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  • Who is a Paediatric Orthopaedic Surgeon ?
  • Why do we need a specialist for dealing with children’s bone problems ?
  • “Children have wonderful healing capacity – to heal on their own” – why the need for specialised medical care ?
  • My child has been advised surgery – is it safe ?
  • Growth variations – Bow legs / Knock knees / In toeing / Flat feet
  • Bow legs and Knock knees
  • In toeing
  • Flatfoot
  • Clubfoot
Who is a Paediatric Orthopaedic Surgeon ?

A Paediatric Orthopaedic Surgeon is the specialist who deals with all problems which affect bones, joints, ligaments and muscles of the growing child.  He or she is best equipped to understand the unique requirements of care which are necessary to deal with the musculoskeletal problems of a growing child.  This unique expertise in the medical and surgical care of children is acquired from advanced training and experience in practice.

They are doctors who have:

  • Graduated from an approved medical school
  • Completed an approved Orthopaedic surgery residency / post graduate program
  • Completed additional subspeciality training (fellowship) in Paediatric Orthopaedics and paediatric spinal deformity (typically one year)
Why do we need a specialist for dealing with children’s bone problems ?

Medical care of a child is different from that of an adult, and no one knows this as well as a Paediatrician (Child specialist).  Similarly, the Orthopaedic care of a child is different from that of an adult.

Nothing can be truer than the common saying “A child is not just a little adult”, when dealing with childhood bone and joint problems.

The anatomic, physiological and metabolic features of a growing skeletal system are different from those of a mature skeletal system, and by extension the problems which affect children’s bones and joints are different as well.  Indeed, some pathologies are unique to the growing child and adolescent.  A general Orthopaedic surgeon may not have adequate expertise or experience in the optimal management of some of these unique pathologies.

This makes Paediatric Orthopaedic practice (Children’s Orthopaedics) a highly specialised and niche service, which provides surgical and non-surgical treatment for various musculoskeletal problems affecting children.

“Children have wonderful healing capacity – to heal on their own” – why the need for specialised medical care ?

While it is true that the healing and remodelling capacity of children following injuries is greater than adults, there are certain key distinctions.

For example, growth plate injuries (physeal injuries) are unique to growing children, and if undetected or inappropriately treated, these may heal with permanent sequelae such as deformity or length discrepancy.  Similarly, developmental problems such as hip dysplasia need to be screened for in the “at risk’ babies, so that they can be identified and treated early with simple measures rather than complex interventions at a later date which will have an adverse impact on the eventual outcome.

Pathologies unique to the growing child such as Perthes’ disease, Developmental coxa vara, Slipped Upper Femoral Epiphysis, Idiopathic scoliosis need a clear understanding of the natural history of the condition, in order to identify any potential adverse clinical or radiological changes which may need early and proactive intervention.

My child has been advised surgery – is it safe ?

Modern anaesthetic techniques and practices are extremely safe, and have greatly reduced the incidence of adverse events.  Your child will be evaluated by an anaesthetist prior to the surgical procedure, and this evaluation may involve blood investigations if necessary.  Make sure you inform the anaesthetist about any background medical problems that your child may have including ongoing medications.

Surgery for a child can be extremely stressful for the parent.  Children are influenced by the reaction of their parents, and it helps a child if the parents present a calm and positive demeanor.

Make sure you discuss all your doubts and anxieties with your surgeon and anaesthetist, however trivial they may appear to be.

Growth variations – Bow legs / Knock knees / In toeing / Flat feet

While all children go through a certain consistency in the pattern of growth and development, there are subtle variations in each child.  Making a distinction between what is abnormal and what is just a growth variation needs knowledge, clinical skill and experience.

A substantial proportion of office Paediatric Orthopaedic practice involves sifting developmental pathologies from such growth variations and treating them appropriately.

Bow legs and Knock knees
In toeing

For more info In toeing


For more info Flatfoot


Clubfoot (Congenital Talipes Equino Varus – CTEV) is the commonest limb deformity in children that is seen at birth, with a reported worldwide incidence of 1 per 1000 live births (higher incidence in India).  The term clubfoot refers to the physical appearance of an affected foot, wherein the heel is drawn up and sole of the foot is turned inwards.  The exact cause for the deformity is unknown and efforts are currently underway to identify a genetic link.  It is commoner in boys than girls.  In the majority of cases, the deformity is a random occurrence with no previous family history of any limb deformities.

for more info ……  Clubfoot

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Paediatric Orthopaedics (Children's Orthopaedic Surgery) is the speciality that deals with ailments or problems affecting the musculoskeletal system (bones, joints and related soft tissues - muscles, tendons, ligaments) in children and adolescents.

Content © 2018 Centre for Paediatric Orthopaedic & Disabilities | Dr. Manoj Padman

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