings and FanDuel for May 20, 2019. We also give you our Straight Cash pick of the night, This is a player that we highlight for tonight as a building block for creating your line-up. Check us out for news and player updates.
Josh Howard of the Straight Cash Fantasy Sports Experts breaks down the MLB DFS slate tonight and gives you the player match-ups we like for DraftKings and FanDuel for May 16, 2019. We also give you our Straight Cash pick of the night, This is a player that we highlight for tonight as a building block for creating your line-up. Check us out for news and player updates.
Josh Howard of the Straight Cash Fantasy Sports Experts breaks down the MLB DFS slate tonight and gives you the player match-ups we like for DraftKings and FanDuel for May 15, 2019. We also give you our Straight Cash pick of the night, This is a player that we highlight for tonight as a building block for creating your line-up. Check us out for news and player updates.
Josh Howard of the Straight Cash Fantasy Sports Experts breaks down the MLB DFS slate tonight and gives you the player match-ups we like for DraftKings and FanDuel for May 13, 2019. We also give you our Straight Cash pick of the night, This is a player that we highlight for tonight as a building block for creating your line-up. Check us out for news and player updates.
Josh Howard of the Straight Cash Fantasy Sports Experts breaks down the MLB DFS slate tonight and gives you the player match-ups we like for DraftKings and FanDuel for May 10, 2019. We also give you our Straight Cash pick of the night, This is a player that we highlight for tonight as a building block for creating your line-up. Check us out for news and player updates.
Josh Howard of the Straight Cash Fantasy Sports Experts breaks down the MLB DFS slate tonight and gives you the player match-ups we like for DraftKings and FanDuel for May 3, 2019. We also give you our Straight Cash pick of the night, this is a player that we highlight for tonight as a building block for creating your line-up. Check us out for news and player updates.
Core questions What are the indications for orthopedic surgery for clavicle fracture? List 5 Xray features of supracondylar fracture Describe the Gartland Classification for Extension-type supracondylar fractures List specific complications of a supracondylar fracture. Describe the sequence of ossification around the elbow. What is Baumann’s Angle? (shownotes) Monteggia fracture-dislocation Toddler’s fracture Nursemaid’s elbow. Describe the radiographic findings and management of: Describe the Ortolani and Barlow maneuvers. (shownotes) List 3 physical exam findings consistent with DDH. List 10 causes of hip pain in children Provide a differential diagnosis of limp in the toddler, school-aged child and adolescent. How would you differentiate between transient synovitis and septic arthritis in a child with hip pain? What is the most common location for septic arthritis in a child? What is the prognosis for transient synovitis? What is the most common cause of septic arthritis? Age < 2 months 2 months – 5 yrs 5 yrs – 12 yrs > 12 yrs Prosthetic joint Sickle cell disease Immunocompromised What are the important pathogens of septic arthritis in the following groups: Describe three mechanisms for the development of septic arthritis in children. Regarding synovial fluid analysis, which tests should be ordered. How are the results interpreted? Describe the management of a child with septic arthritis? What the indications for operative debridement? What are the potential complications of septic arthritis? Describe the pathophysiology of Legg-Perthes disease; how does slipped capital femoral epiphysis (SCFE) occur? Describe the common clinical presentation of SCFE + LCPD Describe 2 radiographic findings consistent with SCFE + LCPD How is SCFE classified? How is this classification used to determine management? (shownotes) What is the risk of bilateral SCFE? (shownotes) What are the potential complications of SCFE? (shownotes) What is a juvenile Tilleaux fracture? How does it occur? What is a triplanar fracture? List seven red flags for pediatric back pain. What is spondylolysis? What is spondylolisthesis? How is it managed? List 4 common apophyseal injuries in children. Wisecracks: List 6 specific xray findings / fractures consistent with non-accidental injury (shownotes) What is a corner / bucket handle fracture? What are the investigations in a complete skeletal survey (shownotes) List 4 conditions with similar presentation to child abuse (shownotes) List causes of pathologic fractures in children. What is the utility of blood culture, ESR and CRP in a child with suspected septic arthritis of the hip? What the mechanism of a lateral elbow condyle fracture and how are they managed? (shownotes) What is the mechanism of a medial elbow condyle fracture and how are they managed? (shownotes) What is the most common pediatric fracture?
