Dr Rashid Anjum
Originally, the term “Orthopedic” referred explicitly to the correction of musculoskeletal deformities in children. Nicolas Andry, a professor of medicine at the University of Paris, coined the term in his textbook published in 1741. This book, directed towards parents, advocated for exercise, manipulation, and splinting to treat child bone deformities. Forty years later, in 1780, Jean-Andre Venel opened the first orthopaedic institute dedicated to treating children’s skeletal deformities. Albeit the word orthopaedics in Greek means straight-child yet pediatric orthopaedics is the youngest offshoot of this speciality. Isn’t it a bit strange!
Pediatric orthopedics is a specialized field of medicine that focuses on the care of children with bone and joint conditions. It is a crucial area of healthcare, as musculoskeletal conditions can have a significant impact on a child’s growth and development. In the realm of healthcare, the field of pediatric orthopaedics stands tall as a beacon of hope and healing for our little champions. From tiny toes to growing limbs, children’s musculoskeletal health requires specialised care and attention. In this article, we will explore some common pediatric orthopedic conditions and discuss their management strategies. Some of the most typical complaints and conditions are mentioned here to aware the parents.
Don’t ignore a limp: It’s important not to ignore a limp, as it can be a sign of an underlying medical condition or injury. There is a spectrum of conditions that can cause a limp in children including transient synovitis to infections to a dislocated hip. Ignoring a limp could potentially worsen the condition or delay necessary treatment. If a limp persists for more than 24-48 hours, it is worth seeing your pediatric orthopedist, regardless of whether or not a child complains of pain.
Muscle growth lags behind bone growth: During growth spurts, the rate of bone growth surpasses that of muscle growth, leading to asymmetrical forces around the joints in children and adolescents. When an active child experiences a growth spurt, their muscles become noticeably tighter and less flexible. Furthermore, in growing children, tendons tend to be stronger than the developing bone, increasing the risk of an avulsion fracture. While an adult would likely experience a muscle strain from a sports injury, an adolescent may suffer from an avulsion fracture, where a tendon pulls off a small piece of bone from its attachment. Treatment typically involves pain management, potential use of crutches, and a period of rest, gradually restoring flexibility and strength.
The prevalence of stress fractures: Nowadays, it is becoming increasingly common for children and adolescents to specialize in a single sport at an early age. However, this specialization increases the risk of overuse injuries such as tendonitis or stress fractures, which are small non-displaced bone breaks. High-impact sports like long-distance running or gymnastics, particularly among females, are particularly prone to these injuries. Female athletes who undergo intense training may also be susceptible to the “female triad” of poor nutrition, irregular menstrual cycles, and weakened bones, making them more prone to stress fractures. As parents and coaches, it is crucial to emphasize the significance of balanced nutrition and diversified training (cross-training) to mitigate these risks.
Referred pain: Sometimes, as is the case of knee pain in a child or adolescent, it’s not always what it seems. Pain in the knee may be referred from the hip joint pathology. In a child between the ages of 4-9 years of age, it may be due to Perthes disease which is degeneration of the femoral head. This is a serious condition which may lead to significant loss of motion and potential deformity if left unchecked. Another serious hip condition that presents in adolescents typically between the ages of 10-15 years of age is Slipped Capital Femoral Epiphysis (SCFE). This also presents with a limp, with the child’s foot turned out, and referred pain to the knee. Symptoms may come on gradually over a few months or it may occur suddenly with severe pain limiting the child’s ability to walk altogether. With SCFE, the growth plate of the femoral head separates from the shaft of the bone. Again, if left untreated, serious and debilitating consequences may occur including pain and arthritis and shortening.
Recognizing red flags: It is of utmost importance to maintain a vigilant eye and be aware of potential red flags in children. If a child’s joint shows signs of inflammation, appearing red and feeling hot to the touch, it could indicate an infection. It is crucial to monitor for any accompanying signs of fever and promptly consult a physician. Infections affecting the bones and joints require antibiotic treatment. Allowing the infection to spread poses a significant risk to the overall health and stability of the affected bone or joint.
The occurrence of arthritis in children: Juvenile arthritis impacts approximately 1 in every 1000 children, with severe arthritis affecting 1 in 10,000 children. Symptoms commonly associated with this condition include muscle pain, joint stiffness, growing pains, fatigue, and depression. Effective management of juvenile arthritis necessitates a multidisciplinary approach to provide the necessary care and oversight.
Developmental Dysplasia of the Hip (DDH)
Developmental Dysplasia of the Hip is a condition characterized by abnormal development of the hip joint. It can range from mild instability to complete dislocation. Management typically involves early detection through screening programs, such as physical examinations and ultrasound imaging. Non-surgical treatments, such as the use of a Pavlik harness or a hip abduction brace, are often effective in correcting mild to moderate cases. Severe cases may require surgical intervention, such as a closed or open reduction, followed by immobilization and rehabilitation.
Clubfoot
Clubfoot, also known as talipes equinovarus, is a congenital condition in which the foot is turned inward and downward. It can affect one or both feet. The Ponseti method is a widely used non-surgical treatment approach for clubfoot, involving gentle manipulation, casting, and the use of a foot abduction brace. In cases where conservative measures fail, surgical correction may be required to realign the foot joints and tendons.
Scoliosis
Scoliosis is a spinal deformity characterized by an abnormal sideways curvature of the spine. It commonly develops during adolescence and can progress rapidly during periods of growth. Mild cases may be managed through close observation and monitoring, while moderate to severe cases may require bracing to halt or slow down the progression of the curvature. Surgical intervention, such as spinal fusion, may be recommended for severe or progressive cases.
Osteogenesis Imperfecta (OI)
Osteogenesis Imperfecta, also known as brittle bone disease, is a genetic disorder characterized by fragile bones that are prone to fractures. Management focuses on reducing the risk of fractures and promoting bone health. This may involve a multidisciplinary approach, including physical therapy, assistive devices (e.g., wheelchairs), medications to increase bone density, and surgical procedures to correct deformities or repair fractures.
In addition to traditional treatments, pediatric orthopedic surgeons are also utilizing new technologies to provide better care to their patients. 3D printing technology, for example, allows for the creation of custom implants, prosthetics, and orthotics for children with musculoskeletal conditions. Virtual and augmented reality technology is also being used to train pediatric orthopedic surgeons and to educate patients and families about surgical procedures and postoperative care.
Pediatric orthopaedic conditions require specialized care and expertise to ensure optimal outcomes for young patients. Early detection, accurate diagnosis, and timely intervention are crucial in managing these conditions. The treatment approaches vary depending on the specific condition and its severity, ranging from non-surgical methods, such as braces and casting, to surgical interventions. Collaborative efforts between orthopaedic specialists, physical therapists, and other healthcare professionals are essential to provide comprehensive care for children with orthopaedic conditions, enabling them to lead active and fulfilling lives.
(The author is Associate Professor Orthopaedics, AIIMS Vijaypur, Jammu. )
Follow our WhatsApp channel
