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. 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 feel frightened and anxious simply because they are seeing a doctor, so the examination must be adapted 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 in a child-friendly way, with a toy or two – is always an advantage. Paediatric orthopaedic surgeons are trained to help children relax so that the examination proceeds like a game. However, one must also know how to handle the anxiety and stress of families when a child has a health problem.
Often what is perceived as a problem in a child simply requires time, because it is actually a growth variant that resolves on its own. For these reasons paediatric physicians, in addition to medical knowledge and skills, must be excellent communicators in order to convey the message to concerned parents.
The examination always begins with a conversation about the reason for the visit, then about the symptoms, their duration, previous injuries and so on. Questions should be directed as much as possible to the child, with parents involved in the answers. After the history, the clinical examination is adapted to the complaints and age of the child, sometimes requiring the doctor to be creative in encouraging the child to perform the requested movement.
During the examination, paediatric orthopaedic surgeons often use imaging methods such as ultrasound (US), X-ray (RTG), computed tomography (CT) or magnetic resonance imaging (MRI), so it is important to bring all previous imaging to the appointment.
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, approximately 70% of paediatric orthopaedic consultations end with the reassurance that the child's condition is not a disease but simply a growth variant – harmless and without impact on later life.
About 20% of children require conservative treatment (physical therapy, casting or orthosis).
In a small number of cases – approximately 10% – surgical treatment is required. In those cases it is very important to explain everything in detail to the parents, and it is sometimes helpful to sketch the operation on paper so that they fully understand what their child will need to go through. Although it is never easy to hear that a child needs surgery, it should be remembered that an operation can make a life-changing difference.