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John F. Sarwark, MD, FAAP, FAAOS • Cynthia R. LaBella, MD, FAAP, FAMSSM u h
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Fully updated and revised, the third edition of this quick reference delivers targeted e
guidance on the diagnosis, treatment, and management of musculoskeletal problems p and Sports Injuries
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and sports-related injuries.
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You’ll turn here often for concise summaries of disorders and injuries; proven
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evaluation, treatment, and rehabilitation approaches; practice-tested tips; and invaluable r
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EFFICIENTLY RESPOND TO DIVERSE CLINICAL CHALLENGES. dit a A Quick Reference Guide
Get all the essentials for addressing io n
• Common sports injuries n
• Fractures NEW IN THE 3RD EDITION d
• Trauma • Femoroacetabular impingement S 3rd Edition
• Limb disorders • Pediatric athletes with disabilities
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• Spine disorders • Bone health evaluation
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• Hip and pelvis disorders Plus, you’ll fi nd step-by-step help r
• Infections with musculoskeletal examina- t
• Tumors tion and evaluation, casting and s
• Skeletal dysplasias splinting, imaging techniques, and I
• And more… rehabilitation strategies. n
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FAST-ACCESS FEATURES r
STREAMLINE ORTHOPAEDIC HELP YOU GET RIGHT TO i
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PROBLEM-SOLVING. THE POINT. s
Each condition-focused chapter steps you Bulleted, outline-format text
through every stage of patient care. lets you rapidly focus in on what
• Etiology/epidemiology you need.
• Signs and symptoms Full-color clinical photographs
• Differential diagnosis and illustrations, as well as radio-
• Diagnostic considerations graphic images, demonstrate exami- SA
• Treatment nation techniques and pathologic R
• Expected outcomes/prognosis physical fi ndings. Multiple tables W
• When to refer and fi gures help simplify diagnosis. AR
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For other pediatric resources, visit the American Academy of Pediatrics at L
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John F. Sarwark, MD, FAAP, FAAOS • Cynthia R. LaBella, MD, FAAP, FAMSSM
AAP
Pediatric
Orthopaedics
and Sports Injuries
A Quick Reference Guide
3rd Edition
John F. Sarwark, MD, FAAP, FAAOS
Cynthia R. LaBella, MD, FAAP, FAMSSM
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who devote their careers to the well-being of our children
Contents
EDITORS/CONTRIBUTORS �������������������������������������������������������������������������������������ix
PREFACE ����������������������������������������������������������������������������������������������������������������xv
PART 1 GROWTH AND MOTOR DEVELOPMENT���������������������������������������������1
Chapter 1 Typical Growth and Motor Development .................................................3
Chapter 2 Atypical Musculoskeletal Growth and Motor Development .....................17
PART 2 MUSCULOSKELETAL EVALUATION ����������������������������������������������������23
Chapter 3 History .................................................................................................25
Chapter 4 Physical Examination ............................................................................33
Chapter 5 Musculoskeletal Imaging Studies ...........................................................63
Chapter 6 Laboratory Studies ................................................................................75
PART 3 MUSCULOSKELETAL INFECTIONS �����������������������������������������������������79
Chapter 7 Osteomyelitis ........................................................................................81
Chapter 8 Septic Arthritis ......................................................................................95
Chapter 9 Miscellaneous Infections ......................................................................101
PART 4 EVALUATING THE LIMPING CHILD ��������������������������������������������������107
Chapter 10 The Limping Child: General Approach and Differential Diagnosis ........109
PART 5 SPINAL DEFORMITIES ���������������������������������������������������������������������119
Chapter 11 Idiopathic Scoliosis and Congenital Scoliosis ........................................121
Chapter 12 Kyphosis .............................................................................................133
Chapter 13 Spondylolysis and Spondylolisthesis .....................................................141
PART 6 BACK PAIN ���������������������������������������������������������������������������������������151
