Advanced Musculoskeletal Physiotherapy Self-

directed Learning Modules:

Emergency Department 2014

Module 8: Paediatrics

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Prepared by Alfred Health on behalf of the Victorian Department of Health 2014

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Module 8: Paediatrics

Contents

Module 8: Paediatrics.............................................................................................28.1 Musculoskeletal presentations in paediatrics..............................................3

Theme 2 Focused clinical assessment of musculoskeletal presentations in paediatrics......................................................................................................................5Theme 3 Imaging for musculoskeletal presentations in Paediatrics........7Theme 4 Common pharmacology for the management of musculoskeletal conditions in paediatrics............................................................9Theme 6 Musculoskeletal presentations in paediatrics by region.........12

Module 8: Paediatrics 3

8.1 Musculoskeletal presentations in paediatrics(older children 6-13 years and adolescent 13-19 years)Theme 1 History taking for musculoskeletal presentations in paediatrics

LEARNING OBJECTIVES:

1. To understand the key principles of history taking for musculoskeletal presentations in paediatrics

2. To understand the importance of mechanism of injury in musculoskeletal presentations in paediatrics

3. To identify in a timely manner presentations of the musculoskeletal that may require inter-disciplinary care/medical review or presentations of non-musculoskeletal origin that require a medical review

4. To establish a preliminary differential diagnosesTo identify the differences between history taking of a child compared to an adult

ASSUMED KNOWLEDGE: Routine physiotherapy history taking for the musculoskeletal presentations Undergraduate physiotherapy assessment of musculoskeletal conditions in

paediatrics Knowledge of normal physical growth and development milestones across the

spectrum of childhood Knowledge of importance of sensitive and appropriate communication at all times

when working with children, their parents / grandparents / carers KNOWLEDGE:

When obtaining information regarding the mechanism of injury, discuss these key areas: crush direct trauma fall

o on outstretched hand (FOOSH)o fall from standing o fall from height/bike/monkey bars/furniture

suspicious history based on mechanism position of limb and joint eg degree of abduction, hyperextension, extension

etc direction of force: axial loading or “jamming compression/distraction ,

varus/valgus force skin integrity (wounds) time of injury, ability to move limb post injury, WB, continue playing? symptoms such as numbness, pins and needles , ‘dead arm’ , tingling consider other sites for injury

o facial/head/neck/thorax/abdomen injury – what are the associated questions to ask?

o Loss of Consciousness/ headstrike/damage to helmet? Overuse/excessive activity Recent growth activity

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Provide examples of how injuries with a similar mechanism will be different in children compared to adults (Brukner and Khan chapter 32 The younger athlete)

What key information is required to assess for red flags? What key information is required in the setting of non-traumatic musculoskeletal

presentations in the ED setting? What key information in a child’s past medical history is important in

musculoskeletal presentations in the ED setting?o Also consider growth and development, behavioural issues, previous

accidents, family – sibling health What key information in a child’s medication history (prescribed and over the

counter medication) is important in musculoskeletal presentations in the ED setting? (Also consider immunization status)

What key information in a patient’s social history is important in musculoskeletal presentations in the ED setting?

o Consider how the child is going at schoolo Frequency, intensity of sport/activity

What is the relevance of determining the first aid/pre hospital treatment? What is the relevance of determining the last intake of food or fluids? What is the relevance of determining the compensable status or health insurance

status of the patient? What aspects of the history might increase the level of suspicion for inflicted

injuries or non-accidental injury? (UpToDate: Orthopaedic aspects of child abuse What do you consider when there is a contrasting history between child and

parent/carer? With an older child what are the issues with confidentiality and privacy you need

to consider?What are the consent issues to consider when working with children?

RECOMMENDED RESOURCES

Brukner & Khan (2012) Clinical Sports Medicine. 4th Edition. McGraw-Hill MedicalChapter 32, The Younger Athlete.

