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  • Unstable pelvic fractures are present when there are multiple breaks in the pelvic ring. Suspect visceral injuries because of high-kinetic energy trauma.
  • Reduction of a hip dislocation should take place prior to 12 hours after the injury. Complications include avascular necrosis (AVN) of the femoral head, degenerative arthritis, and sciatic nerve injury.
  • Slipped capital femoral epiphysis (SCFE) is a disruption of the capital femoral physis that can occur over time. It is most common in overweight adolescent males and is diagnosed on the anteroposterior or frog-leg view of the pelvis.
  • Legg-Calvé-Perthes disease is an idiopathic AVN of the femoral head that is most common in Caucasian children between 4 and 9 years of age. Radiographs demonstrate a small femoral head and epiphyseal collapse as a result of avascular necrosis.
  • A spiral femur fracture in a nonambulatory infant or child suggests child abuse.
  • Distal femoral epiphyseal fractures in children are significant because they can cause growth disturbances in the lower extremity.
  • Ligamentous injuries of the knee are less likely to occur than are epiphyseal injuries. Proximal tibial epiphysis fractures can be significant because they can cause vascular compromise and growth disturbances.
  • Spiral tibial shaft fractures are common in children because of twisting injuries and are termed toddler's fracture in those just learning to walk.
  • Fibular head fractures can occur as a result of motor vehicle bumper injury in children. In order to exclude a significant peroneal nerve injury, make sure there is no foot drop of the affected extremity (loss of dorsiflexion).
  • When examining the child with ankle pain, exclude injuries of the calcaneus, proximal fibula, and base of the fifth metatarsal.
  • The most common fracture of the talus is in the neck, which occurs from forced dorsiflexion. This injury is often complicated by avascular necrosis.
  • Midfoot fractures are rare because of the strong fibrous tissues that surround these bones, and are difficult to detect because of the irregularities of these bones. Lisfranc's fracture occurs at the base of the second metatarsal, where the stability of the midfoot is maintained.
  • The Jones' fracture is a metatarsal neck fracture distal to the apophysis of the base of the fifth metatarsal. Although the apophysis of the fifth metatarsal runs parallel to the axis of the metatarsal shaft, fractures most often are perpendicular to the axis of the metatarsal shaft.

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Fractures of the pelvis are quite rare in children. In contrast to the brittle, adult pelvis, the young pelvis is protected by growing bone and a tremendous amount of cartilage. As a result of this pliability, the young pelvis can absorb tremendous amounts of energy before fracturing. Pelvic fractures in children usually result from high-energy trauma such as automobiles versus pedestrians, motor vehicle crashes, or significant falls. Pelvic fractures are classified depending on their involvement of the pelvic ring, the acetabulum, or one of the apophyses (avulsions). The violent forces necessary to cause pelvic fractures in children often result in multisystem trauma with a combination of head injuries, ...

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