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Specialty Update in Pediatric Orthopedics

The editorial staff of the Journal of Bone and Joint Surgery reviewed over 100 articles published in the last few years on the topic of children's orthopedic conditions. In this review, they offer a brief summary of these problems.

Starting from the arm and working down, each body part is included. For the arm and shoulder, brachial plexus palsy and shoulder instability are discussed. Surgery to release or transfer tendons for brachial plexus injury is presented. Immobilization in a sling with physical therapy is advised for the early treatment of shoulder instability.

The hip is next with coverage of slipped capital femoral epiphysis (SCFE), Legg-Calvé-Perthes disease, and deformities of the hip socket. Age, height, and weight remain important factors in SCFE. Children older than 12 years of age with symptoms for more than two months have the worst slips.

Preserving the hip is the key focus of treatment for all these problems. Some surgical procedures work better than others. In all cases, treatment is needed to prevent joint damage from the abnormal mechanics of the hip joint.

In the knee, congenital (present at birth) problems can affect ligaments and bones. There are also traumatic injuries in athletes. Ligament damage is common, especially affecting girls. So far, studies are focusing on exercise to prevent injuries. Surgery is often needed for the congenital problems.

One child out of every 1,000 live births will have a clubfoot deformity. The goal of treatment is to correct alignment and keep it corrected. Most children will need more than one operation to meet this goal. The results aren't always good. Many children end up with arthritis in the feet.

Other topics covered included hip infection, bone tumors, cerebral palsy, and bone fractures. The rest of the review was taken up with problems in the spine. Delayed growth, scoliosis (curvature of the spine), and spinal muscular atrophy top the list. Surgery for each condition and the complications of each procedure are discussed in detail.

All studies reviewed were in the Level I (highest) Evidence. Level I indicates the studies were high quality. Only those studies that were related to children were included.

References: Daniel J. Sucato, MD, MS and Young-Jo Kim, PhD. What's New in Pediatric Orthopaedics. In Journal of Bone and Joint Surgery. May 2007. Vol. 89A. No. 5. Pp. 1141-1150.

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