Introduction
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
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.