Ten Commandments for Paediatric Musculoskeletal Injuries

Description

In this detailed presentation, Dr. Ashok Johari recounts the complex case of a five-year-old boy suffering from a femur fracture following minor trauma, juxtaposing it with critical insights into pediatric orthopedic care. Initially presented to a rural orthopedic surgeon with persistent pain and low-grade fever, the child underwent plate fixation surgery. Despite this intervention, pain and symptoms persisted, prompting further investigation and ultimately leading to the discovery of a severe infection that had drastically affected the bone structure, resulting in the dislodgement of the femoral head from the shaft. Dr. Johari emphasizes the importance of suspecting underlying infections in cases where pain persists post-surgery and illustrates key lessons learned about treating pediatric fractures, particularly the necessity of conservative debridement and the importance of joint health.



The discussion delves into the complications associated with fractures in children, particularly contextualizing the aspects of pathological fractures. As he describes additional cases, Dr. Johari highlights conditions such as avascular necrosis and various metabolic disorders, including scurvy and osteogenesis imperfecta, which can complicate healing and present challenges in clinical recognition.



Throughout the presentation, several learning points are reinforced: all fractures must be carefully evaluated for potential underlying pathologies, infection should be a primary consideration in cases of ongoing pain, and pediatric care must consider the holistic health of the bone and joints. The talk concludes with a discussion of innovative treatments and long-term management strategies for children with complex orthopedic conditions, advocating for a comprehensive approach that melds surgical expertise with a deep understanding of pediatric bone health.

DOI: 10.1302/3114-230259

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