Royal Children’s Hospital Clinical Practice Guidelines – Child Abusehttp://www.rch.org.au/clinicalguide/guideline_index/Child_Abuse_Guideline/

Children’s Hospitals Australia. Charter on the rights of children and young people in Healthcare services in Australia (PDF)http://www.awch.org.au/pdfs/Charter-Children-Young%20People-Healthcare-Au-version-FINAL-210911b-web.pdf

Up to date Scher, S A & Endom EE (2013) Orthopaedics aspects of child abusehttp://www.uptodate.com/contents/orthopedic-aspects-of-child-abuse?source=search_result&search=child+abuse+orthopaedics&selectedTitle=1~150

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Theme 2 Focused clinical assessment of musculoskeletal presentations in paediatrics

(older children 6-13 years and adolescent 13-19 years)

LEARNING OBJECTIVES:

1. To understand the key aspects in clinical assessment of musculoskeletal presentations in paediatrics in the ED setting

2. To establish key findings to support/refute preliminary differential diagnosis?3. To identify in a timely manner musculoskeletal presentations that may require

inter-disciplinary care/medical review or presentations of non-musculoskeletal origin that require a medical review

ASSUMED KNOWLEDGE Anatomy of the paediatric musculoskeletal: growth patterns of bones, joints,

muscles, tendons, ligaments. Routine musculoskeletal physiotherapy assessment in paediatrics including:

o Limb and spinal assessmento Neurological assessment including peripheral nerveso Gait assessment

KNOWLEDGE:1. Discuss the anatomical differences between adult and growing bone

(Brukner and Khan chapter 32 The younger athlete)2. How would you assess the neurovascular status of the upper and lower limb in a

child?3. What are the relevance of any local skin changes / open wounds?4. When is an assessment of vital signs indicated?5. What is the normal range of vital signs for paediatrics?

(http://www.health.qld.gov.au/pccm/pdfs/pccm_sect_6.pdf page 546)6. How you would differentiate musculoskeletal pain from non- musculoskeletal

pain?7. What are the most common type of musculoskeletal presentations in paediatrics

and what are the likely assessment findings:8. What are the most common non-musculoskeletal presentations in the paediatric

population that may present like a musculoskeletal presentation?o What does your clinical assessment need to include if non-musculoskeletal

causes are suspected?o What findings you would you expect to see on assessment? o What action needs to be taken?o What assessment findings would you expect for a non-accidental injury?

RECOMMENDED RESOURCES

Drake, R, Vogl, W & Mitchell, A, (2005) Gray’s Anatomy for Students. Churchill Livingstone Elsevier. Chapter 7, Upper limb, p707-728.

McRae, R (2010) Clinical Orthopaedic Examination 6th edition. Churchill Livingstone

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Elsevier.

Brukner & Khan (2012) Clinical Sports Medicine. 4th Edition. McGraw-Hill MedicalChapter 32, The Younger Athlete. Shanmugam, C & Maffulli, N (2008) Sporting injuries in Children. Br Med Bull. 86, (1), 33-57. http://bmb.oxfordjournals.org/content/86/1/33.short

Cassas, K & Cassettari-Wayhs, A (2006) Childhood and Adolescent Sports-Related Overuse Injuries. American Family Physician.   73, (6), 1014-1022. http://www.aafp.org/afp/2006/0315/p1014.html

Carson, S, Woolridge, D, Colletti, J & Kilgore, K (2006) Paediatric Upper Extremity Injuries. Pediatric Clinics of North America. 53, 41–67http://hsc.unm.edu/emermed/PED/physicians/residents/articles/Pediatric%20Upper%20Extremity%20Injuries.pdf

Duey-Holtz, A D (2012) Acute and non-acute lower extremity pain in the paediatric population: part II. Journal of Pediatric Health Care. 26, (3), 216-30.http://www.medscape.com/viewarticle/775714

Royal Children’s Hospital: Fracture Educationhttp://www.rch.org.au/fracture-education/

Primary Care Manual QLD Health (see section 6 Paediatric)http://www.health.qld.gov.au/pccm/pccm_resource.asphttp://www.health.qld.gov.au/pccm/pdfs/pccm_sect_6.pdf

Wallis, L, Healy, M, Undy, M, & Maconochie, I (2005) Age related reference ranges for respiration rate and heart rate from 4 to 16 years. Arch Dis Child. 90, 1117–1121http://adc.bmj.com/content/90/11/1117.full.pdf+html

Royal College of Nursing. (2011) Standards for assessing, measuring and monitoring vital signs in infants, children and young people. United Kingdom. http://www.rcn.org.uk/__data/assets/pdf_file/0004/114484/003196.pdf

Up to dateKimura, Y & Southwood, T (2012) Evaluation of the child with joint pain or swellinghttp://www.uptodate.com/contents/evaluation-of-the-child-with-joint-pain-or-swelling?source=see_link

