Purpose or Case Report: Interpreting imaging studies performed on pediatric patients who have undergone orthopedic surgical intervention is a daily occurrence for most radiology practices, both academic and private. These studies are obtained to assess for bony healing, alignment, and complications. An understanding of the general principles of pediatric orthopedics, familiarity with the design features of specific hardware components and why they are used in certain scenarios increases the confidence and ability of a radiologist to report key findings and anticipate possible complications. The aim of this exhibit is to review the anatomy and physiology of the long bone physis, present some of the basic tenets of orthopedic surgery with special attention to those that apply to pediatrics, and provide an image-rich atlas of hardware implements that are utilized in the lower extremities.
Methods & Materials: Educational cases of pediatric patients undergoing orthopedic intervention at a single children’s hospital were organized in a case-based format. Each illustrative case is followed through its clinical course including pre-operative imaging, surgical planning, intra-operative fluoroscopy, as well as clinical and radiologic follow-up.
Results: The use of orthopedic hardware in and around the growing bones of children requires additional considerations not typically employed in adults. Even in the treatment of common fractures, the effects of fracture healing on growing bones and the role that growth has in the healing of bones must simultaneously be kept in mind. Additionally, there are numerous disorders of pediatric bone development, growth and alignment which require an individualized are wholly specific to children and approach to intervention.

Entities that will be presented in this exhibit include common fractures of the lower extremities, slipped capital femoral epiphysis, developmental hip dysplasia, Blount’s disease, leg length discrepancies, and other common and important alignment abnormalities of the hips, knees and ankles. A combination of techniques often employed include serial casting, osteotomy, hemiepiphysiodesis, and guided growth.
Conclusions: A radiologist familiar with basic orthopedic principles and hardware is well-positioned to add value to the care of the post-operative pediatric patient. Understanding what to look for, which findings may be significant, and utilizing correct terminology in reports builds trust with ordering providers and improves the quality of care provided to the patient.