Cerebral Palsy
Cerebral palsy is a diagnosis for a wide range of clinical disorders of movement or gait. Usually the result of an insult to the neonatal brain, the motor development of the infant may be delayed or altered. Orthopaedists may evaluate children who seem “rigid,” or “floppy,” are not sitting up or are not yet cruising furniture. Oftentimes, a medical evaluation is coordinated with the primary care physician or pediatric neurologist. Depending on the age at presentation, motor skills development and cognitive ability, therapeutic regimens may include observation, physical therapy, splinting, braces or surgery.

Clubfoot
Talipes equinovarus or clubfoot is a descriptive term for a congenital birth defect affecting the foot and lower limb. Numerous theories remain unproved except for the fact that genetics may play a role in the condition. The pediatric orthopaedist often evaluates the child to confirm the diagnosis and assess the child for the presence of other postural deformities. Treatment consists of frequent manipulations and castings of the foot in order to diminish the deformity. Complete correction may be obtained through this technique. For residual deformity, surgical correction prior to walking will be recommended.

Hand
The form and function of a child’s hand allows the infant to experience its environment. From the grasping of a parent’s finger, to holding a bottle, to writing one’s first letters, the child’s hand function is frequently commented upon by the parents. When such conditions as syndactly, polydactyly or absence of a digit occur, an early evaluation is warranted. With syndactly, the skin bridge between two fingers may be excessive. There may also be an abnormal joining of tendons or bones beneath the skin abnormality. In the majority of cases, properly timed surgical releases will minimize the impairment. Polydactyly or extra digits are quite common in normal newborns. Unsightly skin tags or scarring may be avoided through proper evaluation and elective removal of the digit.
Finally, the congenital absence of a digit is evaluated to determine if there are any other bones or muscles in the forearm or hand that were affected. The goal of a treatment plan is to restore the ability of the hand to grasp, pinch, and control objects. The treatment plan may consist of splinting and hand therapy with the pediatric occupational therapist and reconstructive surgery between one and three years of age.

Developmental Dysplasia of the Hip
The hip has two major structures: a cup shaped socket called the acetabulum and the ball shaped upper end of the femur (thigh bone). Developmental hip dysplasia implies that the alignment of the head of the femur (ball) to the acetabulum (socket) at birth is not normal. The hip may be dislocated, subluxed or dislocatable. In dislocation, the growing femoral head sits completely out of the socket. In subluxation, the growing head is partially out of the socket and if the head can be displaced by the examiner, it is considered dislocated. Treatment for the unstable hip is aimed at achieving a repositioning of the hip in the socket, maintaining the improved position, and following the child’s hip development. Splints, braces, casts, tendon releases, and bony surgery are possible treatment choices for select hips.

Hemophelia
A Comprehensive Center of Excellence has been established for the children who are born with a blood deficiency, factor VIII and factor IX. Pediatric hematologists, physical therapists, and pediatric orthopedists combine their skills to evaluate and treat this abnormality. In the exceptional cases where medical and conservative management is unable to diminish the severity of the symptoms, then orthopaedic surgeons may use laser arthroscopic surgery to remove the inflamed tissues in the joints, release contractures that limit joint motion or other reconstructive surgery. Long-term stabilization of this condition with minimal impairment is the goal of the team approach.

Neurofibromatosis
Neurofibromatosis is a genetic disorder that typically presents to the children’s orthopaedist either at birth with obvious lower leg deformity or in adolescence with an progressive curvature of the spine. Numerous cafe au lait spots on a child who presents with a fractured tibia (shin bone) at birth or within the first year of life needs an evaluation to determine if there is an underlying condition associated with the pseudoarthrosis of the tibia. The condition requires a long-term association of the parents and child with a facility equipped to treat the problem. Orthoses, physical therapy, and reconstructive surgery are presented as options depending on the deformity. In adolescence, a patient may be detected in a scoliosis screening to have a curvature of the spine. The pediatric orthopedist will attempt to determine if the scoliosis is associated with a previously unrecognized form of neurofibromatosis. In scoliosis associated with neurofibromatosis, the likelihood of curve progression may depend on the age at first evaluation , amount of curvature and whether or not the underlying spine has been directly altered by neurofibromatosis. Observation, bracing, or surgical arrest of the deformity may be discussed

Slipped Capital Femoral Epiphysis
The adolescent boy and girl may be at risk for developing a sudden limp that comes from the hip. In the teenager, the upper end of the thigh bone (capital femoral epiphysis) may move or slip. Some patients will experience a dull groin ache, knee pain, walk with the foot on that side turned out excessively and be limited in how far they can pull their knee to their chin. Others will have a severe, sudden onset of pain and spasm and will be unable to bear weight. Urgent evaluation and referral is needed in order to surgically prevent further slippage and minimize the complication that might ensue. Usually, a surgical procedure is required to fix the femoral head back to the upper end of the thigh bone and hold it there until the bone heals completely in 13-18 months.