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Theme 3 Imaging for musculoskeletal presentations in PaediatricsLEARNING OBJECTIVES:

1. To understand the common investigations for musculoskeletal presentations in paediatrics

2. To understand what investigations need to be requested and interpreted under a shared model of care with the medical team

KNOWLEDGE: When would you consider obtaining an X-ray for a child with musculoskeletal

presentation? When would a CT scan* be indicated for a child with a musculoskeletal

presentation? When would an ultrasound* be indicated for a child with a musculoskeletal

presentation? When would an MRI scan* be indicated for a child with a musculoskeletal

presentation? When would blood investigations* be indicated for a child with a

musculoskeletal presentation? What are other investigations that may be indicated for a child with a

musculoskeletal presentation? What are the advantages and disadvantages of the different modalities of

imaging for children? What are the recommendations of CT scans for children? What is involved with a skeletal survey and when would it be indicated? Which scenarios warrant immediate escalation for a medical review?(*investigations to be requested by ED Consultant)

CLINICAL APPLICATION:Describe for a variety of different children’s ages the normal x-ray of :

Shoulder Elbow –include growth centres of ossification according to age Wrist and hand Pelvis and hip Knee Foot and ankle Spine

Interactive radiology websites for paediatric musculoskeletal imaging:University of Virginia, Introduction to Paediatric Musculoskeletal Radiology http://www.med-ed.virginia.edu/courses/rad/peds/index.html

Government of Western Australia, Department of Health, Imaging guideline pathways: Paediatricshttp://www.imagingpathways.health.wa.gov.au/index.php/imaging-pathways/paediatricsRECOMMENDED RESOURCES

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Raby, N, Berman, L & de Lacey, G (2005) Accident and Emergency Radiology: A Survival Guide. 2nd edition. Elsevier Saunders. Chapter 4, Shoulder, p68-89.

Anderson, J & Read J (2008) Atlas of Imaging in Sports Medicine. 2nd Edition. McGraw-Hill.

Strange, G, Williams, R, Schafermeyer, R & Wiebe, R (2011) Pediatric Emergency Medicine. 3rd Edition. Mc Graw Hill.

Australian Government Australian Radiation Protection and Nuclear Safety Agency (2013) CT Scans for Children Fact Sheet. http://www.arpansa.gov.au/RadiationProtection/Factsheets/is_CTScansReferrers.cfm

Wallace, A & Cain, T (2009) Radiation Risk of Medical Imaging for Adults and Children.Insider Radiology. The Royal Australian and New Zealand College of Radiologists.http://www.insideradiology.com.au/pages/view.php?T_id=57

Cain, T (2009) Children’s X-ray Examination. Insider Radiology.The Royal Australian and New Zealand College of Radiologists.http://www.insideradiology.com.au/pages/view.php?T_id=28&ref_info

European Commission (2000) Referral Guidelines for Imaging. http://ec.europa.eu/energy/nuclear/radioprotection/publication/doc/118_en.pdf

Up to date Jude, C & Modarresi, S (2013) Radiologic evaluation of the hip in infants, children, and adolescents.http://www.uptodate.com/contents/radiologic-evaluation-of-the-hip-in-infants-children-and-adolescents?source=search_result&search=bone+tumours+in+children&selectedTitle=14%7E64

Standard for skeletal surveys in suspected non-accidental injury (NAI) in childrenhttp://www.e-adiography.net/radpath/n/non_accidenta_%20injury%202.htmhttp://www.imagingpathways.health.wa.gov.au/index.php/imaging-pathways/paediatrics/non-accidental-injury#pathway-homehttp://radiopaedia.org/articles/non-accidental-injuries

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Theme 4 Common pharmacology for the management of musculoskeletal conditions in paediatricsLEARNING OBJECTIVES:

1. To understand the key information required when taking a medication history in a child

2. To understand the common pharmacological agents used for musculoskeletal presentations in paediatrics

KNOWLEDGE: What information is required when taking a medication history of a child? Analgesic agents

o What is appropriate analgesia for a child with minor pain?o What is appropriate analgesia for a child with mod-severe pain?

Anti-inflammatory agentso What and when is it appropriate to use anti-inflammatory agents?o When is the use of anti-inflammatory medications contra-indicated in

children? Antibiotics

o When is antibiotics indicated for musculoskeletal presentations in children

Tetanus immunoglobulin and vaccinationsWhen would you consider this?

