Cards+Against+Paediatric+Orthopaedics+ (v1 1)

2 y/o female presents with a
fall out of bed onto her right side.

She is complaining of a painful
right arm. Witnessed by Mum.
PMHx: NAD
SHx: Lives with parents and an
older sibling. No social worker.
‘Cards Against Paediatric Orthopaedics’
by Vickie Wells, Damian Roland & Sarah Edwards (version 1.1)
No obvious deformity.
Tenderness over the distal

radius and ulna on palpation.
Good range of movement

passively but not wanting
to use.
Buckle or
Torus
fracture
Buckle splint: 3/52
No sports: 6/52
Fracture clinic, but
no formal follow-up.
Community form: fracture
2-5 years.
3 y/o male went to run out into
the road, arm grabbed by
parent, dropped to the ground.
Now pain left arm and

not using.
PMHx: nil, usually fit and well.

Arm hanging down by his side.
No swelling or bruising.
No obvious bony deformity.
No obvious pain on palpation.
Cries as soon as elbow flexed.

X-ray only if
history of trauma
or history
is unclear!
Pulled
Elbow
Manipulation:
hyperpronation
method, now
full ROM.
2 y/o female has attended
following a fall.
Just starting to walk,

slipped on a book, twisting
her leg falling awkwardly.
PMHx: Viral wheeze.

No obvious deformity,
swelling or bruising.
Tenderness over the distal
Tibia on axial loading.
Refusing to walk – lifts
up leg.
Toddler
fracture
Soft wrap:
Fracture Clinic
referral.
Community form:
fracture 2-5 years.
14 y/o boy was giving his
friend a piggyback during
a night out.
Falls over – FOOSH.
PMHx: asthma.
No Allergies.
Mild Swelling to wrist.
Tenderness over wrist –
Distal Radius, in particular.
Anatomical snuff
box/telescoping.
Pain on wrist flexion and
extension.
Scaphoid
fracture
Below elbow
backslab.
Fracture Clinic
follow-up.
6 y/o girl was at the park with
friends & family.
Climbing the monkey bars –
slipped and fell onto left elbow.
Pain +++, Swollen +++
No other injuries.
PMHx: NAD
Allergies Nil
Swelling to left elbow.
Obvious deformity.
Unable to move arm due to pain.
No reduced sensation.
Moving all fingers & thumb.
Skin intact.
Displaced
Supra-
condylar
fracture
Analgesia,
plaster, x-ray,
surgical repair.
Admission
required.
10 y/o ran out into the road after
his friend – hit by car at low speed.
Pain to right upper leg, unable to
get up and walk.
999 called and brought to ED.
PMHx: Constipation
Meds: Movicol.
No Allergies.
Pain ++ to upper leg.
Held in flexion at knee.
Unable to move.
Visible swelling ++ to thigh.
Skin intact.
Moving toes, pedal pulse,
no NVD, warm.
Femur
fracture
Analgesia,
femoral block,
Thomas splint.
Orthopaedic
referral: admission.
6 y/o male with ongoing
hip pain for the past
2 months.
Fell today which has
made pain worse.
PMHx: epilepsy.
Walking with limp.
Knee pain – muscular.
Left hip pain – aches.
Pain + internal or external
hip rotation.
Well in self. No fever.
Perthes
disease
Orthopaedic
referral.
May or may not
require surgery.
2 y/o male with limp.
No trauma. Well in self.
Cough /coryzal symptoms
2 weeks ago with mild fever at
the time – now resolved.
Attended with mum.
PMHx: nil.
No obvious deformity or swelling
noted to leg.
No tenderness on palpation hip
to toe.
Full range of movement but pain on
internal and external hip rotation.
No bruises/redness.
Walks – limp noted.
Transient
Synovitis
Home with safety
net advice.
ED Review Clinic
5-7 days.
If no better: bloods
2 month old male.
Rolled over and fell
heavily onto right side.
Crying and unsettled.
Not moving leg.
Stripped and observed.
Visible swelling right lower leg.
Red marks noted lower leg.
Pain on movement – cries.
Multiple bruising noted to
both legs.
#Tibia with
inconsistent
mechanism
(non-ambulant child)
Above knee back slab.
Orthopaedic referral.
Admit to Paediatrics for
safeguarding concerns.
A-form.
15 y/o girl performing at
cheerleading competition.
Fell doing the splits, noted
pain to knee – ‘pop’.
Never happened before.
PMHx: Type 1 diabetic.
Obvious deformity to right knee.
Lateral shift of patella.
+++ pain all over.
Unable to move.
On attempt to move, patella
went back to usual position.
Patella
dislocation
1st dislocation: Cylinder
POP and crutches.
Referral to
Orthopaedics.
Further dislocations:
cricket splint.
5 y/o attending ED with pain
to right knee.
No falls or trauma.
Unable to walk.
PMHx: NAD
Allergies: Nil
Fever 39.4°C
Haemodynamically well
otherwise.
Red, hot and swollen joint.
Restricted movement to knee
due to pain.
Looks unwell.
Septic
Arthritis
Cannula, bloods,
IV antibiotics,
analgesia.
Referral to
Orthopaedics.
Admit.
15 y/o boy running up the stairs,
fell on his knee.
Pain ++
Unable to move, 999 called.
PMHx: NAD / nil meds
Lives with family.
No allergies.
Swollen thigh ++
Pain and unable to move/walk.
Requiring ++ analgesia.
Leg held in partial flexion
with blanket underneath
to support.
Pathological
fracture:
Distal Femur
(possible bone malignancy)
Analgesia, cannula
and bloods.
Above knee backslab.
Refer to Orthopaedics.
Admission.
15 y/o fell playing football.
Ongoing hip pain 3 months,
made worse today.
Unable to walk.
PMHx: Under dietician for
weight management.
No obvious injury to see.
Difficult to mobilise internal
or external hip rotation.
Can walk, but painful.
Left leg appears slightly
shorter than the right.
Slipped
upper
Femoral
Epiphysis
Admit to
Orthopaedics.
Requires surgery
to pin hip joint.
Analgesia.
13 year old boy doing stunts
at the skatepark – FOOSH.
Deformity to arm.
Brought to ED by parent.
PMHx: nil
Visible deformity to forearm.
Skin intact.
Good colour.
Pain mid radius, ulna and
radial head.
Pulse felt.
Reduced ROM due to pain.
Monteggia
fracture:
dislocation of Radial
Head (# prox 1/3 ulna)
Above elbow
backslab.
Analgesia.
Refer Orthopaedics.
Admission.
12-year-old girl fell off her bike
coming down a hill at speed.
FOOSH.
Deformity – homemade sling

