{
 "topic": "Lateral Ligament Injury",
 "slug": "lateral-ligament-injury",
 "category_id": 15661,
 "passage_count": 14,
 "source_chars": 11423,
 "enough_material": true,
 "references": [
  {
   "title": "Netters Pediatrics (Florin \u0422., Ludwig St.)",
   "author": null,
   "pages": [
    161
   ]
  },
  {
   "title": "Berkowitz's Pediatrics",
   "author": "Berkowitz, Carol D.;",
   "pages": [
    906
   ]
  },
  {
   "title": "Pediatrics for Practitioner (Sharad Thora)",
   "author": null,
   "pages": [
    238
   ]
  },
  {
   "title": "Pediatric Clinical Practice Guidelines & Policies, 18th Edition",
   "author": "American Academy of Pediatrics",
   "pages": [
    1231
   ]
  },
  {
   "title": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition",
   "author": "Hay, William W., Levin, Myron J., Deterding, Robin R., Abzug, Mark J.",
   "pages": [
    902,
    908,
    910
   ]
  },
  {
   "title": "Diagnostic Imaging: Pediatrics",
   "author": "A. Carlson Merrow Jr. MD",
   "pages": [
    829
   ]
  },
  {
   "title": "Cover",
   "author": "Vitalsource Download",
   "pages": [
    8408
   ]
  },
  {
   "title": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "author": null,
   "pages": []
  }
 ],
 "passages": [
  {
   "source": "Netters Pediatrics (Florin \u0422., Ludwig St.), p. 161",
   "text": "Patients with lower leg injuries may present with pain, swelling, deformity, and inability to bear weight on the affected limb. Evaluation of these injuries includes performing a thorough neurovascular examination. Diagnosis is confirmed with radiographs. Most of these injuries can be managed with immobilization and orthopedic referral as long as the neurovascular status is normal, but orthopedic consultation is often indicated to determine whether emergent reduction is necessary. Patients with significant tibial and fibular fractures are also at risk for compartment syndrome, which mandates an emergent orthopedic consultation. ## TODDLER\u2019S FRACTURE Toddler\u2019s fractures occur in young ambulatory children, usually from 1 to 4 years of age. These injuries often occur after a"
  },
  {
   "source": "Berkowitz's Pediatrics, p. 906",
   "text": "2. What is the differential diagnosis of knee pain in children? 3. What laboratory tests and radiographic studies are indicated in the evaluation of children with limp? 4. What is the appropriate treatment of the child with a suspected infectious cause of limp? A _limp_ is a gait disturbance that occurs when an effort is made to minimize weight bearing on an affected leg to reduce pain and instability. The disturbance may be secondary to muscle weakness, deformity, pain, or a combination thereof. Muscle weakness may be caused by primary muscle disease, neurologic conditions, or disuse atrophy. Structural causes of limp include leg length discrepancy and joint stiffness, whereas painful causes of limp include trauma; synovitis; infection of bone, joint, or soft tissue; or neoplasm. A limp may be a sign of significant underlying disease, and accurate diagnosis and appropriate management are essential to prevent potentially serious morbidity. ## **Epidemiology**"
  },
  {
   "source": "Pediatrics for Practitioner (Sharad Thora), p. 238",
   "text": "History plays a major role in deciding the nature and the clinical course of arthritis in children. Limitation of daily activities such as dressing oneself, climbing up and down the - **Table 1 Common causes of articular involvement in children** _Inflammatory Infection_ \u2022 Juvenile idiopathic arthritis \u2022 Septic arthritis \u2022 Inflammatory bowel disease \u2022 Osteomyelitis \u2022 Sarcoidosis \u2022 Tuberculosis \u2022 Primary malignancy hematological (acute \u2022 Human immunodeficiency virus leukemias) - \u2022 Neuroblastoma \u2022 Fibromyalgia _Reactive arthritis Systemic disease_ \u2022 Poststreptococcal infection \u2022 Systemic lupus erythematosus (SLE) \u2022 Rheumatic fever \u2022 Kawasaki disease \u2022 Serum sickness \u2022 Systemic sclerosis \u2022 Lyme arthritis \u2022 Henoch-Sch\u00f6nlein purpura _Mechanical Metabolic_ \u2022 Trauma \u2022 Rickets \u2022 Inherited skeletal dysplasias \u2022 Thyroid disease \u2022 Hypermobility \u2022 Avascular necrosis \u2022 Growing pains _Tumors Unknown_ \u2022 Primary of cartilage or bone (benign or malignant) \u2022 Reflex sympathetic dystrophy"
  },
  {
   "source": "Pediatric Clinical Practice Guidelines & Policies, 18th Edition, p. 1231",
