Pediatric Orthopaedic Surgery
Pediatric orthopedic surgery provides surgical and other medical treatments for children. Children's musculoskeletal (bone, joint, or muscle) issues can be effectively diagnosed and treated by pediatric orthopedic surgeons. This includes people from newborn babies to teenagers. Unlike adults, children not only experience a variety of physical issues but also respond to them in a variety of ways.
A personalized treatment plan for the child will be created in cooperation between the parents and the pediatric orthopedist.
Sometimes the child's disease can be completely cured, sometimes surgery may be required if necessary. Pediatric surgeons use specialized training knowledge in creating body-specific implants and procedures, like limb length differences or directed growth for deformity, when surgery is necessary. They are also educated to assess and treat children in a way that keeps them calm and cooperative.
Pediatric orthopedic surgeons frequently work in private children's hospitals to ensure children with numerous medical conditions receive the multidisciplinary care they require from various pediatricians to thrive. (1)
Definition and Overview
A branch of medicine called pediatric orthopedics treats the bones, muscles, and joints of children and teens. A physician who focuses on treating these areas in children, from infants to teenagers, is known as a pediatric orthopedist. Pediatric orthopedic surgeons are another name for pediatric orthopedists. They offer a variety of treatment options, including casts and limb braces, in addition to performing surgery if necessary.
Children have drastically different joint, muscle, and bone structures than adults since their bodies are still developing. When issues emerge, pediatricians frequently refer children to pediatric orthopedists. Growing pains are frequently mistaken for defects by parents because children's bodies undergo significant change during this time. (2)
The most common types of surgery for cases where children benefit and damage their bones and tissues are as follows:
- Arthroscopic surgery
Thanks to advancements in juvenile joint problems, miniaturization of equipment, and technical advancements in adult arthroscopy, arthroscopic surgery for children and adolescents is advancing quickly. The tiny joint size and the existence of adjacent growth plates, on the one hand, and arthroscopy's specialization for youngsters, on the other. There are distinct diseases in addition to the variations in symptoms between illnesses that are typical in children and adults. These features must be understood in order to apply suitable techniques and equipment since arthroscopy can be used on neonates as well. (3)
- Hip preservation
Hip preservation involves using treatment strategies to correct any structural abnormalities of the hip in younger patients to reduce pain and stop the progression of hip degeneration or osteoarthritis before complete hip replacement surgery becomes necessary. While hip replacement surgery corrects structural abnormalities in a patient's hip joint, a child patient with a hip replacement often needs more than one joint replacement surgery throughout life.
- Hip dysplasia
Hip dysplasia in children refers to an improper alignment of the hip's ball-and-socket joint. One or both hips may be affected by a shallow hip socket or a total hip dislocation. In babies and early children, hip dysplasia is a common condition. A Pavlik harness, a non-surgical positioning tool, can be used to flex and abduct a child's hips and fix alignment problems if they are discovered in the early stages of infancy. Hip dysplasia may almost usually be corrected without surgery if it is found during the first few months of life, while surgery may occasionally be necessary. (4)
- Scoliosis correction
Scoliosis surgery repairs the abnormal curvature of the spine (scoliosis). The goal is to safely straighten the child's spine and align your child's shoulders and hips for back problems.
During surgery, the surgeon uses implants such as steel rods, hooks, screws, or other metal devices to straighten the child's spine and support the spinal bones. Bone grafts are placed to hold the spine in the correct position and prevent it from bending again. (5)
- Limb lengthening
Limb lengthening procedures are used to correct limb length discrepancies in children. For treatment, the doctor surgically lengthens the shorter limb using techniques such as external fixation or internal lengthening nails.
- Fracture repair
In order to stop the bone from moving as it heals, the doctor may occasionally apply a splint. Most broken bones, however, might require a cast. Any fracture should be treated medically right away. To secure the bone in place, surgery may occasionally be required to insert plates, pins, or screws. (6)
Pediatric orthopedic surgery procedures are generally recommended for children with
- abnormalities in the growth process,
- broken bones,
- bone and joint infections,
- walking problems,
- sports injuries,
- spine problems,
- ankle or foot surgeries,
- nerve problems,
- extremity deformities,
- problems walking or moving. (7)
Risks and Side Effects
Like any operation, pediatric orthopedic surgeries have risks and side effects. These may include
- blood clots,
- reactions to medicines,
- wound infection,
- the rods or metalwork moving or the grafts failing to attach properly,
- gallstones or pancreatitis,
- damage to the nerves in the spine,
- swelling. (8,9)
Post-Procedure and Follow-up
Depending on the type of surgery, it may be a few in pediatric patients. The child's stomach and intestines may not work for several days after surgery and may need to be fed and fed fluids through an intravenous (IV) line. It is very important to follow all the instructions given to the parents on how to care for the child at home. In addition, to strengthen the muscles and bones, it is necessary to make appropriate exercises for the child. The surgeon checks the child's condition at regular follow-up appointments.
During the healing process, the instructions and directions given by the healthcare team should be carefully followed. For the highest level of recovery, the surgeon and other healthcare team will do their best for the child. In this process, it is the family's greatest duty to protect the mental state of the child.
Pediatric orthopedic treatments and surgeries aim to restore children's health as soon as possible, to relieve them while doing their daily activities, and to return bones and limbs to their former functions. When the process is successfully completed with the health team, the child, and their parents, all of these are provided.
1- OrthoInfo by the American Academy of Orthopaedic Surgeons. What Is a Pediatric Orthopaedic Surgeon? (https://orthoinfo.aaos.org/en/treatment/what-is-a-pediatric-orthopaedic-surgeon/)
2,7- WebMD. What Is Pediatric Orthopedics? (https://www.webmd.com/a-to-z-guides/what-is-pediatric-orthopedics#1-4)
3- National Library of Medicine. Arthroscopic surgery in children. (https://pubmed.ncbi.nlm.nih.gov/20472522/)
4-Johns Hopkins Medicine. Hip Disorders. (https://www.hopkinsallchildrens.org/Services/Orthopaedic-Scoliosis-Surgery/Hip-Disorders)
5,9- MedlinePlus. Scoliosis surgery in children. (https://medlineplus.gov/ency/article/007383.htm.)
6- Johns Hopkins Medicine. Fractures in Children. (https://www.hopkinsmedicine.org/health/conditions-and-diseases/fractures-in-children)
8- NHS. Scoliosis Treatment in Children (https://www.nhs.uk/conditions/scoliosis/treatment-in-children/)