Webinar session for the Knee for Bringing basic orthopaedic and concussion care to the pediatric medical home.

1. Knee Review Webinar
March 24, 2016
Bringing Basic Orthopedic and
Concussion Care to the Pediatric
Medical Home:
A PPOC/CHICO Learning Community
& Integration Program
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu

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We have no financial relationships with
commercial entities producing, marketing, re-
selling, or distributing health care goods or
services consumed by, or used on, patients
relevant to the content we are planning,
developing, presenting, or evaluating.
Disclosure
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu

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Barry Zallen, MD
CHICO Chief Medical Officer
Louis Vernacchio, MD, MSc
PPOC Director of Research and Analysis
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu
Madeleine Kuhn, MPH
CHICO Program Coordinator
Faculty

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Learning Community Schedule
Webinars
7:30am – 8:30am
Date Content
Thursday, June 11, 2015 Concussion
Wednesday, September 9, 2015 Foot and Ankle
Wednesday, December 16,
2015
Hand and Wrist
Wednesday, February 24, 2016 Everything Knee
Date
Wednesday, July 15, 2015
Thursday, August 13, 2015
Thursday, October 29,
2015
Thursday, March 24, 2016
Wednesday, April 27, 2016
Didactic Webinars
7:30am – 9:00am
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu
In-Person Sessions
7:00am – 9:00am, BCH Waltham
Date Content
Wednesday, January 20, 2016 Practical Session
Wednesday, May 25, 2016 Practical Session
Canceled

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Schedule
Welcome and Review
How to order splinting supplies
Case Discussion
Coursework and Wrap-up

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Pediatric Knee Exam Video on YouTube!
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu

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Splinting Supplies
• Your supplier will have a form to fill out when ordering Orthopedic supplies
• Most brochures for splinting include the billing codes
• Bill as you would for other supplies (gauze, needles etc.)
If you are in need of a supplier here are some examples of suppliers:
- Corflex: Scott Foley, Telephone 603.623.3344 Ext. 9129, Email:S.Foley@corflex.com
- Surgicare: Jason Seymour, Sales Representative, Email: jseymour@surgi-careinc.com

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REMINDER: Orthopedic Coursework
1. Select at least 3 cases to
review per practice
2. Complete the case review
form using information from:
• Your EHR
• MyPatients (if applicable)
• Other visit documentation
you may have access to
3. Return to Madeleine by
4/24/2016
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu

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Case Review Results
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu
92% of participants reported
that patients went to ED
without contacting their PCP
first.

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ED
PCP

11. Suggested PCP Patient Engagement
Methods Orthopedic Injuries

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Patient-Facing Videos!

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Exam
Room
Signage
Post
ED Visit
Phone
Calls
Social
Media
Posts
News-
letter
WCC
Handout
Blast
Emails

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Orthopedic Advice and Urgent Access
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu
Answered live between 7:00AM and 5:00PM, Monday through Friday
Appointments will be made in Boston or a BCH satellite
based upon the patient’s location, day of week and urgency

16. Case Scenarios

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Polling Instructions
• During the case scenarios
we will be polling the
audience. A question will
pop-up on your screen
with answer options.
Please pick the answer
you think is correct. We
will give everyone 30
seconds to answer, then
we will reveal the polling
results to the group.

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Stepped Care Approach – Knee
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu

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Stepped Care Approach – Knee
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu

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Case Scenario 1
11-year-old girl presents to your office complaining of right knee pain after an injury during a
soccer game 1 month ago.
She does not recall exactly what happened, but she is sure that she did not come into
contact with another player. She remembers that her right leg was planted on the ground and
that her knee made a “twisting motion.”
She had immediate onset of pain with significant swelling, but she still could ambulate. She
did not seek medical attention at that time, and over the next 2 weeks, the pain and swelling
gradually subsided, but she states that her knee has “given out” several times when she has
tried to play soccer again.
On physical examination, she has full range of motion of the knee without an appreciable
effusion. She is able to perform a straight leg raise and has 5/5 quadriceps and hamstring
strength.
What physical exam maneuver(s) are most likely to be useful in this situation?
(Choose all that apply)
Case adapted from: pedsinreview.aappublications.org/content/30/11/419

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Case Scenario 1 Continued
She has a positive Lachman maneuver. The
remainder of the knee examination findings are
within normal limits. Plain radiographs are
unremarkable
What is the likely diagnosis?
What would you do next to manage this
patient’s condition?