and taken to ED by Dad.
PMHx: Nil
Deformity to forearm –
distal end.
Pink.
NVD – reduced sensation to
thumb and index finger.
Skin intact.
Cool with minimal pulse.
Galeazzi fracture:
Radius fracture with
dislocation of Distal
Radioulnar Joint
(pulseless)
Cannula, plaster, x-ray,
oxygen.
HDU for Ketamine sedation.
Refer to Orthopaedics for
immediate manipulation.
Ongoing orthopaedic
review.
2-year-old boy standing in
high chair.
Leant forward, fell out onto
hard floor.
Fell onto shoulder.
Now not using, pain on moving.
PMHx: nil
Quiet.
Pain, cries when mum picks
him up under his armpits.
Visible bump mid clavicle.
Visible bruising.
No tenting of the skin.
Clavicle
fracture
Broad arm sling.
Clavicle pathway: no formal
follow-up in under 13’s.
Details sent to
Fracture Clinic.
Community form: fracture
2-5 years.
7-year-old with hip pain
for one week.
Not getting better.
No trauma.
PMHx: nil
Fever, but well in self.
Pain to hip.
Reduced ROM on internal or
external hip rotation.
Can walk but slow and painful.
No redness/swelling.
Osteo-
myelitis
Cannula, bloods.
Antibiotics.
Refer to
Orthopaedics.
Admission.
12 y/o male playing
basketball.
Went to catch the ball
and bent finger back.
Now swollen and painful.
PMHx: Nil
Swollen mid phalanx.
Bruised palmar aspect.
Skin intact.
No rotation or usual cascade.
Reduced flexion due to swelling.
No mallet.
Gamekeeper’s
Thumb or
Salter Harris III
Thumb spica/splint.
Fracture Clinic
referral.
No sports.
Analgesia as needed.
12 year old male. Sporty ++,
active most days.
Plays for a local junior
football team.
Pain to right knee area.
No trauma.
PMHx: nil
No injury to see – right
lower leg.
No redness, no bruising.
Skin intact.
Pain proximal tibia.
Hard swelling- proximal tibia.
Full range of movement to leg.
Clinical diagnosis:
x-ray not usually
required

Osgood-
Schlatter
disease
Analgesia,
home, rest.
Physiotherapy
referral.
6 y/o female, fell off her
bike, skidded across grass.
FOOSH.
Pain and swelling, crying ++
Usually fit and well.
No allergies.
Swelling and deformity
to mid-distal forearm.
Warm and pink.
Skin intact.
Doesn't want to move.
Crying ++
‘Cards Against
‘Cards Against Orthopaedics’
Paediatric (Version 1.1)
Orthopaedics’
by Pandora
by Vickie Spillman-Henham
Wells, Damian Roland & Sarah Edwards (version 1.1)
Greenstick
fracture
Backslab.
If displaced, repeat
x-ray post-plaster.
Refer to Fracture Clinic.
Analgesia, no sports.
15-year-old boy, out playing
football with friends.
Grass wet. Skidded.
Outstretched leg and fell.
Felt a ‘pop’ – now in pain.

