info@ogwa.com.au
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Paediatric Orthopaedics
We offer a comprehensive paediatric orthopaedic service for children from newborn to adolescence including an assessment and bracing service for Developmental dysplasia of the hip DDH.
Conditions
Developmental Dysplasia of the Hip (DDH)
Developmental Dysplasia of the Hip (DDH)
Dysplasia describes any abnormality in the shape of hip joint, but most commonly refers to a “shallow” socket. It causes uneven pressure on the socket and typically presents with activity related groin pain in younger adults. There is a spectrum of disease from a frankly dislocated hip to a stable hip in a mildly shallow socket.
In newborns screening for dysplasia with a clinical check or ultrasound may reveal the diagnosis. Early treatment with a brace can improve a dislocated or dysplastic hip and help prevent problems in later life.
In older children with significant differences in the structure of their hip, surgery is occasionally recommended to improve the anatomy or treat pain.
Osteochondritis Dissecans (OCD)
Osteochondritis Dissecans (OCD)
Osteochondritis Dissecans (OCD) is a condition of childhood where a small area of bone loses its blood supply and becomes susceptible to fracture. This is most commonly seen on the inner side of the knee where it may cause pain and in some instances, cause a piece of bone and cartilage to break free into the joint giving symptoms of catching or locking.
Abnormal Gait / Limp
Abnormal Gait / Limp
Children below the age of eight often have a variable pattern of walking (gait) which is considered normal. A consistently abnormal gait however, is referred to as a limp and may be a sign of more significant pathology.
In young children, persistent limp may suggest an infection or inflammation of a joint. In older children, hip conditions such as Perthes’ disease, Slipped Capital Femoral Epiphysis (SCFE), or inflammation around a growth plate (eg: Osgood-Schlatter’s disease at the knee or Sever’s disease at the heel) are some of the more common causes.
Symptoms such as night pain, fever, or unexplained weight loss raise concerns for a more malign issue and require urgent review.
Limb Alignment
Limb Alignment
Children’s limbs go through shape changes as they grow, particularly in the lower limbs. Whilst most are considered normal physiological variants, occasionally these changes do indicate pathology that requires treatment or monitoring over time.
Conditions include in-toeing gait, knock knees (Genu Valgum), bowed legs (Genu Varum), flat feet (Pes Planus), and leg length differences.
Foot and Toe Deformity
Foot and Toe Deformity
Similar to adults, children may have changes in the shape of their toes that may be either congenital or develop as they grow. While many do not require treatment, they should be assessed and reviewed as growth continues. Surgical correction may be required if the change in shape causes rubbing, pain, or problems with shoe wear.
Paediatric Trauma and Sports Injury
Paediatric Trauma and Sports Injury
Injuries to bone or ligament in the growing skeleton present unique surgical problems as they often involve damage to the growth plate (physis). This can produce delayed complications including premature growth plate closure producing differences in leg length, or partial growth plate closure producing angular deformity.
Patellofemoral Instability
Patellofemoral Instability
The patella or kneecap sits at the front of the knee and is important in the function of knee movement. A patellar dislocation is a common injury where the patella moves out to the side of the knee which can be significantly painful and may go on to happen in a recurring manner. This can cause issues with normal day to day function, particularly getting in and out of a chair or going up and down stairs, as well as returning to sport.
Ligamentous Injury
Ligamentous Injury
The knee is held together by bands of tissue known as ligaments. These provide stability to the knee. The ligaments on either side of the knee are called collateral ligaments (medial and lateral), and the two ligaments on the inside of the knee are called cruciate ligaments (anterior and posterior). The Anterior Cruciate Ligament (ACL) is one of the most commonly injured ligaments, often occurring as a result of a pivoting or twisting injury during sport. This can leave the knee feeling unstable, with an inability to return to sport or other normal activities. It is possible to injure more than one ligament at a time, making for a more complex injury and increasing the potential for ongoing instability.
Meniscus Injury
Meniscus Injury
The meniscus is a fibrocartilage structure that improves weight distribution to cartilage in the knee. When torn (commonly in conjunction with other knee injuries) it produces symptoms of catching and pain and may occasionally result in a knee that is unable to fully extend (locked knee). Some children have an anatomic predisposition to injury with a meniscus shaped like a “coin” rather than the typical “horseshoe” appearance. This is called a discoid meniscus.
Operations:
- Bracing for Developmental Dysplasia of the Hip
A brace is used to stabilise a dislocated hip within the hip socket, or to help a shallow hip to become deeper with growth.
Typically, adjustments to a brace take place at 2 – 12 week intervals depending on the age of the child and type of brace fitted. Brace fitting is available on Tuesday’s supervised by our specialist paediatric orthotist.
- Peri-Acetabular Osteotomy (PAO)
Peri-Acetabular Osteotomy (PAO) describes cutting the bone around the hip socket. It is used to realign the hip socket (acetabulum) in adolescents or young adults with developmental dysplasia or hip impingement symptoms (FAI). Special surgical instruments are used to cut the bone until it can be moved independently from the pelvis. The socket can then be aligned in a more anatomically normal position. This surgery is shown to relieve symptoms and may delay the need for hip replacement.
- Knee Arthroscopy
Arthroscopy describes the use of a camera and specialist tools to work inside the joint. This is done through small keyhole incisions in the skin and in the knee. Arthroscopy can be used to treat injuries to the meniscus or the cartilage surfaces, or to allow for stabilisation procedures for the patellofemoral joint.
- Guided growth
Guided Growth is a technique used in growing children to alter the length or alignment of bones. Small plates, often referred to as “8-plates” (as they resemble the number “8”) or screws are used to stop growth across all or part of a growth plate. This is used most commonly around the knee to correct knock knees, bow legs, or a difference in leg length. Depending on the technique and age of the child this may be a reversible or repeatable procedure.
- Femur / tibia osteotomy
Osteotomy describes the cutting of a bone. Following previous fracture, or due to variation in growth, limbs may be incorrectly aligned or rotated and result in mechanical problems at the hip, knee, or ankle. Surgery to change the alignment or rotation involves cutting the bone. This may be done with custom planned or intra-operative guides to aid in positioning and aims to restore normal anatomy or alter anatomy to offload the injured portion of a joint.
- ACL reconstruction
Most commonly the Anterior Cruciate Ligament (ACL) reconstruction takes tissue from the patient’s own knee and uses it to reconstruct the cruciate ligament by passing it through tunnels in the knee, allowing the patient to have a stable, functioning knee so they can return to normal activities, including sport.
In children ACL stabilisation is particularly important to protect against further damage to the menisci or cartilage in the knee.
The surgical technique for ACL reconstruction in adolescents or older children is altered slightly from the adult technique in order to reduce risk of damage to the growth plate. In younger children special ‘growth plate sparing’ ACL reconstruction techniques may be required.
- Patellar stabilisation surgery
In cases of recurrent patellofemoral instability, it may be appropriate to stabilise the patellofemoral joint. This may involve a combination of bony and soft tissue procedures to try to improve alignment, restore more normal anatomy to prevent dislocation.
The surgical technique for Patella stabilisation in children may be altered slightly from the adult technique. Commonly “tibial tubercle osteotomy” is reserved for children with minimal growth remaining and alternate techniques are employed for younger children to reduce the risk of damage to growth plates.