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Case Scenario 2
13-year-old boy has a few month history of
medial-sided right knee pain. He is the starting
center fielder on his baseball team. The pain
does not reduce his level of activity, but he is
sore after games. He denies swelling or “giving
way” episodes. On physical examination, he
has full range of motion of his knee. The knee
is slightly tender over the medial joint line, but
no varus or valgus instability is present.
Anterior drawer and Lachman testing results
are normal.
Which of the following management
strategies would you choose at this point?
Case adapted from: pedsinreview.aappublications.org/content/30/11/419

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Case Scenario 2 Continued
You recommend icing, regular NSAID use, and
activity modification. The patient returns in 3
weeks and reports that he has been unable to
resume his normal activity without significant
pain. On exam, he remains tender over the
medical joint line and you detect a small knee
effusion.
What is the next step in your management of
this patient?

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Case Scenario 3
A 15-year-old softball catcher presents to the athletic trainer complaining of diffuse
bilateral knee pain over the past 4 months. She reports experiencing significant pain during
the last 2 to 3 innings of each game. She localizes the pain to the front of her knee and says
that it's “deep inside under her kneecap.” She denies any symptoms of instability or any
locking episodes. Of note, she reports that the pain is reproduced when she walks up and
down stairs or sits with her knees bent for a long period of time. She denies any recent
trauma or recent illness.
On physical examination, she has painless knee range of motion bilaterally. The rest of the
physical examination findings are normal. Anteroposterior, lateral, notch, and sunrise
radiograph views yield normal results.
What is the most likely diagnosis?
Case adapted from: pedsinreview.aappublications.org/content/30/11/419

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Case Scenario 3 Continued
Patellofemoral Syndrome
• diagnosis of exclusion (perhaps positive
patellar grind test)
• Common in female athletes, especially with
large Q-angle

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Case Scenario 4
A 12 year-old boy is playing soccer when another player falls onto the outside of his leg
and he feels his knee buckle inward. He is able to bear weight but with some pain
afterwards. On exam, there is full ROM in the knee with no joint effusion.
Which physical exam maneuver is most likely to be positive in this patient?

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Case Scenario 4 Continued
What treatment would you recommend for this injury?

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Meeting Evaluation
You will be receiving a session evaluation survey via
email.
Please take a moment to fill out the session evaluation
survey and provide us with your feedback so that we
can continue to improve and meet your expectations
and for CME Credits!
A recording of this session will be emailed tomorrow
with the follow-up email.
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu

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Learning Community Schedule
Webinars
7:30am – 8:30am
Date Content
Thursday, June 11, 2015 Concussion
Wednesday, September 9, 2015 Foot and Ankle
Wednesday, December 16,
2015
Hand and Wrist
Wednesday, February 24, 2016 Everything Knee
Date
Wednesday, July 15, 2015
Thursday, August 13, 2015
Thursday, October 29,
2015
Thursday, March 24, 2016
Wednesday, April 27, 2016
Didactic Webinars
7:30am – 9:00am
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu
In-Person Sessions
7:00am – 9:00am, BCH Waltham
Date Content
Wednesday, January 20, 2016 Practical Session
Wednesday, May 25, 2016 Practical Session
Canceled

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Thank You!
© 2014 Pediatric Physicians’ Organization at Children’s (PPOC). For permission please contact ppoc@childrens.harvard.edu