RECOMMENDED RESOURCES

Beggs, S (2008) Paediatric Analgesia. Australian Prescriber. 31, p63-5. http://www.australianprescriber.com/magazine/31/3/63/5/

The Royal Children’s Hospital 2013) Pain relief for Children http://www.rch.org.au/kidsinfo/fact_sheets/Pain_relief_for_children_-_Paracetamol_and_Ibuprofen/

Hamilton, B, Milne, C, Orchard, J & Paoloni, J (2009) Non-steroidal anti-inflammatory drugs (NSAIDs) in sports medicine. Guidelines for sensible use. British journal of sports medicine. http://bjsm.bmj.com/content/early/2009/06/21/bjsm.2009.059980.abstract Ball, V & Younggren, B (2007) Emergency Management of Difficult Wounds: Part I. Emergency Medicine Clinics of North America.http://www.mdconsult.com/das/article/body/385344101-2/jorg=journal&source=&sp=18944593&sid=0/N/577108/s0733862707000041.pdf?issn=0733-8627

Therapeutic Guidelines (2013 eTG onlinehttp://online.tg.org.au/ip/ (search tetanus)

Haver, J &Jones, B (2013) Evaluation and management of pain in childrenhttp://www.uptodate.com/contents/evaluation-and-management-of-pain-in-children?

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source=search_result&search=analgesia+and+children&selectedTitle=1~150Theme 5 Fractures and radiological interpretation in paediatrics

LEARNING OBJECTIVES:

1. To understand principles of fracture management in paediatrics in the ED 2. To be able to identify on plain film imaging common fractures in paediatrics

and recognise when referral to a specialist is indicated3.

ASSUMED KNOWLEDGE: Principles of fracture management in adults Bony anatomy – epiphysis, diaphysis, metaphysis

KNOWLEDGE: Define the following terminology

o Physiso Apophysiso Torus (buckle) fractureo Greenstick fractureo Bowing fracture

What are the factors that affect bone remodeling in children? (RCH website) What is the average age of physeal closure in boys and girls? What is the key information to include when describing a fracture - include

the clinical narrative as well as the radiologic interpretation? (uptodate) Describe the common fracture patterns seen in children Describe the Salter Harris classification for physeal fractures What are the principles of management of physeal fractures? (RCH website) What is the time of appearance of secondary ossification centres? (RCH

website) What are the indications for application of a backslab? (RCH website) Review the paediatric fracture guidelines for each region on the RCH website

and indicate when specialist referral is required http://ww2.rch.org.au/clinicalguide/fractures/#Emergency

View the powerpoint presentation on the RCH website o http://ww2.rch.org.au/clinicalguide/fractures/#Education

Complete the quiz on the RCH websiteo http://www.rch.org.au/fracture-education/Quiz/

RECOMMENDED RESOURCESRang M, Pring M, & Wenger DR (2005) Rang's Children's Fractures. 3rd Edition. Lippincott Williams & Wilkins, Philadelphia.

Strange, G, Williams, R, Schafermeyer, R & Wiebe, R (2011) Pediatric Emergency Medicine. 3rd Edition. Mc Graw Hill.

The Royal Children’s Hospital (2012) Fracture Educationhttp://www.rch.org.au/fracture-education/http://www.rch.org.au/clinicalguide/guideline_index/Fracture_Casting_videos/

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http://ww2.rch.org.au/clinicalguide/fractures/

Up to date:Mathison. D & Agrawal, D (2013) General principles of fracture management: Fracture patterns and description in children.http://www.uptodate.com/contents/general-principles-of-fracture-management-fracture-patterns-and-description-in-children?source=see_link

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Theme 6 Musculoskeletal presentations in paediatrics by region

LEARNING OBJECTIVES:

1. To understand the assessment and management principles for common musculoskeletal presentations in paediatrics according to the different regions in the context of the ED setting

2. To identify which musculoskeletal presentations in paediatrics require review with the ED Consultant and/or referral to medical specialist

ASSUMED KNOWLEDGE: Physiotherapy management of acute, sub-acute and chronic musculoskeletal

conditions Simple first aid management of musculoskeletal conditions Application of slings, splints, cam walkers, gait aids for musculoskeletal

conditions in paediatrics

KNOWLEDGE:For the following list of injuries consider:

What are the most likely assessment findings? What management is appropriate in the ED setting? What type of injury would require the involvement of the ED Medical team? What type of injury would require the involvement of the Orthopaedic team? When would you request an urgent review? How would you provide adequate pain control in ED and on discharge? How might age impact management?