Core questions What are the indications for orthopedic surgery for clavicle fracture? List 5 Xray features of supracondylar fracture Describe the Gartland Classification for Extension-type supracondylar fractures List specific complications of a supracondylar fracture. Describe the sequence of ossification around the elbow. What is Baumann’s Angle? (shownotes) Monteggia fracture-dislocation Toddler’s fracture Nursemaid’s elbow. Describe the radiographic findings and management of: Describe the Ortolani and Barlow maneuvers. (shownotes) List 3 physical exam findings consistent with DDH. List 10 causes of hip pain in children Provide a differential diagnosis of limp in the toddler, school-aged child and adolescent. How would you differentiate between transient synovitis and septic arthritis in a child with hip pain? What is the most common location for septic arthritis in a child? What is the prognosis for transient synovitis? What is the most common cause of septic arthritis? Age < 2 months 2 months – 5 yrs 5 yrs – 12 yrs > 12 yrs Prosthetic joint Sickle cell disease Immunocompromised What are the important pathogens of septic arthritis in the following groups: Describe three mechanisms for the development of septic arthritis in children. Regarding synovial fluid analysis, which tests should be ordered. How are the results interpreted? Describe the management of a child with septic arthritis? What the indications for operative debridement? What are the potential complications of septic arthritis? Describe the pathophysiology of Legg-Perthes disease; how does slipped capital femoral epiphysis (SCFE) occur? Describe the common clinical presentation of SCFE + LCPD Describe 2 radiographic findings consistent with SCFE + LCPD How is SCFE classified? How is this classification used to determine management? (shownotes) What is the risk of bilateral SCFE? (shownotes) What are the potential complications of SCFE? (shownotes) What is a juvenile Tilleaux fracture? How does it occur? What is a triplanar fracture? List seven red flags for pediatric back pain. What is spondylolysis? What is spondylolisthesis? How is it managed? List 4 common apophyseal injuries in children. Wisecracks: List 6 specific xray findings / fractures consistent with non-accidental injury (shownotes) What is a corner / bucket handle fracture? What are the investigations in a complete skeletal survey (shownotes) List 4 conditions with similar presentation to child abuse (shownotes) List causes of pathologic fractures in children. What is the utility of blood culture, ESR and CRP in a child with suspected septic arthritis of the hip? What the mechanism of a lateral elbow condyle fracture and how are they managed? (shownotes) What is the mechanism of a medial elbow condyle fracture and how are they managed? (shownotes) What is the most common pediatric fracture?
Today we discuss a few cases we have seen. We discuss 2 cases, both involved poorly adapted gaits from injury, adaptations that had become the client's new norm. Once you get past Ivo's case presentation, which is very in depth, the discussions quickly go into very important topics that we all over look, namely gait and gait rehab, gait thresholds, metabolic thresholds, cortical fatigue, and how to use some neurologic principles to restore a problematic gait. Key Tag words: gait, concussion, head trauma, cortical fatigue, endurance, strength, gait analysis, gait problems, gait rehab, running, running injuries, run-walk, SCFE, slipped epiphysis, femoral growth plate, hip stress fractures, growth plate injury, hip dysplasia, limping gait, club foot, step length, stride length Links to find the podcast: iTunes page: https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138?mt=2 Libsyn Directory URL: http://directory.libsyn.com/episode/index/id/6087848 Our Websites: www.thegaitguys.com summitchiroandrehab.com doctorallen.co shawnallen.net Our website is all you need to remember. Everything you want, need and wish for is right there on the site. Interested in our stuff ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.com or thegaitguys.tumblr.com) and you will come to our websites. In the tabs, you will find tabs for STORE, SEMINARS, BOOK etc. We also lecture every 3rd Wednesday of the month on onlineCE.com. We have an extensive catalogued library of our courses there, you can take them any time for a nominal fee (~$20). Our podcast is on iTunes and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.
The Fantasy Insiders Show w/ Joel Henard & Will Carroll & Nick Gwinn
Host Joel Henard will sit down with co-host Mike Hilbig (@TheFantasyDR) from The Fantasy Insiders powered by SoCalledFantasyExperts.com and get you up to date on the latest news and notes from around the fantasy baseball world. Tonights guest will be Tim McLeod from the Prospect 361 Podcast. Joel Henard is a member of the Fantasy Sports Writers Association (FSWA), and has been a podcaster since his first show “Hoosier Fantasy Baseball Insider” debuted in 2009. Shortly thereafter, Joel met injury expert Will Carroll, who was integral in Joel adding “Baseball Prospectus Radio” and “Baseball Daily Digest Radio” to his broadcast catalog. He's also hosted the “Sports Illustrated Fantasy Podcast”, “The Nickel”, “Fantasy Pros 911's Podcast” and “The Fantasy Alarm Podcast.” Mike Hilbig- @TheFantasyDR The Doctor has his FMD from a reputable Internet website, also he has his Honours Degree and Diplomas from several Canadian Colleges and Universities. He can be found writing grammatically atrocious articles, appearing on many podcasts, tweeting about sports, and drinking far too much beer and scotch when not operating his practice.
The Fantasy Insiders Show w/ Joel Henard & Will Carroll & Nick Gwinn
Host Joel Henard will sit down with co-host Mike Hilbig (@TheFantasyDR) from The Fantasy Insiders powered by SoCalledFantasyExperts.com and get you up to date on the latest news and notes from around the fantasy baseball world . This week the guys were joined by David Rubin from SCFE. Joel Henard is a member of the Fantasy Sports Writers Association (FSWA), and has been a podcaster since his first show “Hoosier Fantasy Baseball Insider” debuted in 2009. Shortly thereafter, Joel met injury expert Will Carroll, who was integral in Joel adding “Baseball Prospectus Radio” and “Baseball Daily Digest Radio” to his broadcast catalog. He's also hosted the “Sports Illustrated Fantasy Podcast”, “The Nickel”, “Fantasy Pros 911's Podcast” and “The Fantasy Alarm Podcast.” Mike Hilbig- @TheFantasyDR The Doctor has his FMD from a reputable Internet website, also he has his Honours Degree and Diplomas from several Canadian Colleges and Universities. He can be found writing grammatically atrocious articles, appearing on many podcasts, tweeting about sports, and drinking far too much beer and scotch when not operating his practice David Rubin Dave started playing fantasy sports during the dark ages of pen and paper. He is also an avid reader and watcher of sci fi, fantasy, horror, and other escapist pursuits. He cannot be found on social media, and he is proud of that. . http://socalledfantasyexperts.com/week-3-hot-topics
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