   "text": "## **http://pediatrics.aappublications.org/content/136/3/588** ## **ANTERIOR CRUCIATE LIGAMENT INJURIES: DIAGNOSIS, TREATMENT, AND PREVENTION (CLINICAL REPORT)** ## _Cynthia R. LaBella, MD, FAAP; William Hennrikus, MD, FAAP; Timothy E. Hewett, PhD, FACSM; Council on Sports Medicine and Fitness; and Section on Orthopaedics_ ABSTRACT. The number of anterior cruciate ligament (ACL) injuries reported in athletes younger than 18 years has increased over the past 2 decades. Reasons for the increasing ACL injury rate include the growing number of children and adolescents participating in organized sports, intensive sports training at an earlier age, and greater rate of diagnosis because of increased"
  },
  {
   "source": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition, p. 908",
   "text": "Medial collateral ligament (MCL) and lateral collateral ligament (LCL) injuries are graded on a scale of 1\u20133. Grade 1 injury represents a stretching injury. Grade 2 injury involves partial disruption of the ligament. Grade 3 injury is a complete disruption of the ligament. Radiographs are useful, especially in the skeletally immature athlete, to look for distal femoral or proximal tibial bone injury. MRI scans are used if grade 3 injury or concomitant intra-articular derangement is suspected. ## \u00bb **Treatment** Treatment is almost always conservative. Initial injuries should be iced and elevated. A protective brace is worn **876** **CHAPTER 27**"
  },
  {
   "source": "Diagnostic Imaging: Pediatrics, p. 829",
   "text": "- \u25cbPreadolescent children without \u2191 activity intensity - Insufficiency fractures occur in children with focal or systemic processes leading to bone weakening - Treatment includes cessation of stresses with adequate time for bone repair & recovery of normal ossification - \u25cbRest & immobilization to prevent completion of fracture or permanent growth disturbance from physeal injury **(Left)** _Lateral radiograph of the ankle in an 8 year old with limping shows a band of vertically oriented sclerosis in the talar head \ufb08, typical of a stress injury._ **(Right)** _Lateral radiograph of the foot in a 3 year old shows a band of vertically oriented sclerosis in the posterior aspect of the cuboid \ufb08, a common location for a stress injury._ ![](/tmp/pdf-images/pdf-0829-26.png) ![](/tmp/pdf-images/pdf-0829-27.png)"
  },
  {
   "source": "Cover, p. 8408",
   "text": "Long-term management is symptom-based and unique to each child, most often requiring a multidisciplinary team of medical providers and therapists. Common conditions resulting from brain injury requiring medical attention and multidisciplinary care include spasticity/dystonia, attention-deficit/hyperactivity disorder, seizures, sleep disturbance, cognitive dysfunction, mood disorders, headaches, and fatigue. Children with TBI are also at higher risk for developing endocrine abnormalities, especially in the initial year following injury. ## **OUTCOMES** ## **Mild TBI** While children with mild TBI may have a longer time to complete recovery when compared to adults, the overall prognosis of concussive injuries is good."
  },
  {
   "source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "In the absence of obvious trauma, fever, or systemic symptoms, the next step in the approach to the differential diagnosis of a limp is to determine the focality of the findings and the degree of pain. Localized pain suggests repetitive microtrauma, bone tumor, or an acquired skeletal deformity. Repetitive microtrauma may be responsible for osteochondrosis, a term referring to chronic inflammation of the physis and surrounding structures. This condition is more common in boys, and can involve the pelvis, knee, or foot. Osteochondrosis of the ischiopubic synchondrosis (Van neck disease), presents as vague groin or buttock pain in school-aged children. Sinding-Larsen\u2013Johansson disease involves the inferior pole of the patella, and Osgood\u2013Schlatter disease involves the proximal tibia, both classically affecting young adolescents. Osteochondrosis can involve the foot bones in three locations: The tarsal navicular bone (Kohler disease) in younger children and the metatarsal heads (Freiberg disease) or the"
  },
  {
   "source": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition, p. 910",
   "text": "## **FOOT & ANKLE INJURIES** Injuries in the lower leg, ankle, and foot are common in pediatric athletes. The types of injuries sustained typically depend on the age group. Young children tend to have diaphyseal injuries, in contrast to older children in rapid growth, who tend to have epiphyseal and apophyseal injuries. Skeletally mature adolescents are prone to adult-pattern ligamentous injury. Although fractures of the ankle are possible with inversion and eversion mechanisms, the most common acute injury involving the ankle is the lateral ankle sprain. ## **1. Ankle Sprain** ## ESSENTIALS OF DIAGNOSIS & TYPICAL FEATURES - \u00bb Mechanism is usually inversion and plantarflexion. - \u00bb Swelling and pain in the ankle over the ligament. - \u00bb Bruising over the ankle."