Chapter 14 Back Pain: General Approach and Differential Diagnosis. ......................153
PART 7 PEDIATRIC CERVICAL SPINE ������������������������������������������������������������163
Chapter 15 Pediatric Cervical Spine: Basic Radiographic Interpretation ..................165
Chapter 16 Torticollis ...........................................................................................171
Chapter 17 Atlantoaxial Rotatory Subluxation or Fixation ......................................179
PART 8 HIP DISORDERS �������������������������������������������������������������������������������187
Chapter 18 Developmental Dysplasia of the Hip ....................................................189
Chapter 19 Perthes Disease ...................................................................................195
Chapter 20 Slipped Capital Femoral Epiphysis .......................................................199
Chapter 21 Snapping Hip ......................................................................................205
Chapter 22 Femoroacetabular Impingement ..........................................................211
vi Contents
PART 9 ROTATIONAL AND ANGULAR DEFORMITIES ����������������������������������219
Chapter 23 Rotational and Angular Deformities: General Treatment Guidelines ......221
Chapter 24 In-toeing .............................................................................................223
Chapter 25 Out-toeing ..........................................................................................229
Chapter 26 Angular Variations: Genu Varum (Bowleg) and Genu Valgum
(Knock-Knee) .....................................................................................231
PART 10 UPPER EXTREMITY PROBLEMS �������������������������������������������������������235
Chapter 27 Brachial Plexus Injuries .......................................................................237
Chapter 28 Nursemaid Elbow (Radial Head Subluxation) ......................................249
Chapter 29 Congenital Upper Limb Differences .....................................................253
PART 11 PEDIATRIC SPORTS MEDICINE AND INJURIES ��������������������������������271
Chapter 30 Preparticipation Physical Evaluation.....................................................273
Chapter 31 Strains, Sprains, and Dislocations ........................................................283
Chapter 32 Traumatic Muscle Injuries ...................................................................301
Chapter 33 Overuse Injuries ..................................................................................311
Chapter 34 Patellofemoral Disorders .....................................................................343
Chapter 35 Internal Derangement of the Knee (Knee Injury) .................................355
Chapter 36 Sports-Related Concussion ..................................................................375
Chapter 37 Pediatric Athletes With Disabilities .......................................................389
PART 12 COMMON FRACTURES AND PHYSEAL INJURIES ���������������������������405
Chapter 38 Pediatric Trauma Overview ..................................................................407
Chapter 39 Imaging Fractures ...............................................................................409
Chapter 40 Fracture Types Overview .....................................................................411
Chapter 41 Stages of Fracture Healing ...................................................................415
Chapter 42 Physeal Fractures ................................................................................419
Chapter 43 Bone Health Evaluation in the Child Vulnerable to Fracture ..................425
Chapter 44 Common Fractures of the Upper Extremities .......................................433
Chapter 45 Common Fractures of the Lower Extremities .......................................451
Chapter 46 Casting and Splinting ..........................................................................465
Chapter 47 Occult Fractures (Injury Not Detected by Radiography) .......................479
Chapter 48 Compartment Syndrome .....................................................................483
Chapter 49 Nonaccidental Trauma ........................................................................489
PART 13 FOOT AND ANKLE ��������������������������������������������������������������������������499
Chapter 50 Foot and Ankle: General Considerations ..............................................501
Chapter 51 Clubfoot .............................................................................................505
Chapter 52 Flatfoot ...............................................................................................511
Chapter 53 Metatarsus Adductus and Metatarsus Varus ..........................................515