1. Shoulder a. Fracture of the clavicle b. Sprain, Subluxation and dislocation of the acromio-clavicular jointc. Subluxation/Dislocation of the glenohumeral jointd. Proximal humerus #e. Little league’s shoulder

2. Elbow a. Supracondylar humerus fracturesb. Medial and lateral condyle fracturesc. Radial head subluxation (pulled elbow)d. Proximal radial and ulnar fracturese. Little league’s elbowf. Osteochondritis dissecans of the capitellumg. Panners disease

3. Wrist and hand a. Distal radial and ulnar fracturesb. Fractures of the phalangesc. Metacarpal fracturesd. IP dislocatione. Skiers thumb

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4. Spine a. Spondylolysis and spondylolisthesisb. Scheuermans disease

5. Hip a. Apophysitides (ASIS, Rec fem, AIIS, psoas)b. Perthes diseasec. Slipped capital femoral epiphysisd. Snapping hip

6. Knee a. Osgood Schlattersb. Sinding-Larsen-Johannsson diseasec. ACL/MCL injuryd. Avulsion # tibial spine/segond’s fracturee. Patella dislocation/fracture/dysfunctionf. Osteochondritis dissecans of the femoral condyleg. Patellofemoral painh. Referred hip paini. Tibial and fibula fractures

7. Foot and ankle a. Distal tibia and fibula fracturesb. Talus fracturesc. Tarsal fracturesd. Talar dome injurye. Metatarsal fracturesf. Phalanges fractureg. Sever’s diseaseh. Kohlers diseasei. Tarsal coalitionj. Apophysitis (5th MT)k. Freiberg’s diseasel. Lateral ligament sprainm. High ankle sprain (syndesmosis)

What should your assessment of the limping child include and what are the most common differential diagnosis to consider?

Differential diagnosisWhat assessment signs would make you suspect a non-musculoskeletal cause and what action will need to be taken?What fractures and injury/fracture patterns are suspicious for non-accidental injury?What are some common presentations in paediatrics to consider?

Types of malignancy – which bones? Infections – which joints? Inflammatory disorders?

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Complete the following educational resources (You will need to register to do it) Common paediatric orthopaedic conditions education resource

http://thinkgp.com.au/education/content/372 The limping child http://thinkgp.com.au/education/content/367

RECOMMENDED RESOURCESRang, M, Pring, ME & Wenger D (2005) Rang's Children's Fractures. 3rd Edition. Lippincott Williams & Wilkins, Philadelphia.

Strange, GR, Williams, RA, Schafermeyer, RW & Wiebe RA (2011) Pediatric Emergency Medicine. 3rd Edition. Mc Graw Hill.

Brukner & Khan (2012) Clinical Sports Medicine. 4th Edition. McGraw-Hill MedicalChapter 32, The Younger Athlete.

The Royal Children’s Hospital (2013)http://www.rch.org.au/ortho/education_training/Education_training/http://www.rch.org.au/fracture-education/http://www.rch.org.au/clinicalguide/guideline_index/Fracture_Casting_videos/http://ww2.rch.org.au/clinicalguide/fractures/

Smithuis, R (2008) Elbow – Fractures in Children. Radiology Assistant. Radiological Society of Netherlands.http://www.radiologyassistant.nl/en/p4214416a75d87/elbow-fractures-in-children.html

Fitzgerald, D (2012) Orthopaedic problems in children. Medical Observer.http://www.medicalobserver.com.au/news/orthopaedic-problems-in-children

Medscape Reference (2013) Orthopaedic Surgery Articles.http://emedicine.medscape.com/orthopedic_surgery

Medscape Reference (2013) Emergency medicine articles.http://emedicine.medscape.com/emergency_medicine

Up to date:Harvey, B & Hergenroeder, A (2012) Management of osteochondritis dissecans (OCD)http://www.uptodate.com/contents/management-of-osteochondritis-dissecans-ocd?source=search_result&search=osteochondritis+dissecans+children&selectedTitle=1%7E22

Harvey, B & Hergenroedfer, A (2012) Clinical manifestations and diagnosis of osteochondritis dissecans (OCD)http://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-osteochondritis-dissecans-ocd?source=search_result&search=osteochondritis+dissecans+children&selectedTitle=2%7E2 2 Gomez, J (2013) Plica syndrome

