Pediatrics Case 4 ED Management
There is no indication for emergent orthopedic consultation in these cases. All symptomatic cases should be treated with a knee immobilizer (sling for elbows, air cast for ankles) and crutches and made non-weight-bearing. Outpatient referral to orthopedics should be routine for all patients. Those with early lesions (stage I or II) and open physes are typically managed conservatively, with 6 weeks of non-weight-bearing, followed by 6 weeks weight-bearing-as-tolerated with slow return to exercise after this if pain is resolved. Those with more advanced lesions (stage III or IV) and adults with closed growth plates will not heal with conservative management and will require curative excision, usually through an arthroscopic approach.