Chapter 54 Pes Cavus and Cavovarus ....................................................................519
Chapter 55 Calcaneal Valgus ..................................................................................523
Chapter 56 Foot and Ankle: Miscellaneous Conditions ...........................................525
Contents vii
PART 14 BENIGN AND MALIGNANT MUSCULOSKELETAL TUMORS ������������547
Chapter 57 Evaluation of Benign and Malignant Musculoskeletal Tumors ...............549
Chapter 58 Common Benign Tumors ....................................................................555
Chapter 59 Malignant Tumors ...............................................................................577
PART 15 LIMB-LENGTH DISCREPANCY ����������������������������������������������������������589
Chapter 60 Limb-Length Discrepancy ...................................................................591
PART 16 NEUROMUSCULAR DISORDERS, PART 1 �����������������������������������������601
Chapter 61 Cerebral Palsy .....................................................................................603
Chapter 62 Myelomeningocele (Spina Bifida) ........................................................611
PART 17 NEUROMUSCULAR DISORDERS, PART 2 �����������������������������������������621
Chapter 63 Neurodegenerative Disorders ...............................................................623
Chapter 64 Hereditary Neuropathies: Charcot-Marie-Tooth Disease .......................631
Chapter 65 Spinal Muscular Atrophy .....................................................................637
Chapter 66 Friedreich Ataxia .................................................................................645
Chapter 67 Arthrogryposis ....................................................................................653
PART 18 GENETIC DISEASES AND SYNDROMES WITH
MUSCULOSKELETAL MANIFESTATIONS ������������������������������������������661
Chapter 68 Skeletal Dysplasias ..............................................................................663
Chapter 69 Metabolic Bone Diseases .....................................................................675
Chapter 70 Neurofibromatosis 1 ............................................................................683
Chapter 71 Hemophilia .........................................................................................689
Chapter 72 Achondroplasia ...................................................................................695
Chapter 73 Down Syndrome .................................................................................701
PART 19 RHEUMATOLOGIC AND CONNECTIVE TISSUE DISEASES ��������������707
Chapter 74 Juvenile Idiopathic Arthritis .................................................................709
Chapter 75 Autoimmune Connective Tissue Diseases .............................................723
Chapter 76 Inherited Connective Tissue Diseases ...................................................737
INDEX ���������������������������������������������������������������������������������������������������������������� 747
Editors
John F. Sarwark, MD, FAAP, FAAOS Cynthia R. LaBella, MD, FAAP,
Professor of Orthopaedic Surgery FAMSSM
Northwestern University Feinberg School of Professor of Pediatrics
Medicine Northwestern University Feinberg School of
Martha Washington Professor of Medicine
Orthopaedic Surgery Medical Director, Institute for Sports
Head, Orthopaedic Surgery Medicine
Ann & Robert H. Lurie Children’s Hospital Ann & Robert H. Lurie Children’s Hospital
of Chicago of Chicago
Chicago, IL Chicago, IL
Contributing Authors
Lindsay M. Andras, MD, FAAP Jennette L. Boakes, MD
Associate Professor of Orthopaedic Surgery Pediatric Orthopaedic Surgeon
Children’s Orthopaedic Center Shriners Hospitals for Children – Northern
Children’s Hospital Los Angeles California
Los Angeles, CA Clinical Professor of Orthopaedic Surgery
University of California, Davis School of
Arvind Balaji, MD, FAAP
Medicine
Fellow, Primary Care Sports Medicine
California Northstate University College of
Children’s Hospital of Philadelphia
Medicine
Philadelphia, PA
Sacramento, CA
Holly J. Benjamin, MD, FAAP,
Susannah M. Briskin, MD, FAAP
FACSM
Associate Professor of Pediatrics
Professor of Orthopaedic Surgery and
Division of Pediatric Sports Medicine
Rehabilitation Medicine
Rainbow Babies & Children’s Hospital
Professor of Pediatrics
University Hospitals Cleveland
Director of Primary Care Sports Medicine
Medical Center
University of Chicago
Cleveland, OH
Chicago, IL
Rebecca Carl, MD, MS, FAAP
David T. Bernhardt, MD, FAAP
Institute for Sports Medicine
Professor
Ann & Robert H. Lurie Children’s Hospital
Department of Pediatrics
of Chicago
Department of Orthopedics and
Assistant Professor of Pediatrics
Rehabilitation
Northwestern University Feinberg School of
Division of Sports Medicine
Medicine
University of Wisconsin School of Medicine
Chicago, IL
and Public Health
Madison, WI