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http://www.uptodate.com/contents/plica-syndrome?source=search_result&search=osteochondritis+dissecans+children&selectedTitle=3%7E22

Hergenroeder, A (2012) Causes of chronic knee pain in the young athletehttp://www.uptodate.com/contents/causes-of-chronic-knee-pain-in-the-young-athlete?source=search_result&search=osteochondritis+dissecans+children&selectedTitle=4%7E22

Chorley, J & Powers, C (2013) Clinical features and management of ankle pain in the young athletehttp://www.uptodate.com/contents/clinical-features-and-management-of-ankle-pain-in-the-young-athlete?source=search_result&search=osteochondritis+dissecans+children&selectedTitle=5%7E22

Hergenroeder, A (2012) Approach to the young athlete with chronic knee pain or injuryhttp://www.uptodate.com/contents/approach-to-the-young-athlete-with-chronic-knee-pain-or-injury?source=search_result&search=osteochondritis+dissecans+children&selectedTitle=6%7E22

Clark, M (2012) Overview of the causes of limp in childrenhttp://www.uptodate.com/contents/overview-of-the-causes-of-limp-in-children?source=search_result&search=osteochondritis+dissecans+children&selectedTitle=7%7E22

Chorley, J (2012) Elbow injuries in the young athletehttp://www.uptodate.com/contents/elbow-injuries-in-the-young-athlete?source=search_result&search=osteochondritis+dissecans+children&selectedTitle=8%7E22

Boutis, K (2013) Foot fractures (other than metatarsal or phalangeal) in childrenhttp://www.uptodate.com/contents/foot-fractures-other-than-metatarsal-or-phalangeal-in-children?source=search_result&search=osteochondritis+dissecans+children&selectedTitle=9%7E22

Kienstra, A & Macias, C (2012) Osgood-Schlatter disease (tibial tuberosity avulsion)http://www.uptodate.com/contents/osgood-schlatter-disease-tibial-tuberosity-avulsion?source=search_result&search=osteochondritis+dissecans+children&selectedTitle=10%7E22

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Chorley, J & Powers, C (2012) Evaluation of foot and ankle pain in the young athletehttp://www.uptodate.com/contents/evaluation-of-foot-and-ankle-pain-in-the-young-athlete?source=search_result&search=osteochondritis+dissecans+children&selectedTitle=11%7E22

Hergenroeder, A (2012) Traumatic causes of acute knee pain and injury in the young athletehttp://www.uptodate.com/contents/traumatic-causes-of-acute-knee-pain-and-injury-in-the-young-athlete?source=search_result&search=osteochondritis+dissecans+children&selectedTitle=12%7E22

Agrawal, D & Mathison, D (2013) General principles of fracture management: Fracture patterns and description in childrenhttp://www.uptodate.com/contents/general-principles-of-fracture-management-fracture-patterns-and-description-in-children?source=search_result&search=children+fractures&selectedTitle=1%7E150

Hergenroeder, A (2012) Distal femoral fractures in childrenhttp://www.uptodate.com/contents/distal-femoral-fractures-in-children?source=search_result&search=children+fractures&selectedTitle=2%7E150

Schweich, P (2012) Initial management of distal forearm fractures in childrenhttp://www.uptodate.com/contents/initial-management-of-distal-forearm-fractures-in-children?source=search_result&search=children+fractures&selectedTitle=3%7E150

deWebber, K (2013) Overview of stress fractureshttp://www.uptodate.com/contents/overview-of-stress-fractures?source=search_result&search=children+fractures&selectedTitle=4%7E15 0

Manning Ryan, L (2012) Midshaft humeral fractures in childrenhttp://www.uptodate.com/contents/midshaft-humeral-fractures-in-children?source=search_result&search=children+fractures&selectedTitle=5%7E150

Boutis, K (2013) Ankle fractures in childrenhttp://www.uptodate.com/contents/ankle-fractures-in-children?source=search_result&search=children+fractures&selectedTitle=8%7E150

Manning Ryan, L (2013) Proximal humeral fractures in childrenhttp://www.uptodate.com/contents/proximal-humeral-fractures-in-children?source=search_result&search=children+fractures&selectedTitle=9%7E150

Chapman, J & Cohen, J (2012) Proximal tibial fractures in childrenhttp://www.uptodate.com/contents/proximal-tibial-fractures-in-children?source=search_result&search=children+fractures&selectedTitle=10%7E150

