What is orthopaedics?
Orthopaedics (Greek orthos – straight or upright, and paidion – child) is the branch of medicine concerned with the study, prevention and treatment of diseases and injuries of the musculoskeletal system. It was first described in 1741, when French physician Nicolas Andry equated orthopaedics with the art of preventing and correcting bodily deformities in children.
The branch takes its very name from children and began its development from paediatric orthopaedics. Indeed, the symbol introduced at that time – a young tree being straightened as it grows by being tied to an upright post – has endured to this day.
Today orthopaedics is primarily a surgical specialty, but it is through paediatric orthopaedics that the importance of prevention and conservative – non-operative – treatment is most evident.
What do paediatric orthopaedic surgeons do?
Paediatric orthopaedics is a subspecialty focused on the musculoskeletal system (bones, joints and muscles) of the growing child, from the newborn period through adolescence and adulthood. Paediatric orthopaedic surgeons often work in multidisciplinary teams and collaborate closely with paediatricians, school physicians, physiatrists and rheumatologists.
Because children grow, their musculoskeletal problems differ from those of adults. It should be noted that children are not small adults – a child's body responds differently to deformity, injury or infection. Children are also psychologically, mentally and emotionally different from adults.
They cannot always say what is wrong, answer questions, or be patient and cooperative during an examination. They may sometimes feel frightened and anxious simply because they are seeing a doctor, so the examination must be adapted to the child to make it as comfortable as possible for everyone.
Paediatric orthopaedic surgeons prevent, recognise and treat a wide range of musculoskeletal conditions in children, including:
- Limb and spinal deformities present at birth or appearing later in life (clubfoot, flat foot, scoliosis, torticollis, developmental dysplasia of the hip, limb length discrepancy)
- Gait abnormalities (limping)
- Tendon insertion pain (tendinitis)
- Injuries to major joints (meniscal tear, ankle sprain)
- Ruptured ligaments (ACL, ankle ligaments)
- Fractures or consequences of malunited fractures
- Joint instability (shoulder dislocation, patellar instability)
- Bone, muscle and joint infections (osteomyelitis, septic arthritis)
- Other joint inflammation (transient synovitis, juvenile arthritis)
- Musculoskeletal tumours
- Cerebral palsy
- Bone dysplasias (rickets, achondroplasia, osteogenesis imperfecta)
- Syndromic conditions (Down syndrome, Marfan syndrome)
- Muscular dystrophies
- Spina bifida
What does a paediatric orthopaedic examination look like?
Working in a welcoming clinic environment adapted for children – decorated or equipped in a way children find interesting, with the odd toy – is always an advantage. Paediatric orthopaedic surgeons are trained to examine children in a way that helps them relax, so that the examination proceeds like a game.
However, one must also know how to handle the anxiety and stress that arise in families when a child has a health problem. Often what is perceived as a problem in a child simply needs time, since it is in fact a growth variant that resolves on its own.
A paediatric orthopaedic examination always begins with a conversation about the reason for the visit, then about the child's symptoms, how long they have lasted, previous injuries and so on. Questions should be directed to the child as much as possible, given their age and health, with parents involved in the answers.
After the conversation, the clinical examination should be adapted to the child's complaints and age, so the doctor sometimes has to be creative to encourage the child to perform the requested movement. During the examination, paediatric orthopaedic surgeons often make use of imaging methods such as ultrasound (US), X-ray, computed tomography (CT) or magnetic resonance imaging (MRI).
A paediatric orthopaedic examination is like completing a puzzle. The history, clinical examination and imaging are all pieces of a puzzle that must be assembled sensibly so that every piece makes sense.
What happens after the examination?
Fortunately, around 70% of paediatric orthopaedic consultations end with the reassurance that the child's condition is not a disease but simply a growth variant, that it is harmless and has no impact on later life.
Around 20% of children need to be included in conservative treatment after the examination (physical therapy, casting or wearing an orthosis). In such cases it is necessary to explain the condition to the parents and the child (if older), describe the nature of the condition and explain what we aim to achieve with conservative treatment.
In the smallest number of cases, around 10% of children need surgical treatment after a paediatric orthopaedic examination. In these cases it is very important to explain everything to the parents in detail, and it can help to sketch the operation on paper so they fully understand what their child needs to go through in the period ahead.
Although it is never pleasant to hear that a child needs surgery, it is worth remembering that it can make a lifelong difference for the child.