Pediatric Orthopedics

Orthopedics for Children

Your child, whether an infant or adolescent, may need specialized bone and joint care for orthopedic and developmental conditions. He or she will receive a personalized evaluation and treatment plan including nonsurgical and surgical treatments for:

• Complex Hip Disorders
• Congenital Anomalies
• Hip Dysplasia
• Limb Deformity
• Neuromuscular Disorders
• Pediatric Fractures
• Perthes Disease
• Slipped Capital Femoral Epiphysis
• Spinal Deformity

COMPLEX HIP DISORDERS

Pediatric hip conditions can affect children of any age. Hip dysplasia is a condition where the hip socket does not form correctly and can be associated with hip dislocation at birth or abnormal development of the socket as the child grows. If pediatric hip dysplasia is left untreated, it can lead to early hip problems in adulthood, including hip arthritis. Your child’s pediatric orthopedic surgeon may try nonsurgical methods to help the hip develop normally, such as braces or casts.

Some pediatric hip conditions require surgical treatment in order to allow the hip joint to develop normally. These procedures may include cutting and realigning the pelvic and thigh bones and reconstructing the hip joint, procedures known as pelvic and femoral osteotomies. Some osteotomies are appropriate only in small children, while others may be beneficial for older children with hip dysplasia. One such osteotomy, the periacetabular or “Ganz” osteotomy, may prevent the development of early arthritis in older children with hip dysplasia. Carolina Regional Orthopaedics, PA is one of a small number of centers in the region where this osteotomy is performed.

HIP DYSPLASIA

Hip dysplasia is a condition where the hip socket does not form correctly and can be associated with hip dislocation at birth or abnormal development of the socket as the child grows. This condition, if left untreated, can lead to early hip problems in adulthood, including arthritis. Your child’s surgeon may try nonsurgical methods to help the hip develop normally, such as braces or casts.

Older children with hip dysplasia may benefit from the periacetabular or “Ganz” osteotomy to prevent the development of early arthritis. Carolina Regional Orthopaedics, PA is one of a small number of centers in the region where this osteotomy is performed.
It usually affects the left hip and is predominant in:

• Girls
• First-born children
• Babies born in the breech position (especially with feet up by the shoulders)

LIMB DEFORMITY

While knock knees and bow legs are common in childhood and usually resolve as the child grows, certain limb conditions do not correct on their own and may lead to leg length differences or angular deformity.

Just a few of the conditions that may lead to differences in the growth of the limb are:

• Blount’s disease
• Skeletal dysplasias
• Femoral or fibular deficiencies
• Physeal bar formation after traumatic injuries

Your surgeon may recommend surgery to help restore the normal alignment of your child’s arm or leg. These include slowing down the growth of the longer limb, changing the direction of growth of an angled limb, or sometimes cutting the bone (known as an osteotomy) and realigning the limb into a better position.

Carolina Regional Orthopaedics, PA surgeons have experience using a number of techniques to change limb alignment including guided growth (to use the body’s normal growth patterns to correct the deformity), osteotomies and internal fixation (for immediate and accurate correction of limb differences), and external fixation (for lengthening bones and correcting angular deformities).

NEUROMUSCULAR DISORDERS

Physicians at Carolina Regional Orthopaedics, PA strive to offer comprehensive orthopedic care for children with neuromuscular disorders such as cerebral palsy, muscular dystrophy, and Down’s syndrome, amongst others. Much of this care can involve coordination of physical and occupational therapy for children, wheelchair fittings, and orthotics to help with braces.

Surgical management for these conditions may be indicated to assist your child in daily activities such as walking, running, and even sitting. These procedures are complex and need to be individualized to each patient to maximize outcomes. Some commonly performed procedures include botulinum toxin-A injections for muscle spasticity, tendon lengthening or transfers, bony realignment procedures known as osteotomies, hip reconstruction, and spinal fusion surgery. Spinal fusion is often performed for scoliosis but may also be required for neck disorders, chest wall deformities, or kyphosis (round-back).

PEDIATRIC FRACTURES

Childhood fractures occur frequently. From common injuries such as broken wrists or elbows to those that are more complex involving multiple bones, pediatric orthopedists at Carolina Regional Orthopaedics, PA have the experience to treat your child’s injury expediently and appropriately. Each child is monitored after his or her injury to ensure that all fractures heal and that no growth plate injury occurred at the time of the initial fracture. Potential complications of broken bones including incomplete healing, infection, or injury to the growth plate of the bone may need treatment after the injury. Your child’s surgeon will be able to discuss the injury, treatment, and what you can expect down the road.

PERTHES DISEASE

Perthes is a condition in children characterized by a temporary loss of blood supply to the hip. Without an adequate blood supply, the rounded head of the femur (the ” ball ” of the hip) dies. The area becomes intensely inflamed and irritated.

Perthes disease is usually seen in children between 4 to 10 years old. It is five times more common in boys than in girls.

SLIPPED CAPITAL FEMORAL EPIPHYSIS

Slipped capital femoral epiphysis (SCFE) is an unusual disorder of the adolescent hip. For reasons that are not well understood, the ball at the upper end of the femur (thigh bone) slips off in a backward direction. This is due to the weakness of the growth plate. Most often, it develops during periods of accelerated growth, shortly after the onset of puberty.

The condition is diagnosed based on a careful history, physical examination, observation of the gait/walking pattern, and X-rays of the hip. The X-rays help confirm the diagnosis by demonstrating that the upper end of the thigh bone does not line up with the portion called the femoral neck.

SPINAL DEFORMITY

Spinal conditions such as scoliosis (curving of the spine), kyphosis (increasing round-back of the spine), spondylolysis (stress fracture of the spine), and spondylolisthesis (movement of one part of the spine on another part) may affect children during their early or late childhood years. The majority of spinal disorders do not require bracing or surgery although regular checkups are needed to ensure that the condition does not worsen.

Carolina Regional Orthopaedics, PA surgeons may use a combination of bracing and spinal casting to prevent your child from needing spinal surgery. When your child’s physician feels that non-operative management is no longer appropriate, he may recommend spinal fusion. While the specifics of the procedure will be discussed by your child’s doctor, spinal fusion most commonly involves the placement of screws, hooks, and rods in the spine in order to prevent the deformity from worsening and perhaps even improve the appearance. Carolina Regional Orthopaedics, PA pediatric orthopedic surgeons have a great deal of experience treating children with all types of spinal conditions, from mild to the most severe.