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Manning Ryan, L (2012) Epicondylar and transphyseal elbow fractures in childrenhttp://www.uptodate.com/contents/epicondylar-and-transphyseal-elbow-fractures-in-children?source=search_result&search=children+fractures&selectedTitle=11%7E150

Manning Ryan, L (2012) Evaluation and management of condylar elbow fractures in childrenhttp://www.uptodate.com/contents/evaluation-and-management-of-condylar-elbow-fractures-in-children?source=search_result&search=children+fractures&selectedTitle=12%7E150

Schweich, P (2012) Proximal fractures of the forearm in childrenhttp://www.uptodate.com/contents/proximal-fractures-of-the-forearm-in-children?source=search_result&search=children+fractures&selectedTitle=13%7E150

Schweich, P (2012) Diagnosis and assessment of distal forearm fractures in childrenhttp://www.uptodate.com/contents/diagnosis-and-assessment-of-distal-forearm-fractures-in-children?source=search_result&search=children+fractures&selectedTitle=14%7E150

Schweich, P (2012) Midshaft forearm fractures in childrenhttp://www.uptodate.com/contents/midshaft-forearm-fractures-in-children?source=search_result&search=children+fractures&selectedTitle=16%7E150

Stone, K & White, K (2013) Hip fractures in childrenhttp://www.uptodate.com/contents/hip-fractures-in-children

Chapman, J & Cohen, J (2012) Tibial and fibular shaft fractures in childrenhttp://www.uptodate.com/contents/tibial-and-fibular-shaft-fractures-in-children

Schweich, P (2013) Closed reduction and casting of distal forearm fractures in childrenhttp://www.uptodate.com/contents/closed-reduction-and-casting-of-distal-forearm-fractures-in-children?detectedLanguage=en&source=search_result&search=Closed+reduction+and+casting+of+distal+forearm+fractures+in+children&selectedTitle=1%7E150&provider=noProvider

Manning Ryan, L (2013) Evaluation and management of supracondylar fractures in childrenhttp://www.uptodate.com/contents/evaluation-and-management-of-supracondylar-fractures-in-children?detectedLanguage=en&source=search_result&search=Evaluation+and+management+of+supracondylar+fractures+in+children&selectedTitle=1%7E18&provider=noProvider

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Stone, K & White, K (2012) Femoral shaft fractures in childrenhttp://www.uptodate.com/contents/femoral-shaft-fractures-in-children?source=search_result&search=children+fractures&selectedTitle=23%7E150Boutis, K (2012) Metatarsal and toe fractures in childrenhttp://www.uptodate.com/contents/metatarsal-and-toe-fractures-in-children?source=search_result&search=children+fractures&selectedTitle=24%7E150

Schutzman, S (2013) Evaluation of the immobile arm in childrenhttp://www.uptodate.com/contents/evaluation-of-the-immobile-arm-in-children?source=search_result&search=children+fractures&selectedTitle=25%7E150

Bloom, J (2012) Overview of metacarpal fractureshttp://www.uptodate.com/contents/overview-of-metacarpal-fractures?source=search_result&search=children+fractures&selectedTitle=26%7E150

Manning Ryan ,L (2012) Elbow anatomy and radiographic diagnosis of elbow fracture in childrenhttp://www.uptodate.com/contents/elbow-anatomy-and-radiographic-diagnosis-of-elbow-fracture-in-children?source=search_result&search=children+fractures&selectedTitle=28%7E150

Chapman, J & Cohen (2013) Overview of tibial fractures in childrenhttp://www.uptodate.com/contents/overview-of-tibial-fractures-in-children?source=search_result&search=children+fractures&selectedTitle=29%7E150

Chorley, J & Upton, D (2013) Overview of acute wrist injuries in children and adolescentshttp://www.uptodate.com/contents/overview-of-acute-wrist-injuries-in-children-and-adolescents?source=search_result&search=children+fractures&selectedTitle=30%7E150

Brooks, G & Chorley, J (2012) Traumatic causes of acute shoulder pain and injury in children and adolescentshttp://www.uptodate.com/contents/traumatic-causes-of-acute-shoulder-pain-and-injury-in-children-and-adolescents?source=search_result&search=children+fractures&selectedTitle=32%7E150

Patellar dislocations in children and adolescentshttp://www.uptodate.com/contents/recognition-and-initial-management-of-lateral-patellar-dislocations