Osteogenesis Imperfecta
Brittle bone disease was a term coined to describe children who suffered numerous fractures without obvious cause. Genetic research has demonstrated that there is a wide spectrum in this condition, however. The pediatric orthopaedist will routinely treat the newborn with fractures of the collarbone, humerus, shin and thigh and be asked to predict if and when the child will ambulate. Greater challenges occur with the evaluation of a child with severe bone deformities who now desires to walk or the child who presents with an usual fracture or recurrent fractures.

Modern lightweight orthotics, intensive physical therapy, pool therapy and reconstructive surgery to minimize or correct deformities and fractures, may be offered to the patient and family

Blount’s Disease
Bowlegs are often considered cute or “inherited from dad.” However, when the deformity persists after three years of age, medical consultation should be considered. Pediatric orthopaedists may be able to predict in the toddler age group, which bowleg deformities will spontaneously go away and do not require treatment. In other children with persistent or progressive bowing, the pediatric orthopedist will obtain x-rays or blood work to evaluate for an underlying condition contributing to the problem. Treatment plans are designed to promote restoration of a normal alignment to the bowed legs. A second group of adolescent patients will often times present with a single bowing outward of the shin bone. Again, the pediatric orthopedist will assess the condition to determine if trauma, infection, or other conditions contributed to this late onset deformity and recommend treatment options according to the age of the adolescent and severity of the deformity on x-ray.

Scoliosis
Curvature of the spine demands evaluation regardless of the age of your child. The spinal curvature may result from a misshapen vertebrae, otherwise normal adolescent growth or an occult spinal cord problem.

Congenital scoliosis is discovered when the parent notes a lump in the child’s back when your child is sitting or standing. X-rays will define how significant the abnormality is and whether or not it will adversely affect the remaining normal growth of the spine. Since development of other major systems were occurring in the embryo when the spinal defect occurred, the pediatric orthopaedist may consult other subspecialists in the assessment of your child. Treatment options include observation of those forms of congenital scoliosis that are not likely to progress or cause spinal imbalance to surgical arrest of those curves that are worsening.

Adolescent idiopathic scoliosis results when the otherwise normal pubertal growth spurt goes awry. Scoliosis screening program may be effective in identifying these (insert video clip of scoliosis exam) children and referring them for further assessment. The term “idiopathic” implies that the pediatric orthopaedist has performed a thorough examination of the patient, confirmed the presence of a significant curve by x-ray and found no evidence of an underlying condition that accounts for the spinal deviation. Treatment options depend on the age at presentation, severity of the curve, and whether or not a majority of the growth spurt has occurred.

Juvenile Rheumatoid Arthritis
A limping, irritable child will attract the attention of parents and care givers. Oftentimes, the limp is intermittent and without evidence of a fever or pain. The diagnosis of juvenile rheumatoid arthritis occurs in a multispecialty setting for the child with a single swollen joint to the ill-appearing multiple joint involvement patient. A comprehensive care plan emphasizing the medical control of the inflammation and restoration of joint function is emphasized. The patient is closely monitored if the condition is not improving or there is increasing difficulty with walking or use of the upper extremities.

Spina Bifida
Referring to a child as having an “open spine” is a misnomer. This congenital birth defect may have a wide spectrum in its presentation and future prognosis. Myelomeningocele (spina bifida) implies that a defect occurred in the womb. The result is a spine and spinal cord that may be malformed. The spinal deformity may be minimal and result only in a shortened trunk. Others will have a rapidly progressive bending of the spine forward or to the side that will adversely affect the child long-term. The associated spinal cord may be tethered abnormally or may be severely affected with varying degrees of paralysis or weakness in the legs. A mulidisciplinary team approach including the services of a pediatric neurosurgeon, urologist, and physical therapist may aid in the comprehensive care of the child.