pediatric

Kohler's Disease

DefinitionKohler's Disease

 

Osteonecrosis of the navicular

 

Epidemiology

 

Present at age 4-6 years

- same as Perthes disease

 

M:F 5:1

 

Bilateral in 20%

 

Aetiology

 

Repetitive trauma to maturing ossific nucleus

Monteggia

Paediatric Monteggia APPaediatric Monteggia Lateral

 

Definition

 

Fracture / plastic malformation of proximal ulna with dislocation of radial head

 

Xray

 

Radio-capitellar line disrupted

 

Ankle Fracture

Ossification

 

Distal tibia

- appears by 2 years

- closed at maturity

- asymmetrical closure

- central initially, then posteromedial to anterolateral

- accounts for Tillaux and Triplanar fractures

 

Distal fibula

- appears by 2 years

- closes 2 years after distal tibia

 

Medial Malleolar Extension

- begins age 7

- closes age 10

 

Metastasis

DDx

 

Leukemia 

Neuroblastoma 

Wilm's    

 

Last two usually occur in < 5 year age group

 

Bone scan is method of choice for screening for metastasis

 

Leukemia

 

Epidemiology

 

Most common form of cancer in children 30%

- ALL 5 x AML

- 3 : 100 000