Pediatric Orthopaedics in India
Pediatric Orthopaedics is treatment to properly evaluate and treat musculoskeletal (bone, joint, or muscle) problems in a young, teenager child who is still growing. This includes newborn babies through teenagers. In this treatment the techniques used are physical therapy, braces and splints and observation of growth. Conditions like injuries, scoliosis, congenital deformities and neurological disorders. These conditions can hamper the growth of the children in a long run.Hence Pediatric surgery is important part in improving the function of musculoskeletal in many childhood disorders.
Pediatric Orthopedic Conditions
- Traumatic injuries
- Juvenile Rheumatoid Arthritis
- Neuromuscular disorders
- Injuries related to sports activities
- Disorders related to postures (computer related and back pain injuries)
- Condition of burn contractures
- limb deformities like torsional problem, knock knee problem, flat feet and bow legs
- Infections of bones and joint problems
- Congenital malformations
Congenital and Hereditary Pediatric Conditions
Congenital disorder, also known as congenital disease, birth defect or anomaly, is a condition existing at or beforebirth regardless of cause. Of these diseases, those characterized by structural deformities are termed “congenital anomalies” and involve defects in a developing fetus. Birth defects vary widely in cause and symptoms.
Congenital limb defects : This defect occur when a portion or the entire upper or lower limb fails to form normally or does not form when the baby is developing in the uterus. Treatment options may include:
- Prosthetics (artificial limbs)
- Orthotics (splints or braces)
- Rehabilitation (physical or occupational therapy)
Club foot: It, also called congenital talipes equinovarus (CTEV), is a congenital deformity involving one foot or both.The affected foot appears to have been rotated internally at the ankle. Without treatment, people with club feet often appear to walk on their ankles or on the sides of their feet. Most cases of clubfoot are successfully treated with nonsurgical methods that may include a combination of stretching, casting, and bracing. Treatment usually begins shortly after birth.Thier are two ttypes of surgery
- Less extensive surgery : it targets only those tendons and joints that are contributing to the deformity. In many cases, this involves releasing the Achilles tendon at the back of the ankle or moving the tendon that travels from the front of the ankle to the inside of the midfoot (this procedure is called an anterior tibial tendon transfer).
- Major reconstructive surgery for clubfoot involves extensive release of multiple soft tissue structures of the foot. Once the correction is achieved, the joints of the foot are usually stabilized with pins and a long-leg cast while the soft tissue heals.
After 4 to 6 weeks, the doctor will remove the pins and cast, and typically apply a short-leg cast, which is worn for an additional 4 weeks.
Developmental Dysplasia of the Hip
The hip is a “ball-and-socket” joint. In a normal hip, the ball at the upper end of the thighbone (femur) fits firmly into the socket, which is part of the large pelvis bone. In babies and children with developmental dysplasia (dislocation) of the hip (DDH), the hip joint has not formed normally. The ball is loose in the socket and may be easy to dislocate.DDH is most often present at birth, it may also develop during a child’s first year of life.
- Legs of different lengths
- Uneven skin folds on the thigh
- Less mobility or flexibility on one side
- Limping, toe walking, or a waddling, duck-like gait
- For 6 months to 2 years. If a closed reduction procedure is not successful in putting the thighbone is proper position, open surgery is necessary. In this procedure, an incision is made at the baby’s hip that allows the surgeon to clearly see the bones and soft tissues.
- For Older than 2 years. In some children, the looseness worsens as the child grows and becomes more active. Open surgery is typically necessary to realign the hip. A spica cast is usually applied to maintain the hip in the socket.
Osteogenesis Imperfecta (OI)
Osteogenesis imperfecta (OI) or Brittle Bone Disease is a complicated, variable and rare disorder. Its major feature is a fragile skeleton, but many other body systems are also affected. OI is caused by a mutation (change) in a gene that affects bone formation, bone strength and the structure of other tissues. It is a life-long disorder
Muscular Dystrophy (MD)
Mucular dystrophy is a group of diseases that cause progressive weakness and loss of muscle mass. In muscular dystrophy, abnormal genes (mutations) interfere with the production of proteins needed to form healthy muscle.
Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty .Scoliosis is typically classified as either congenital (caused by vertebral anomalies present at birth), idiopathic (cause unknown, sub-classified as infantile, juvenile, adolescent, or adult, according to when onset occurred), or secondary to a primary condition
There are three main categories of treatment: observation, bracing, and surgery. Consequently, there are treatments available that do not involve surgery, but in some individuals, surgery may be their best option.
Limb Length Discrepancies
Differences between the lengths of the upper and/or lower arms and the upper and/or lower legs are called limb length discrepancies (LLD). length differences cause problems in the functioning of the arm.
Causes for leg length discrepancy
Previous Injury to a Bone in the Leg
A broken leg bone may lead to a limb length discrepancy if it heals in a shortened position. This is more likely if the bone was broken in many pieces. It also is more likely if skin and muscle tissue around the bone were severely injured and exposed, as in an open fracture.
Broken bones in children sometimes grow faster for several years after healing, causing the injured bone to become longer. A break in a child’s bone through the growth center near the end of the bone may cause slower growth, resulting in a shorter leg.
Bone infections that occur in children while they are growing may cause a significant limb length discrepancy. This is especially true if the infection happens in infancy. Inflammation of joints during growth may cause unequal leg length. One example is juvenile arthritis.
Bone Diseases (Dysplasias)
Bone diseases may cause limb length discrepancy, as well. Examples are:
- Multiple hereditary exostoses
- Ollier disease
Growth Related Conditions
Tibial torsion is an inward twisting of the shin bones (the bones that are located between the knee and the ankle). Tibial torsion causes your child’s feet to turn inward, or have what is also known as a “pigeon-toed” appearance. It is typically seen among toddlers
Femoral Anteversion is an inward twisting of the thigh bone, also known as the femur (the bone that is located between the hip and the knee). Femoral anteversion causes the child’s knees and feet to turn inward, or have what is also known as a “pigeon-toed” appearance.
Osgood–Schlatter disease (OSD), also known as apophysitis of the tibial tubercle, or Lannelongue’s disease, is an inflammation of the patellar ligament at the tibial tuberosity. It is characterized by a painful lump just below the knee and is most often seen in young adolescents.
Joint Pain Treatment
A joint is the area at which two bone ends meet to provide motion to a body part. Joint pain can be caused by injury or disease affecting any of the ligaments, bursae, or tendons surrounding the joint. Injury or disease can also affect the ligaments, cartilage, and bones within the joint, leading to a painful joint. Pain.
cause joint pain are:
- Autoimmune diseases such as rheumatoid arthritis and lupus
- Chondromalacia patellae
- Crystals in the joint: gout (especially found in the big toe) and CPPD arthritis (pseudogout)
- Infections caused by a virus
- Injury, such as a fracture
- Osteomyelitis (bone infection)
- Septic arthritis (joint infection)
- Unusual exertion or overuse, including strains or sprains