Caring for a child’s health is one of the most significant responsibilities of a parent. When it comes to orthopaedic issues, children have unique needs because their bones, muscles, and joints are still developing. Paediatric orthopaedic conditions can range from common injuries to complex congenital abnormalities.

This guide provides an in-depth look at common paediatric orthopaedic cases, treatment options, and surgical interventions, offering parents valuable insights into ensuring their child’s musculoskeletal health.

Understanding Paediatric Orthopaedic Conditions

Paediatric orthopaedic conditions involve disorders of the musculoskeletal system in children, including the bones, joints, muscles, ligaments, and tendons. Since children’s bones are still growing, they respond differently to injuries and deformities than adults. Early diagnosis and timely intervention of paediatric orthopaedic cases can often correct these issues, helping children lead active and healthy lives.

Common Paediatric Orthopaedic Conditions

Let’s take a look at the orthopaedic conditions commonly suffered by children.

• Clubfoot (Talipes Equinovarus): A congenital deformity, clubfoot causes the foot to turn inward and downward. Without treatment, this condition can lead to difficulty walking and other mobility issues.
• Developmental Dysplasia of the Hip: This occurs when the hip joint doesn’t form properly, causing partial or complete dislocation. It can lead to uneven leg lengths or arthritis if untreated.
• Scoliosis: Scoliosis refers to an abnormal lateral curvature of the spine. It can be idiopathic (unknown cause), congenital, or related to neuromuscular conditions like cerebral palsy.
• Cerebral Palsy and Orthopaedic Implications: Children with cerebral palsy may experience muscle spasticity, joint contractures, and skeletal deformities. Orthopaedic intervention aims to enhance mobility and reduce discomfort.
• Slipped Capital Femoral Epiphysis: Slipped capital femoral epiphysis is a condition where the ball at the top of the femur slips out of place, often during growth spurts. It commonly affects adolescents and can cause hip pain and limited mobility.
• Osteogenesis Imperfecta (OI): Known as “brittle bone disease,” this is a genetic condition that causes fragile bones prone to fractures. Children with OI may also have deformities, short stature, and hearing loss.
• Leg Length Discrepancy: In a condition where one leg is shorter than the other, leg length discrepancy can result from congenital factors, trauma, or infections affecting bone growth.
• Paediatric Fractures: Children are highly active, making fractures one of the most common paediatric orthopaedic cases. Fractures often occur in the forearm, clavicle, and lower limbs.

Diagnostic Tools and Techniques

Diagnosing paediatric orthopaedic conditions involves a comprehensive approach that includes the following steps:

Medical History: Gathering information about the child’s symptoms, onset, family history, and any previous injuries or conditions.

Physical Examination: Assessing the child’s posture, gait, and range of motion, and checking for deformities or swelling. Special tests are used to evaluate specific conditions like hip dysplasia or scoliosis.

Imaging Studies:

• X-rays: Commonly used to detect fractures, dislocations, and bone deformities.
• MRI: Provides detailed images of soft tissues like ligaments, tendons, and cartilage.
• Ultrasound: Useful for detecting joint and soft tissue problems, especially in infants.
• CT scans: Sometimes used for more complex cases to get a clearer view of bone structures.

Laboratory Tests: Blood tests may be ordered to rule out infections, inflammatory conditions, or metabolic disorders that can affect the bones and joints.

Consultation with Specialists: Paediatric orthopaedic surgeons and specialists may be consulted for conditions requiring surgical interventions or complex treatments.

Treatment Modalities

Treatment modalities for paediatric orthopaedic conditions vary depending on the type and severity of the condition. Below are the common treatment approaches:

Conservative (Non-Surgical) Treatments

Conservative or non-surgical treatments of orthopaedic conditions affecting children include:

• Physical Therapy: Helps improve strength, flexibility, and mobility. It is often used for conditions such as cerebral palsy, clubfoot, or scoliosis.
• Bracing and Casting: Used to immobilise and support bones and joints while they heal, such as for fractures, dislocations, or conditions like scoliosis.
• Medications: Pain relief is often managed with non-steroidal anti-inflammatory drugs (NSAIDs), and in some cases, muscle relaxants may be prescribed for spasticity.
• Orthotic Devices: Custom-made foot or ankle braces can help manage conditions like flat feet or clubfoot and prevent further deformities.
• Stretching Exercises: For muscle tightness or joint contractures, gentle stretching can prevent deformities and improve mobility.

Paediatric orthopaedic surgery

Commonly used paediatric orthopaedic surgical procedures include spinal surgery, arthroscopy, procedures for repairing fractures and correcting deformities, joint replacements and others. We have discussed more about this in the next segment.

Traction

Skin or Skeletal Traction is often used to manage fractures or deformities by applying a pulling force to realign bones, particularly in the early stages of bone growth.

Growth Modulation

In certain conditions, such as angular deformities of the limbs (e.g., bowlegs or knock knees), growth plates can be modified to help correct the alignment as the child grows.

Supportive Care and Observation

For some mild conditions such as hip dysplasia or mild scoliosis, the treatment might focus on monitoring and observation to see if the condition resolves as the child grows, or if intervention is necessary later.

Lifestyle and Activity Modification

Recommendations regarding activity restrictions or modifications may be made to prevent aggravating conditions, especially during recovery or for conditions like juvenile arthritis.

Alternative Therapies

• Aquatic Therapy can be particularly useful for children with musculoskeletal conditions, offering low-impact exercise to improve strength and mobility.
• Chiropractic Care and Osteopathic Manipulation are sometimes used to manage musculoskeletal pain or alignment issues but should always be conducted under a paediatric specialist’s guidance.

