Paediatric orthopaedics

Paediatric Orthopaedics is a specialised service which provides surgical and non-surgical treatment for children affected with congenital, developmental and acquired musculoskeletal conditions. Children are growing and developing physically, mentally, and emotionally so they need care that not only addresses their current needs but also protects their future health and well-being.

Possible Causes:

Children need special care as their anatomic and physiological development differs from that of adults. Orthopaedic conditions, in children, that are related to birth and congenital defects require ongoing treatment and care from birth into adulthood. 

Congenital and hereditary causes:

Clubfoot:

An infant’s foot is turned inward and downward, making it impossible to walk. Congenital limb defect - an arm or leg doesn’t form normally as a baby grows in the uterus. Limb length differences – when both limbs are not of equal length and may cause the child to limp. 

Developmental dysplasia of the hip - when the hip ball and socket don’t fit together properly, it increases the risk of hip instability, Becker muscular dystrophy (BMD) which causes weakness of skeletal muscles, breathing muscles, and the heart muscle. Cerebral palsy – a neurological disorder that affects body movement, muscle control, coordination, reflexes, posture, and balance. 

Neuromuscular diseases affect the function of muscles due to problems with the nerves and muscles in the body. 

Growth related causes:

Kyphosis is a deformity of the backbone. It’s when the bones of the spine in the upper back curve outward more than they should. Perthes disease is a rare hip condition that affects children where the ball-shaped top of a child’s thighbone breaks down and re-forms. 

Nursemaid’s elbow is a type of elbow injury. It’s when a forearm bone (radius) slips out of place from where it normally attaches to the elbow joint. Scoliosis is an abnormal curvature of the spine toward either the left or the right side of the body. Metatarsus adductus (the foot turns inward), Tibial torsion (the shinbone turns inward). 

Femoral anteversion (the thighbone turns inward), in which the child may look pigeon-toed. Osteosarcoma is a bone cancer that occurs mostly in children and adolescents. This tumour develops around the hip, shoulder, or knee and spreads rapidly to other parts of the body.

Inflammatory and infectious causes:
Juvenile rheumatoid arthritis- An auto-immune disease in which the immune system, begins to attack healthy cells and tissues instead of fighting off harmful bacteria or viruses resulting in inflammation, redness, heat and pain. Osteomyelitis is an inflammation or swelling of bone tissue. It’s most often caused by a bacterial infection of the blood. Septic arthritis is an infection in the joint (synovial) fluid and joint tissues.

Traumatic injuries:

A fracture is a partial or complete break in the bone when more force is applied to the bone than the bone can absorb. Overuse and sports injuries can affect nearly any part of the body or any portion of the musculoskeletal system, including the bones, joints, nerves, muscles, tendons, ligaments or cartilage. 

Dislocation is a joint injury that occurs when the ends of two connected bones come apart.  A sprain is an injury caused by sudden stretching, twisting, or tearing of a ligament while a strain is caused by pulling or tearing of a muscle or a tendon.  Growth plate fracture affects the layer of growing tissue near the ends of a child's bones.

Risk Factors:

Children may be at a higher risk of orthopaedic problems due to:

• Genetics - congenital disorders are present from birth, and hereditary disorders are transmitted from parents to their children through the genes. Some of these are metasarsus adductus, clubfoot, dysplasia of the hip, limb defects, osteogenesis imperfecta and muscular dystrophy.
• Sports - strains, sprains, broken bones, bruises, scrapes, and concussions are most commonly diagnosed in children who play sports. These are mostly due to overtraining, lack of conditioning, and improper form or technique.  

Signs & Symptoms: 

Some of the signs and symptoms among children who need orthopaedic care include:

• Spinal deformities. which is an abnormal alignment or curve of the bony vertebral column. Pain results from stressed joints and pinched nerves, not the abnormal curve. 
• Persistent pain in the joints or muscles.  Common overuse injuries are in the elbows, knees, hips, Achilles tendons, and shins (shin splints). 
• Difficulty with movement or balance. Muscular dystrophy symptoms may not appear until a child is older. In Duchenne muscular dystrophy, children fall more often than other children, walk on their toes and often have delayed milestones in walking and language. With clubfoot, an infant’s foot points downward and turns inward making it difficult to walk.
• Muscle weakness, twitching, cramps, and pain.
• Difference in the length of limbs. This sometimes affects the gait and, disturbs the whole lower limb biomechanics and may cause pain in the lower back, hips or knees.
• Tumours. Osteosarcoma is a bone cancer which occurs mostly in children and adolescents. This tumour develops around the hip, shoulder, or knee and spreads rapidly to other parts of the body.
• Trauma. Children get injured in accidents that may cause a fracture to any part of the body.

Diagnosis: 

Paediatric orthopaedic specialists at Medcare will diagnose orthopaedic problems among children based on:

• The child’s symptoms.
• Imaging tests such as x-rays, CT scans and MRI scans.
• For neuromuscular problems, specialised tests such as lumbar puncture, muscle biopsy, or nerve conduction study.
• Electromyography.
• Genetic testing. 

Treatment Options: 

From the simplest to the most complex orthopaedic treatment for children consult our paediatric orthopaedic specialists in Dubai or Sharjah by visiting Medcare. A paediatric orthopaedic doctor has specialized training in management of acute, chronic and congenital musculoskeletal conditions in children.

Treatment for any condition is always personalised based on your child’s age, development and size. Depending on which part of the body has a problem, the paediatric orthopaedic doctor will recommend:

• Medications.
• Rehabilitation and physical therapy. 
• Prosthetics (artificial limbs).
• Orthotics (splints or braces).
• Surgery.

Some common conditions seen in children and their treatment:

• Fractures: Children’s knee joints are sensitive and any pressure may pull the kneecap out of its groove, or a direct blow may damage ligaments and tendons, causing an anterior cruciate ligament (ACL) injury or posterior cruciate ligament (PCL) injury. So, surgery may be required to treat these injuries.
• Common shoulder and elbow injuries in children include fractures, dislocations, sprains and strains. Nonsurgical treatment can include the use of a splint or sling. Surgery is required for severe and displaced fractures.
• Shoulder dislocations are prevalent in sports such as cycling and gymnastics. A sudden force to the shoulder can cause the top of the upper arm bone to pop out of the socket of the shoulder blade. Surgery is required if there is damage to the nerves, blood vessels, tendons or ligaments.
• For congenital or hereditary conditions like difference in limb length, doctors recommend advanced limb lengthening procedures.  Limb lengthening is a surgical procedure to lengthen and/or straighten deformed bone segments or replace missing bone. It works by helping to gradually grow new bone and soft tissues (skin, muscle, nerves, blood vessels, etc.). 

  Clubfoot is treated by the Ponseti method, which uses gentle stretching and casting to gradually correct the deformity. Scoliosis (mostly idiopathic) is an abnormal curvature of the spine toward either the left or the right side of the body. It is usually treated with braces or a surgical procedure called "spinal fusion" that straightens the curve and then fuses the vertebrae together so that they heal into a single, solid bone. This will stop growth completely in the part of the spine affected by scoliosis. 

  Osteosarcoma is a bone cancer in which the tumour develops around the hip, shoulder, or knee, and the treatment for malignant tumors involves a combination of chemotherapy, radiation, and surgery. 

• Children can develop infections called osteomyelitis (bone infection with swelling of the bone tissue), and septic arthritis (joint infection in the synovial fluid and joint tissues). The treatment for these conditions includes antibiotics and surgery as required.