  },
  {
   "source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "The most common cause of limping in all ages is trauma, either acute or repetitive microtrauma (e.g., stress fractures). Older children who limp as a result of trauma can generally describe the mechanism of injury and localize pain well. The toddler and preschool age groups, with their limited verbal ability and cooperation skills, often provide a diagnostic challenge. A common type of injury in this population (often not witnessed) is the aptly named \u201ctoddler\u2019s fracture,\u201d a nondisplaced spiral fracture of the tibial shaft that occurs as a result of torsion of the foot relative to the tibia. Occult fractures of the bones in the foot also occur in young children. Initial plain radiographic findings may be subtle, or at times nonexistent, but will become apparent in 1 to 2 weeks. Another fracture often lacking initial radiographic confirmation is a Salter\u2013Harris type I fracture, which presents as tenderness over a physis after trauma to a joint area. Stress fractures may also lack overt radiographic findings."
  },
  {
   "source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "and ankle dislocations) if tenderness and swelling is isolated to the distal fibula and/or adjacent lateral ligaments distal to the tibial anterior joint line. Low-risk ankle injuries include lateral ankle sprains, nondisplaced S-H type I and II fractures of the distal fibula, and avulsion fractures of the distal fibula and lateral talus. One study found the LRAR to be 100% sensitive in children of ages 3 to 16 and reduced ankle radiography by 20%."
  },
  {
   "source": "Berkowitz's Pediatrics, p. 906",
   "text": "## **Differential Diagnosis** Trauma is a frequent cause of limp in children and adolescents. In toddlers, a fall may not be witnessed, and they may present with limp or refusal to walk because of an occult fracture, such as toddler fracture (Figure 118.1). _Toddler fracture_ is an oblique or spiral fracture of the middle or distal tibia that occurs after a fall or jump involving a twisting motion. Toddlers are at risk for such injuries because of their unsteady gait. Tpyically, standard anteroposterior (AP) and lateral radiographic views are obtained to determine if a fracture is present. The radiographic appearance may initially be normal, and **881**"
  },
  {
   "source": "Algorithms in Pediatrics, p. 602",
   "text": "- ) Fever, redness, moderate-to-severe pain, pinpoint pain or tenderness, and weight loss are clues to more serious causes of limb pain that require additional investigations and referrals to specialists (rheumatologists, orthopedic surgeons, neurologists, hematologist/oncologists). ## **SUGGESTED READINGS** 1. Abbassian A. The limping child: a clinical approach to diagnosis. Br J Hosp Med (Lond). 2007;68(5):246-50. 2. Berard R. Approach to the child with joint inflammation. Pediatr Clin North Am. 2012;59(2):245-62. ## ~~**KEY POINTS**~~ - ) A detailed history and physical examination are critical in the initial assessment, with attention paid to the nature of the pain, presence of limp, weight-bearing status, morning 3. Gedalia A. Joint pain in children: an algorithmic approach. Isr Med Assoc J. 2002;4(10):837-42. 4. Leung AK, Lemay JF. The limping child. J Pediatr Health Care. 2004;18(5): 219-23. 5. Tse SM, Laxer RM. Approach to acute limb pain in childhood. Pediatr Rev. 2006;27(5):170-9."
  },
  {
   "source": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition, p. 902",
   "text": "Little League: http://www.littleleague.org. Accessed: January 31, 2018. ~~Kobayashi K: et al: Lateral compression injuries in the pediatric~~ elbow: Panner\u2019s disease and osteochondritis dissecans of the capitellum. J Am Acad Orthop Surg 2004;12:246\u2013254 [PMID: 15473676]. - \u00bb Elbow flexion contracture. ## **HAND & WRIST INJURIES** Lateral elbow pain in a slightly older throwing athlete, usually aged 13\u201315 years, can be secondary to osteochondritis dissecans (OCD), which is a more worrisome diagnosis than Panner disease. Unlike Panner disease, which is self-limiting, OCD lesions can lead to permanent destruction of the bone. It is an injury to the subchondral bone and its overlying articular cartilage. Although it can involve different sites of the elbow, including the olecranon, radial head, or trochlea, it most commonly affects the capitellum. Repetitive valgus"
  }
 ]
}