Correction and Treatment of Pediatric Orthopedic Deformities

Pediatric Orthopedy

You are born with 270 bones! But, by the time you become an adult, you only have 206 bones because some of the bones join together as you grow. Bones support and protect the organs in your body, produce blood cells, store minerals, and allow your joints to move. Your bone is alive and can repair itself if it is broken. Bone can get bigger and stronger from exercise or lifting weights and smaller and weaker if you don't exercise enough.

Pediatric orthopedic surgeons specialize in the treatment of growing bones, joints and muscles. Growing bodies have an entirely different set of needs from fully developed bodies. Therefore, children must be treated as more than just small adults. That is why, when it comes to injuries, neuromuscular disorders such as cerebral palsy, spina bifida, myelomeningocele and muscular dystrophy, scoliosis and congenital deformities, pediatric orthopedic specialists are attentive to immediate recovery, as well as future development. Techniques most commonly used to treat these conditions include physical therapy, braces, splints and surgery, when necessary.

Conditions Treated
• Cerebral palsy
• Spina bifida
• Myelomeningocele
• Muscular dystrophy
• Scoliosis
• Kyphosis
• Torticolisul muscular congenital
• Clubfoot and other foot and ankle deformities
• Genu valgum/Genu vargum
• Vertical talus
• Out-toeing
• Leg Length Discrepancy
• Skeletal dysplasias
• Developmental dysplasia of the hip
• Osteogenesis imperfecta
• Limb defects
• Musculoskeletal infections
• Neurofibromatosis
• Blount’s disease
• Knee injuries and disorders
• Osgood-Schlatter disease

How surgery can help children with cerebral palsy?
Surgery is one of the many options available to help children with cerebral palsy improve mobility, posture and ensure healthy growth. Most doctors recommend physical therapy and medication before surgery.
Surgery can correct or improve movement and alignment in the legs, ankles, feet, hips, wrists and arms. These operations are performed on the muscles, tendons, bones and nerves.

As is the goal with all treatment of cerebral palsy, surgery aims to give children the greatest chance of living as independently as possible. Movement problems caused by cerebral palsy can improve over time, but they also carry the risk of getting worse.

Surgery for Osteogenesis Imperfecta in Children
For children who are still growing and have had repeated fractures of the same bones, our orthopedic surgeons may recommend a procedure known as rodding surgery. This surgery helps to prevent repeated fractures of the long bones in the arms and legs and ensures that these bones heal correctly.

In rodding surgery, which is performed using general anesthesia, the surgeon corrects the bone deformity and uses a special type of metal rod to properly align the bone. After surgery, your child may need a cast or a splint for two to four weeks to enable the bone to heal completely.

Scoliosis Surgery
Severe scoliosis typically progresses with time, so your doctor might suggest scoliosis surgery to help straighten the curve and prevent it from getting worse.

Surgical options include:
• Spinal fusion.
In this procedure, surgeons connect two or more of the bones in the spine (vertebrae) together so they can't move independently. Pieces of bone or a bone-like material are placed between the vertebrae. Metal rods, hooks, screws or wires typically hold that part of the spine straight and still while the old and new bone material fuses together.
• Expanding rod. If the scoliosis is progressing rapidly at a young age, surgeons can attach one or two expandable rods along the spine that can adjust in length as the child grows. The rods are lengthened every 3 to 6 months either with surgery or in the clinic using a remote control.
• Vertebral body tethering. This procedure can be performed through small incisions. Screws are placed along the outside edge of the abnormal spinal curve and a strong, flexible cord is threaded through the screws. When the cord is tightened, the spine straightens. As the child grows, the spine may straighten even more.

Limb lengthening/correction
When a limb needs to be lengthened, or a bone needs to be corrected, there are several orthopedic non-surgical and surgical treatments available, depending on the severity of the issue and the patient’s medical history. Your doctor or orthopedic surgeon will carefully evaluate what is appropriate for the case considering your child’s age, her/his medical history, the physical examination, imaging, and blood and/or nerve tests.

What is the most common bone deformity surgical treatment?
The most common surgical method to treat bone deformities consists of carefully cutting the bone on purpose and then lengthening or correcting the limb. This corrective procedure, called osteotomy, may be performed with either internal or external fixation devices (more rarely together) to stabilize the cut bone.
Orthopedic internal fixation allows to correct the bone deformity all at once. The surgeon will operate your child under general anesthesia, and will apply metal rods, screws or plates – that will remain in place under the skin after orthopedic surgery – to adjust the bones.

Orthopedic external fixation, with metal rods or pins located outside the limb, is recommended in case of a quite complex bone deformity, which cannot be repaired using open reduction with an internal fixation device, and which is safer to correct gradually, avoiding injury to soft tissues such as nerves or blood vessels.

How can a bone deformity be corrected with an orthopedic external fixator?
An external fixation device allows the new bone to strengthen and harden while growing in the new shape/length. To achieve the bone deformity correction, the external fixator needs gradual adjustments to help the new bone tissue to grow into place over time. When the orthopedic surgeon is happy with the bone’s length, shape and alignment, adjustments will no longer be needed. However, your child will still wear the external fixator, which will support the limb while the new bone tissue hardens and the limb becomes stronger. These two phases – the “correction” and “consolidation” steps together – usually last from 4 to 12 months.

At the end of the bone fracture healing process, the external fixator will be removed. Your child may need to wear a cast for a short while after the fixator frame has been removed.

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