Nil injury to see.
Pain on leg internal or
external hip rotation.
Pain on walking. Easier to
lay down.
No redness, no swelling,
no bruising.
Avulsion
fracture
of ASIS
Analgesia,
walking crutches (partial).
Bed rest, no sports.
Physiotherapy.
Fracture Clinic follow-up.
May require Surgery
for fixation.
13-year-old on way to school.
Fell off bike, went over
handlebars. Helmet on!
Hit elbow on curb whilst falling.
No other injuries.
Shaken, pale and in pain.
Reduced ROM to elbow +
Can pronate.
Normal wrist flexion and
extension. Reduced power.
Pulse present.
Lateral
Condyle
#Elbow
Analgesia.
Broad arm sling,
collar and cuff.
Plaster if pain not
managed and displaced.
Fracture Clinic referral.
6-year-old girl, fell off balance beam
during PE at school. Approx 1 ft.
Landed on floor, hitting elbow on
beam on the way down.
Pain ++
Parent called to pick up as very upset.
Analgesia given pre ED, usually well,
no allergies.
No injury to see.
Will not fully flex or
extend elbow.
No swelling, no bruising.
No NVD.
Pink and warm.
Posterior
fat pad
(+ve)
May not see the
fracture.
Analgesia, no sports.
BAS.
Fracture Clinic for
follow-up.
15-year-old doing gymnastics.
Handstand/backflip.
Landed awkwardly.
FOOSH and arm gave way,
landing on the floor.
Unable to continue.
Attended ED.
Swollen elbow – medial side.
Skin intact. Pink.
Pulse.
No NVD.
Reduced ROM at elbow –
possible, but slowly due to pain.
Medial
Condyle
#Elbow
Analgesia.
Broad arm sling,
collar and cuff.
POP if displaced.
15-year-old boy. Running
during football.
Fell down a ditch, inverting
ankle.
Pain on walking – limp.
Shoe feels tight.
Red and swollen foot –
along 5th metatarsal.
Warm to touch.
Some bruising noted.
Skin intact.
Moving all toes.
Base 5th
Metatarsal
fracture
Analgesia, crutches.
Cohesive strapping –
boot.
R.I.C.E.
Fracture clinic for
follow-up.
15-year-old boy climbing on a
flat roof.
Slipped and fell through floor
support onto elbow, approx 5ft.
Pain ++ elbow.
No other injuries. ADHD.
Swollen ++ elbow.
Reduced elbow dimples.
Skin intact. Good colour.
Pulse.
Unable to flex or extend elbow.
Moving fingers.
Pain just at the elbow.
Olecranon
fracture
Broad arm sling, POP if
displaced.
May required Surgery.
Analgesia PO/IN/INH.
15-year-old girl, running down
the stairs.
Lost balance in high-heeled

shoes.
Fell 6 steps, inverting ankle.
Usually fit and well. Sporty +

Swollen ankle ++
Lateral side/posterior edge.
Bruised +
Skin intact.
Pedal pulse.
Non weight bearing.
Tillaux
fracture
Analgesia.
Below knee plaster.
Refer to Orthopaedics,
?fixation.
Crutches.
14-year-old male, had an
argument with mum.
Punched a wall.
Under CAMHS.
Swollen ++ hand.
Pain mid-distal 4th and
5th Metacarpal.
Skin intact. Bruised.
Full ROM to fingers – no mallet.
Usual cascade, no rotation.
‘Cards Against
‘Cards Against Orthopaedics’
Paediatric (Version 1.1)
Orthopaedics’
by Pandora
by Vickie Spillman-Henham
Wells, Damian Roland & Sarah Edwards (version 1.1)
Boxer’s
fracture
Orthopaedics/Plastics:
?manipulate & plaster after
discussion with appropriate
specialty.
Otherwise – neighbour strap, volar
plaster, high arm sling.
School nurse referral – anger
management!
14-year-old female, recurrent
dislocations to shoulder.
Popped out and cant get back in –
has already tried.
At home.
PMHx: Ehlers-Danlos syndrome.
Anterior swelling to
shoulder.
Skin intact.
In pain ++
Entonox required.
Shoulder
dislocation
Analgesia – PO/INH/IN.
Relocate ASAP.
+/- Ketamine sedation
as needed.
Repeat x-ray, broad arm sling.
Fracture Clinic for referral.
Physiotherapy.
Rules:
1. Teams of 2-3 work best,
but can be played individually.
2. Match each patient to the correct

Exam Findings, X-ray, Diagnosis and
Management Plan (i.e. one card of
each colour, matched together).
3. Allow 30-45 minutes per game.


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2 y/o female presents with a

fall out of bed onto her right side.

Tenderness over the distal

Good range of movement

Now pain left arm and

PMHx: nil, usually fit and well.

No obvious bony deformity.

No obvious pain on palpation.

Cries as soon as elbow flexed.

‘Cards Against Paediatric Orthopaedics’

Just starting to walk,

PMHx: Viral wheeze.

Deformity – homemade sling

Not getting better.

‘Cards Against Paediatric Orthopaedics’

Grass wet. Skidded.

Outstretched leg and fell.

Felt a ‘pop’ – now in pain.

Lost balance in high-heeled

Fell 6 steps, inverting ankle.

Usually fit and well. Sporty +

2. Match each patient to the correct

3. Allow 30-45 minutes per game.

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