Orthopaedic problems in children are common.
Some of the conditions occur as part of the child’s development. Typically, paediatricians look out for likely symptoms of these conditions and will refer your child to a paediatric orthopaedics specialist when needed.
Below are some of the most common orthopaedic problems and injuries you need to watch out for:
The medical term used to describe problems with the formation of the hip joint in children is called hip dysplasia. The location of the problem can be in the femoral head (ball of the hip joint), acetabulum (socket of the hip joint), or both.
Years prior, the condition has been known as congenital dysplasia of the hip (CDH). Recently, developmental dysplasia of the hip (DDH) has become the accepted terminology.
While the exact cause of hip dysplasia has not been identified, several factors are believed to contribute to the development of the condition.
Some of the identified risk factors include:
- Children born in breech position
- Children with a family history of hip dysplasia
- Oligohydramnios (lack of intrauterine fluid)
- Children born with “packaging problems” (conditions that result from the child’s in-utero position [i.e. torticollis, clubfoot, etc.] are called packaging problems)
Treatment intervention will depend on the age of the child. The primary goal of the treatment is to position the hip joint properly (“reduce” the hip). Once the adequate reduction is obtained, the body will eventually adapt to the new position.
The birth abnormality that causes a child’s feet to point down and inward is called clubfoot. While the condition does not often cause pain, when left untreated, it can cause long-term problems.
The cause of clubfoot has not been identified. While it has been associated with other congenital malformations like arthrogryposis and spina bifida, in some instances, it occurs independently.
Clubfoot occurs when the tendons on the back and the inside of the foot are too short. The condition is also classified into two—rigid or supple (flexible). The former classification is commonly linked to other congenital malformations and is considered more difficult to treat.
Typically, treatment for the condition often begins soon after the child is born. However, treatment of the condition is not an emergency.
While it is typically started the first few weeks of life, the timing can be based on the preference of the treating orthopaedic surgeon and the parents. Treatment of clubfoot will consist of manipulating the foot and casting in the corrected position after. The manipulation is gradually increased over a span of several months until the normal position of the foot is restored.
The manipulation technique is called “The Ponseti Method”, it was named after the doctor who introduced the treatment.
Metatarsus adductus is a prevalent foot condition often seen in infants and newborns. The condition is characterized by the toes and the forefoot pointing inward. The appearance of the foot sole is also often described as “bean-shaped.”
Metatarsus adductus is considered the result of the so-called “packaging problems” (the child’s position in the womb). Other packaging problems include clubfoot, hip dysplasia, and torticollis.
Special footwear, physical therapy, and stretching are some of the recommended medical interventions for the condition. However, 90 to 95 per cent of metatarsus adductus cases will eventually resolve on its own even without treatment. If there is rigid deformity (the foot cannot be stretched to the normal position), cast treatment will be recommended.
Ideally, casting should be initiated in the first 6 months of life. If casting will not improve the position of the foot, surgery may be recommended. Surgery, however, will only be resorted to after the child turns 3 years old.
The infection within the hip joint is called septic hip. The condition is also known as infectious arthritis or septic arthritis.
Children afflicted with septic arthritis have bacteria within the hip joint. The bacteria will accumulate as pus and can become very painful. The condition is often attributed to group B streptococcus. Haemophilus influenza (Hib) is also considered a likely culprit.
In adults, the condition is often caused by Streptococcus or Staphylococcus bacteria.
Septic hip is treated using antibiotics. As soon as the hip aspiration will show bacteria, antibiotics will be given.
Once the organism’s susceptibility has been identified from culture, antibiotics given may be modified. Antibiotic treatment will often last for 3 (or more) weeks. Infections within the joint will often require surgery as the infection might damage the cartilage permanently.
If a child is diagnosed with an infection of the hip, surgery to clean out the joint is often recommended. The procedure done can be arthrotomy or joint irrigation and aspiration (guided by ultrasound) may be performed.
Since the hip is still growing, protecting the cartilage is considered vital. Sustaining damage to the cartilage might put patients at risk of permanent hip damage. If the damage to the cartilage is severe, patients might need hip replacement later on in life.