Frequently Asked Questions

What are the causes of orthopedic problem in child

Congenital, Developmental, Trauma, Infection, Metabolic,

How pediatric orthopedic difference from adult orthopedics?

Children are not young adult. Children’s musculoskeletal system is different from adult. Children responses to trauma, infection and deformities are different from adult. Children have more capacity of remodeling & adaptation to environment. So treatment in children with orthopedic problem are managed differently than adult. So they need pediatric orthopedic surgeon, who is trained & have special interest in treatment in orthopedic problem of pediatric age group from birth to 19 year age.

How bones are different in children then adult
  1. Children bone grow in length and width and have fast remodeling.
  2. Kids ligament are stronger than bone. So injury to physial growth plate is common. They can cause limb deformity / shortening
  3. Children bones are more flexible and have thick periosteum. They bend more / have incomplete fracture & heal very fast.
  4. Bone end in joint of children are made by very thick soft cartilage so more prone to damage by vascular injury and infection.
  5. Cartilaginous growth plate & bone end in younger child are not visible on x-ray so they may need ultrasound/ mri/ arthrogram.
Limb shortening in congenital bone deficiency can be managed or not?

Now with the invention of new technique of limb, joint reconstruction by the ilizarov and drohr paley, most of the limb & joint deficiency, deformity, shortening can be reconstructed. Child can have fully mobile joint and equal limb. But these reconstruction should be done by experienced reconstructive surgeon only. Parents should also have patience as these reconstruction require multiple surgery, long rehabilitation and probability of complication.  Management start in very age of life.

how early congenital anomaly like club foot, congenital hip dislocation and other congenital limb deformity should be managed.

Early the identification & intervention, better the outcome. Deformity like club foot and hip instability are supple and easily manageable in early infancy but as age increases stiffness increases and reducibility decreases. So early identification is very important. Treatment should be started as early as possible.

what are the emergencies in pediatric orthopedic

Bone and joint infection, trauma is the emergency in children where treatment is needed at urgent basis.  

What are the chances of improvement in cerebral palsy.

Cerebral palsy occur because of brain insult so complete cure is not possible. More than 80% children can be given good quality of life with early identification and early intervention by good quality multimodal therapy. More info on www.trishlafoundation.com

Are any possibility of limb lengthening/ deformity correction in late childhood/ adult

Now limb lengthening and deformity correction can be done in any age group. Different methods are being used like ilizarov (ring fixater), rail external fixater (lrs), nail, plate, osteotomy etc.

Is progression of knee joint arthritis can be stopped by bony surgery (hto)

Yes. We can prevent the progression of knee joint osteoarthritis by doing corrective osteotomy of proximal tibia. But this technique will be effective only in patients with leg bowing/ proximal tibia/ distal femur deformity. Arthritis due to systemic causes like rheumatoid arthritis cannot be prevented.

Is any treatment available for flat feet.

flat feet without any pain don’t need any treatment. In children it is normal and get corrected by 7-8 year age. Bare foot walking give more chance to foot to develop arch. Arch support/ special shoes prevent the development of arch. Exercise to improve power of small muscle of foot and calf stretching helps in developing arch. Painful flat feet need special shoes, and not relieved then may need surgery.

Treatment of angular deformity of bone is better in child or adult.

Treatment of mild angular deformity near the joint due to trauma and vit d deficiency in small kids below the age of 6 year can correct with the age. But sever angular deformity in young kids and even mild to moderated deformity in elder children will need growth modulation or osteotomy. In growth modulation, by the small incision small plate/ screw will applied near the physial growth plate so that deformity will correct with increase in height but after age of 13 year they need osteotomy to correct the deformity.  

What are the causes of orthopedic problem in child?

Congenital, developmental, trauma, infection, metabolic abnormality are the common causes of orthopedic problem in children. In infancy congenital , infection, in growing children developmental, trauma and in adolescent injury is the commonest cause. 

how pediatric orthopedic difference from adult orthopedics.

Children are not young adults.  Children’s musculoskeletal system is different from an adult. Children’s responses to trauma, infection, and deformities are different from an adult. Children have more capacity for remodeling & adaptation to the environment. So treatment in children with the orthopedic problem is managed differently than an adult. So they need a pediatric orthopedic surgeon, who is trained & have a special interest in treatment in the orthopedic problem of the pediatric age group from birth to 19 year age. 

how bones are different in children than adult
  1. Children bone grow in length and width and have fast remodeling.
  2. Kids’ ligament is stronger than bone. So injury to physial growth plate is common. They can cause limb deformity / shortening
  3. Children’s bones are more flexible and have thick periosteum. They bend more / have incomplete fracture & heal very fast. 
  4. Bone end in joint of children is made by very thick soft cartilage so more prone to damage by vascular injury and infection.  
  5. Cartilaginous growth plate & bone end in the younger child are not visible on x-ray so they may need ultrasound/ mri/ arthrogram.  
Limb shortening in congenital bone deficiency can be managed or not

Now with the invention of a new technique of limb, joint reconstruction by the ilizarov and drohr paley, most of the limb & joint deficiency, deformity, shortening can be reconstructed. A child can have a fully mobile joint and equal limb. But these reconstructions should be done by the experienced reconstructive surgeon only. Parents should also have patience as these reconstructions require multiple surgeries, long rehabilitation, and the probability of complications.  Management starts at the very age of life.

how early congenital anomaly like club foot, congenital hip dislocation, and other congenital limb deformities should be managed.

Early identification & intervention, better the outcome. Deformity like club foot and hip instability is supple and easily manageable in early infancy but as age increases stiffness increases and reducibility decreases. So early identification is very important. Treatment should be started as early as possible.

what are the emergencies in pediatric orthopedic?

Bone and joint infection, trauma is the emergency in children where treatment is needed at urgent basis.   

What are the chances of improvement in cerebral palsy?

Cerebral palsy occurs because of brain insult so complete cure is not possible. More than 80% of children can be given a good quality of life with early identification and early intervention by good quality multimodal therapy. More info on www.trishlafoundation.com

is any possibility of limb lengthening/ deformity correction in late childhood/ adult?

Now limb lengthening and deformity correction can be done in any age group. Different methods are being used like ilizarov (ring fixator), rail external fixator (lrs), nail, plate, osteotomy, etc.

is the progression of knee joint arthritis can be stopped by bony surgery (hto)?

yes. We can prevent the progression of knee joint osteoarthritis by doing corrective osteotomy of the proximal tibia. But this technique will be effective only in patients with leg bowing/ proximal tibia/ distal femur deformity. Arthritis due to systemic causes like rheumatoid arthritis cannot be prevented.

is any treatment available for flat feet?

Flat feet without any pain don’t need any treatment. In children, it is normal and gets corrected by 7-8 years of age. Barefoot walking gives more chance to foot to develop an arch. Arch support/ special shoes prevent the development of the arch. Exercise to improve the power of small muscle of foot and calf stretching helps in developing arch. Painful flat feet may need arch support and if not relieved then they may need surgery.

treatment of angular deformity of bone is better in child or an adult?

Mild angular deformity near the joint due to trauma and vit d deficiency in small kids below the age of 6 years corrects with the growth in majority of cases. But sever angular deformity in young kids and even mild to moderated deformity in elder children will need growth modulation or osteotomy. In growth modulation, by the small incision small plate/ screw will be applied near the physial growth plate so that deformity will correct with an increase in height but after the age of 13 years, they need osteotomy to correct the deformity.   

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Dr. Jitendra Kumar Jain
Trishla Orthopedic Clinic & Rehab center
182C / 350A, Tagore Town, Prayagraj (Allahabad) U.P-211002, India

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