Pediatric orthopaedics is a subspecialty of orthopaedics that focuses on the musculoskeletal problems common to children and adolescents. Children are not merely, as the saying goes, small adults—many basic differences exist between the orthopaedic problems frequently seen in adults and those prevalent in children and adolescents.
The most unique characteristic of this age group is that they are actively growing; when physicians deal with pediatric musculoskeletal problems, they must consider the effect further growth will have on any treatments and on the anticipated outcomes.
In recognizing and emphasizing such differences, this subspecialty has opened the door to more careful study of both common and rare afflictions of the musculoskeletal system, which has led upgraded treatment protocols and improved prognoses for many abnormalities.
The pediatric orthopaedic surgeons at MedStar Health specialize in a wide range of diseases and abnormalities in children and adolescents, including:
- Fractures and dislocations
- Congenital abnormalities such as clubfoot and congenital hip dislocation
- Neuromuscular disease such as cerebral palsy and spina bifida
- Common problems of the child such as intoeing, flatfeet, toe walking, and growing pains
- Sports injuries
- Bone tumors
- Bone infections such as osteomyelitis and septic arthritis
Fractures in children differ significantly from fractures in adults.
For instance, covering the surface of all bones is a membrane called the periosteum; a child's periosteum is thicker than an adult periosteum and contains active, bone-making cells with a very rich blood supply. Therefore, children's fractures heal much more rapidly than adult fractures.
Children rarely need physical therapy after their fractures heal—once a child's fracture heals and any cast is removed, normal use of the extremity is all that is required to restore function. Additionally, joint stiffness in children is quite uncommon, whereas in adults it is of much greater concern.
However, pitfalls also exist in children's fractures. At the end of each long bone (for example, the bones in arms or legs), children have a soft cartilage growth plate. This growth plate is sensitive to trauma or injury. On occasion, it can close or partially close, which means it can stop growing, leaving a child with a shortened bone or, more commonly, an angular deformity of the arm or leg.
With very severe or unusual injures—such as fractures around the elbow, adjacent to joints, or in or near growth plates— pediatric orthopaedic surgery may be necessary to realign the fractured pieces of bone.
Leg Length Discrepancy
Leg length discrepancy, a difference between the lengths of the lower limbs, can occur in children for a number of reasons. A small leg length discrepancy (a quarter of an inch or less) is quite common in the general population and of no clinical significance. Larger leg length discrepancies, though, become more significant.
Frequently, the condition follows a fracture—broken bones in children sometimes grow faster for several years after healing (resulting in a longer leg). If the break occurs in the growth center near the end of the bone, however, it can cause slower growth (resulting in a shorter leg).
A congenital abnormality associated with a condition called hemihypertrophy (asymmetrical body growth) can also lead to leg length discrepancy. Or, it may result from neuromuscular diseases such as polio and cerebral palsy. Still, many times, no cause can be identified.
The long-term consequences of a leg length discrepancy may include knee pain, back pain, and abnormal gait or limp.
To evaluate the condition, Medstar Health specialists will take sequential x-rays to measure the exact discrepancy, while following its progression, and can establish a treatment plan once all the facts are known: the bone age (skeletal age and chronological age are not necessarily equal—frequently, a child's bone age will be significantly different), the exact amount of discrepancy, and the cause, if it can be identified.
Risk of Treatment
Before signing consent for any operation, parents must be fully aware of the benefits, alternatives, risk, complications, and postoperative plans associated with that operation. The following guidelines were compiled by MedStar Health specialists for you to consider when faced with the possibility of any pediatric orthopaedic surgery or any other pediatric surgeryl.
- The fundamental philosophy of treatment is that the result of treatment must better than not doing anything at all, or that the benefits outweigh the risks. Additionally, the chosen method should disrupt life the least.
- Consider alternative treatments. Your surgeon will work with you to determine which option is best for your child. Examples of treatment alternatives include:
- Repeated x-ray checks
- Shoe raises
- Various kinds of operations
- No immediate treatment; monitoring instead
- Be confident that everyone at MedStar Health takes the precautions necessary to minimize the risks of any surgery, including
- Patients are closely monitored.
- Staff members follow and complete many checklists.
- Co-pilots are designated for most activities.
- Regular meetings are held to review problems and to plan avoidance strategies.
- Each MedStar Health facility has a quality assurance program in place.
- All staff members endeavor to recognize complications early so any effects are minimized.
- Think about and discuss the risks of surgery—experience has shown that it is better to discuss risk before an operation than to have complications come as a complete surprise. The following certain issues have been known to follow various kinds of operations:
- General operation risks: Infection, accumulation of blood at the operative site that must be released, swelling under the cast causing tightness so the cast must be split, separation of the incision edges, bandages that fall off, casts that fall off, bandages that soak through, swelling at the site of operation, tender scar, spread scar, patches of numb skin, and operations that fail to achieve their objectives.
- Anesthetic complications: Bruised lip, tape allergy, multiple intravenous punctures, lung problems (hoarseness, pneumonia, croup). Death rate is 1 in 100,000.
- Hospital stay and recovery: Times vary considerably, and only rough estimates can be given.
- If you have further questions about available alternatives and the major risks of certain treatments, MedStar Health pediatricians or surgeons are available to discuss them with you.