Pediatric orthopedics is a specialty that focuses on musculoskeletal (muscles, bone and joint) conditions found in children – the most common of which are categorized as:
- Congenital
- Developmental
- Traumatic
- Infectious
- Physiological
Pediatric Orthopedics: Congenital Conditions
Congenital orthopedic conditions are seen immediately from birth, the most common of which is talipes equinovarus or “clubfoot”. Observed in 1 of 1,000 live births, clubfoot is more common in male children than in females. The cause is unknown, though the position of the fetus during gestation or genetic factors associated with growth arrest may be at fault. Untreated, the child will not be able to walk properly. While there is no pain, tingling or numbness, clubfoot can lead to arthritis of the foot if allowed to progress. Treatment should begin immediately after diagnosis, and includes castings and braces to hold the feet in position, as well as manipulations by surgeons, physiotherapists or orthotic specialists.
Pediatric Orthopedics: Developmental Conditions
Developmental conditions occur during the process of growth and development after a normal birth. These include developmental dysplasia of the hip (DDH), Legg-Calve-Perthes disease, slipped capital femoral epiphysis (SCFE), and adolescent idiopathic scoliosis (AIS).
- Developmental dysplasia of the hip (DDH) is a developmental misalignment of the hip joint in which the socket of the acetabulum (part of the pelvic bone) is too shallow to allow the head of the femur (thigh bone) to fit into it completely. The exact cause is unknown. This condition is usually associated with breech presentations. The ligaments around the joint are stretched resulting in instability in the hip joint. Symptoms include limping while walking, asymmetric length of the legs, and difficulty walking freely. Following an x-ray or ultrasound diagnosis, doctors will determine the degree of dislocation and decide whether it can be corrected conservatively or if a surgery is required. Non-surgical treatment for infants younger than two months involves placing the child in a harness to keep the joint in place. Older babies up to two years are treated by reduction and spica casting in which the hipbone is manually repositioned. Surgical treatment involves re-alignment of the hipbone so that the socket can hold the femur’s head in position, followed by a cast to maintain the joint in that position.
- Legg-Calve-Perthes disease results from a lack of blood supply to the head of the femur bone (thigh bone), leading to bone destruction or osteonecrosis. The ball of the ball and socket joint is affected. The blood flow impairment could be due to trauma, inflammatory conditions or altered circulation. It is commonly seen in children between 6-8 years, who present with thigh pain and difficulty in walking. An X-ray will show a damaged and undernourished femur head, and a bone scan may be used to confirm the diagnosis. Treatment aims in restoring the blood supply, while braces are used to give the affected limb adequate rest. The child is advised to refrain from sports activities that involve leg activity. Occasionally surgery is required.
- Slipped capital femoral epiphysis (SCFE) is usually seen in adolescents and describes the condition in which the head or the ball of the femur bone slips backward from the normal position. The symptoms are limping while walking and the patient is unable to bear weight on the affected limb. Treatment requires surgery in which the femoral head is fixed to the acetabulum of the hipbone by screws. This condition is associated with obesity.
- Adolescent idiopathic scoliosis (AIS) is an abnormal curvature of the spine. The spine develops laterally (sideways) instead of growing straight, forming an s-shaped curvature. There are degrees of scoliosis ranging from 20-40 degrees depending on the deviation from a straight spine. A 20-degree curvature means the deviation is small and can be treated with braces and has a tendency to regress after few years. A 40-degree curvature may require surgical intervention. It is important to be evaluated if this condition is suspected.
Pediatric Orthopedics: Infectious Conditions
Infections of the bone and joints result from a bacterial invasion into the bone or joint through the blood. The septic arthritis of the joints presents with fever, weakness, pain and swelling of the joint. The hip joint is most commonly affected, although the knee, shoulder and ankle joints are also susceptible. The swelling requires an operative drainage along with infusion of antibiotics.
Pediatric Orthopedics: Traumatic Conditions
Trauma to the joints due to sudden strains, sprains and fractures are common. Symptoms are pain, tenderness, and difficulty moving the affected limb. Treatment comprises of rest to the affected part, ice application to reduce the inflammation, antibiotics, and painkillers to subside the pain. Rest is crucial for complete and permanent recovery. These injuries must be evaluated by a professional.
Pediatric Orthopedics: Physiological Conditions
- Internal tibial torsion (ITT) makes the leg face inwards while walking, however the condition usually resolves spontaneously by six years of age.
- Metatarsus adductus (also known as pigeon toe) causes the toes to bend together and face inwards when walking. Commonly experienced by children younger than 3, pigeon toe requires physiotherapy exercises and in rare cases, a cast is required. Occasionally, surgical correction of this problem is needed.
- Flat feet: Children who experience flat feet are lacking the normal arch of the foot, affecting their posture while walking and standing. Treatment is to encourage patients to build the sole muscles and strengthens the lax ligaments by walking on uneven surfaces like at a beach or on a mountain. Physical therapy is very successful in treating this condition.
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For help understanding your child’s orthopedic condition, including treatment options, please contact Warner Orthopedics and Wellness at 225-754-8888 or contact us HERE.
Dr. Meredith Warner is a board certified, Fellowship Trained Foot and Ankle, Orthopedic surgeon practicing in Baton Rouge, Louisiana. Dr. Warner is committed to offering her patients an accurate diagnosis along with a comprehensive treatment plan in order to get them back to a pain free life. Dr. Meredith Warner specializes in the treatment of orthopedic issues, providing operative and non-operative treatment plans of orthopedic problems, including musculoskeletal pain such as chronic back, neck and foot pain, reconstructive surgery of the foot and ankle, arthritis, diabetic, hammer toe, bunion, wound care, work injuries, fitness and nutrition and osteoporosis issues.