Brooks, G, Fitzgerald, D & Hergenroeder, A (2012) Musculoskeletal injury in the young athlete: Overview of treatment principles for nonoperative injurieshttp://www.uptodate.com/contents/musculoskeletal-injury-in-the-young-athlete-overview-of-treatment-principles-for-nonoperative-injuries?source=search_result&search=soft+tissue+injuries+in+children&selectedTitle=1%7E150

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Hergenroeder, A (2012) Approach to the young athlete with acute knee pain or injuryhttp://www.uptodate.com/contents/approach-to-the-young-athlete-with-acute-knee-pain-or-injury?source=search_result&search=soft+tissue+injuries+in+children&selectedTitle=2%7E150

Caviness, A (2013_Evaluation of cervical spine injuries in children and adolescentshttp://www.uptodate.com/contents/evaluation-of-cervical-spine-injuries-in-children-and-adolescents?source=search_result&search=soft+tissue+injuries+in+children&selectedTitle=5%7E150

Chorley, J & Upton, S (2012) Evaluation of wrist pain and injury in children and adolescentshttp://www.uptodate.com/contents/evaluation-of-wrist-pain-and-injury-in-children-and-adolescents?source=search_result&search=soft+tissue+injuries+in+children&selectedTitle=6%7E150

Caviness, A (2013) Spinal cord injury without radiographic abnormality (SCIWORA) in childrenhttp://www.uptodate.com/contents/spinal-cord-injury-without-radiographic-abnormality-sciwora-in-children?source=search_result&search=soft+tissue+injuries+in+children&selectedTitle=12%7E150

Decker, J & Hergenroeder, A (2012) Overview of musculoskeletal neck injuries in the young athletehttp://www.uptodate.com/contents/overview-of-musculoskeletal-neck-injuries-in-the-young-athlete?source=search_result&search=soft+tissue+injuries+in+children&selectedTitle=19%7E150

Chorley, J & Powers, C (2012) Clinical features and management of heel pain in the young athletehttp://www.uptodate.com/contents/clinical-features-and-management-of-heel-pain-in-the-young-athlete?source=search_result&search=severs+disease&selectedTitle=1%7E16

Lehman, T (2012) Systemic onset juvenile idiopathic arthritis: Clinical manifestations and diagnosishttp://www.uptodate.com/contents/systemic-onset-juvenile-idiopathic-arthritis-clinical-manifestations-and-diagnosis?source=see_link

Lehman, T (2012) Systemic onset juvenile idiopathic arthritis: Course,

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prognosis, and complications http://www.uptodate.com/contents/systemic-onset-juvenile-idiopathic-arthritis-course-prognosis-and-complications?source=see_linkClark, M (2012) Approach to the child with a limphttp://www.uptodate.com/contents/approach-to-the-child-with-a-limp?source=related_link

Krogstad, P (2013) Bacterial arthritis: Clinical features and diagnosis in infants and childrenhttp://www.uptodate.com/contents/bacterial-arthritis-clinical-features-and-diagnosis-in-infants-and-children?source=related_link

Krogstad, P (2013) Clinical features of hematogenous osteomyelitis in childrenhttp://www.uptodate.com/contents/clinical-features-of-hematogenous-osteomyelitis-in-children?source=related_link

DeLaney, T, Hornicek, F & Mankin, H (2013) Clinical presentation, staging, and prognostic factors of the Ewing sarcoma family of tumorshttp://www.uptodate.com/contents/clinical-presentation-staging-and-prognostic-factors-of-the-ewing-sarcoma-family-of-tumors?source=related_link

Krogstad, P (2013) Evaluation and diagnosis of hematogenous osteomyelitis in childrenhttp://www.uptodate.com/contents/evaluation-and-diagnosis-of-hematogenous-osteomyelitis-in-children?source=related_link

Chintagumpala, M, Gebhardt, M & Wang, L (2013) Osteosarcoma: Epidemiology, pathogenesis, clinical presentation, diagnosis, and histologyhttp://www.uptodate.com/contents/osteosarcoma-epidemiology-pathogenesis-clinical-presentation-diagnosis-and-histology?source=related_link

Tis, J (2013) Overview of benign bone tumors in children and adolescentshttp://www.uptodate.com/contents/overview-of-benign-bone-tumors-in-children-and-adolescents?source=related_link

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Module 8: Paediatrics 22