Most Common Paediatric Orthopaedic Surgeries

Paediatric orthopaedic surgeries are performed to treat a variety of conditions affecting bones, joints, and muscles in children. Some of the most common paediatric orthopaedic surgeries include:

Fracture Repair Surgery

In cases where fractures cannot be effectively treated with a cast or when there is significant displacement of bone fragments, surgical intervention may be necessary. This procedure typically involves the use of pins, screws, or plates to realign and stabilise the bones, facilitating proper healing.

Clubfoot Surgery (Ponseti Method or Soft Tissue Surgery)

Clubfoot is a congenital deformity characterized by the inward and downward turning of the foot. Surgical correction is frequently necessary when non-surgical interventions, such as casting, prove ineffective. Treatment options may involve tendon lengthening or joint releases to restore proper foot alignment.

Scoliosis Surgery

For individuals with severe spinal curvature that cannot be effectively treated with bracing or physical therapy, a spinal fusion procedure is often recommended. During this procedure, two or more vertebrae are fused using metal rods, screws, and bone grafts. This helps to correct the curvature of the spine and prevent any further progression of the condition.

Hip Surgery (Paediatric Hip Dysplasia or Perthes Disease)

For conditions such as hip dysplasia, where the hip joint does not form properly, or Perthes disease, a condition in which blood supply to the femoral head is disrupted, surgical intervention may be necessary. Procedures such as hip joint realignment, also known as pelvic osteotomy, or hip replacement may be recommended in severe cases, particularly when non-surgical treatments like bracing have proven ineffective.

Tendon Lengthening Surgery

In cases of conditions such as cerebral palsy or muscular dystrophy, where tight muscles or tendons lead to contractures or deformities, surgical lengthening of tendons is performed to enhance movement and increase range of motion.

Leg Lengthening Surgery

In instances of substantial differences in limb length, typically resulting from congenital conditions or prior fractures, an external fixator device is employed to gradually extend the bones over some time.

Knee Surgery (Patellar Instability or ACL Reconstruction)

Surgical procedures are often necessary for children who have experienced patellar instability (dislocated kneecap) or torn anterior cruciate ligaments because of sports injuries. These procedures may involve reconstructing the anterior cruciate ligaments or realigning the patella to restore proper function to the knee.

Post-Surgical Care and Rehabilitation

Post-surgical care and rehabilitation are crucial for paediatric orthopaedic surgery recovery, aiding healing, and mobility, and reducing complications. Specific care varies based on the surgery type, but common elements include monitoring healing, improving movement, and minimising risks.

Immediate Post-Surgical Care

After surgery, the child will be closely monitored for infection, bleeding, and pain. Pain relief will be managed with medications or nerve blocks. Proper wound care and rest are important for healing, along with ice packs and compression wraps.

Immobilisation and Bracing

After surgery, children may need a cast, splint, or brace to prevent further injury. Special braces may be used to stabilise joints or the spine during recovery for surgeries such as anterior cruciate ligament reconstruction or spinal fusion.

Physical Therapy and Rehabilitation

Physical therapy is often crucial for a successful recovery and for helping the child regain mobility, strength, and function after surgery.

Functional Training and Adaptive Techniques

Certain other techniques may also be used such as:

• Occupational Therapy: For surgeries affecting the hands, wrists, or upper extremities, occupational therapy may be necessary to help the child regain the ability to perform daily tasks, such as eating, dressing, and writing.
• Assistive Devices: The child may need crutches, walkers, or wheelchairs during the initial recovery phase to assist with mobility.
• Posture and Gait Training: For spinal surgeries or lower extremity surgeries, posture and gait training may be incorporated to ensure proper movement patterns and prevent long-term issues.

Monitoring for Complications

Monitoring for infection and deep vein thrombosis after surgery is key. Look out for signs such as fever, redness, warmth, and unusual drainage. Lower limb surgeries raise the risk of deep vein thrombosis, requiring medication or compression stockings. Regular check-ups are vital for serious fractures or deformities to ensure proper healing and detect any potential issues like non-union or hardware problems.

Nutritional Support

Proper nutrition is important for recovery, with a focus on protein, calcium, and vitamin D for tissue repair and bone healing. It is essential to keep the child well-hydrated, particularly during physical therapy or after surgeries. Supplements like calcium or vitamin D may be recommended by the doctor to aid in healing, especially for bone-related procedures.

Emotional and Psychological Support

For children undergoing extensive surgeries or long recovery periods, psychological counselling may be beneficial to help them cope with pain, anxiety, or frustration. Connecting with other families or children who have undergone similar surgeries can offer emotional support and helpful advice.

Sources:

• https://orthopedicspecialists.net/common-pediatric-orthopedic-conditions-and-their-treatments/
• https://www.ouh.nhs.uk/paediatricorthopaedics/information/conditions/
• https://www.hopkinsmedicine.org/health/conditions-and-diseases/pediatric-orthopedic-conditions
• https://www.mayoclinic.org/departments-centers/pediatric-orthopedics/overview
• https://www.arhamphysio.com/blog/nonsurgical-treatments-for-pediatric-orthopaedic-conditions/
• https://www.novanthealth.org/services/rehabilitation/pediatric-therapy/
• https://www.betterhealthpt.com/learn/orthopedics/orthopedic-physical-therapy-a-guide-better-health/
• https://www.sparshhospital.com/blog/paediatric-orthopaedics/