Pediatric orthopedics is a specialty that focuses on the orthopedic issues of children. Pediatric orthopedic surgeon are those experienced professionals in treating the musculoskeletal (bone, joint or muscle) issues in a child. Usually, children’s musculoskeletal issues are different from those of the adults. It is because a child’s growing body’s response to injuries, infections and deformities will be different from those of the adults. A slight change in the growth can become a problem. The common pediatric problems are
- Clubfoot (CTEV)
- Congenital hip dislocation (CDH)
- Cerebral Palsy
- Joint or bone infections and tumors
Paediatric fractures are different from adult fractures. The treatment of these fractures is also different as the bones in children are more flexible than adults and they have the capacity to heal faster too. Hence many fractures in children can be managed conservatively with casting alone. But some fractures which cannot be aligned in acceptable position by casting alone may require surgical correction.
Commonly done procedures in paediatric fractures are
- Manipulation under anaesthesia and plaster
- K wire fixation (Pinhole surgery)
- Nail fixation (TENS)
The treatment varies according to the fracture and the age of the patient.
Club foot is the abnormal position of the foot which appears at birth or during childhood. A child with club foot will have misshaped foot. It will cause him/her to turn the ankle inward and also affects proper way of walking. Both feet are affected in most of the cases. But, in such cases, one foot is more affected than the other.
When you notice any of these signs, it is necessary to consult with the pediatric orthopedic surgeon immediately. Because, if it not corrected at the beginning, it can worsen by day by day and your baby will find it difficult to walk in the normal way.
Club foot can be treated and the child will be able to recover from all the problems related to that. The first stage of treatment is casting or tapping of the foot which can be done from 2nd week of birth. Frequent check ups and plaster change are needed for the child. Casting can be completed by two or three months. After that, the baby may need special shoes with or without a bar.
Normally, surgery is indicated in
- children who do not respond to casting
- delayed treatment
It is necessary to have regular follow-ups after the treatments. Regular check-ups can make sure that the club foot does not come back.
Cerebral palsy is a group of chronic disorders that causes damage or abnormalities to the brain. It affects the central nervous system and changes the motion of muscles. It can be mild, moderate and severe. As a result, the baby will face problems while learning to roll over, crawl, walk, or sit. It can start before, during or after birth in the first years of life. When the child starts showing the signs and symptoms, you should consult with a pediatric orthopedic surgeon. Delays in the development and movement can be considered as the early signs of cerebral palsy.
The symptoms of cerebral palsy may vary. It may include:
- Tight muscles, causing rigidity and spasms.
- Loose muscles, making limbs week and floppy.
- Damaged reflexes, balance and coordination.
The parents of the patient should have to go in hand with the doctor who treats their child. The treatments aim at finding out the child’s abilities and increase the level of independence. The treatments may include:
- Orthopedic treatments to treat the problems with muscles, bones, nerves, tendons and joints.
- Physical therapies to improve movement and strength.
- Occupational therapies to teach daily routine skills such as dressing, eating etc.
- Speech and language therapies to treat communication problems.
- Social learning and educational programs.
- Psychological treatments to help them to deal with stress and other other issues.
- Behavior therapies to increase emotional and social development.
- Other health improvement treatments such as neurologists, nutritionists and eye doctors.
After diagnosing the problem, the doctor may immediately begin the physical therapies. They may also use braces, splints and casts to increase the stability and movements of the joints and increase the muscle strength and functioning. The doctor may also use a drug called botox to inject into the spastic muscles to loosen them. Other medications and mechanical aids are also used.
If the patient has a severe contracture, the child may have to under go for a surgery in order to lengthen the muscles.
Congenital Hip Dislocation
Congenital hip dislocation or developmental dysplasia is the abnormal formation of the hip joint. In this condition, the ball on top of the thighbone will not be held tightly in the socket. The pediatricians examine every new born baby in order to find whether the baby has the problem of hip dislocation which can be corrected from that stage itself. But if the dislocation is not noticed at the beginning stage, it will be more complicated to treat and correct.
Child with hip dislocation problem will show certain signs such as:
- Length difference in the legs
- Irregular skin folds on the thigh
- Less flexibility or mobility on one side
- Toe-walking, limping, wadding, or a duck-like gait
If your child has any of these problems, you should consult with an Orthopaedic surgeon. After careful physical examination, the doctor may also suggest for x-rays of the hip of the child for a complete diagnosis.
The treatment method will vary according to the age of the child. There are both non surgical and surgical treatments. The treatment varies according to age and presentation. Surgical procedures are usually done in babies from six months and above.
Scoliosis is a condition that affects the growing spine of children and adolescents. It is an exaggerated lateral curvature of the spine. Generally, the spine will look like a straight line down the middle of the back. When the person or the child gets affected by scoliosis, the spine will look like the alphabet “c” or “s”. It can result from a variety of causes.
To diagnose the problem, the doctor may conduct physical examination, x-ray and scans to find out the severity of the spinal curve. The treatment may vary according to the severity of the curve and the place where the curve occurred. It may vary from simple bracing of the spine to complex surgeries to correct the deformity. Generally, curves that measure from 25 to 50 degree are considered as large enough for treatment. Curves greater than 50 degrees may require surgery.