Introduction

  Children’s orthopaedics is different from its adult counter­part because growth is still taking place. This can work for or against the child and surgeon. On the positive side there are great powers of remodelling and recovery (Fig. 27.1). Conversely, a growth plate injury or congenital shortening of a limb will produce progressive deformity (Fig. 27.2).

The understanding of children’s orthopaedics is helped by a knowledge of its terminology (Table 27.1 gives examples).

Many orthopaedic conditions are congenital, i.e. present at birth. Some are immediately obvious, for example the absence of a limb; others such as cerebral palsy or developmental dysplasia of the hip may not be clinically detectable at birth hut declare themselves later. In addition, some acquired conditions arise against a background of genetic susceptibility, for example immune deficiency predisposing to infec­tion. Finally, children present great variation within the spectrum of normality (e.g. gait pattern), while others have conditions such as postural abnormalities which are self-limiting. These may cause great concern to a family. Clinical assessment and explanation must be just as thorough as for a child with an obviously severe condition.

Figure 27.3 presents a helpful system for treating orthopaedic conditions in childhood.

The term ‘orthopaedics’ (straight child) originally referred to correction of deformity in children. The speciality gener­ally has expanded beyond all recognition and this includes shortening.

children’s orthopaedics. Not only has deformity to be addressed, often with sophisticated technology for investigation and treatment, but the children’s orthopaedic surgeon is concerned with a much wider range of musculoskeletal disease, along with closer involvement in the general care of the child in the community. The role of the orthopaedic surgeon may be primary or secondary, according to the overall needs of the child.